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Asare-Baah M, Salmon-Trejo LAT, Venkatappa T, Garfein RS, Aiona K, Haas M, Séraphin MN. Factors Associated With the Discontinuation of Two Short-Course Tuberculosis Preventive Therapies in Programmatic Settings in the United States. Open Forum Infect Dis 2024; 11:ofae313. [PMID: 38915338 PMCID: PMC11194754 DOI: 10.1093/ofid/ofae313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
Background The objective of this study was to investigate timing and risk factors for discontinuation of short-course tuberculosis preventive therapy (TPT) comparing directly observed 3-month isoniazid/rifapentine (3HP) vs self-administered 4-month rifampin (4R). Methods This was a subanalysis of a 6-month health department cohort (2016-2017) of 993 latent tuberculosis infection (LTBI) patients initiating 3HP (20%) or 4R (80%). Time at risk of TPT discontinuation was compared across regimens. Risk factors were assessed using mixed-effects Cox models. Results Short-course TPT discontinuation was higher with 4R (31% vs 14%; P < .0001), though discontinuation timing was similar. Latino ethnicity (hazard ratio [HR], 1.80; 95% CI, 1.20-2.90) and adverse events (HR, 4.30; 95% CI, 2.60-7.30) increased 3HP discontinuation risk. Social-behavioral factors such as substance misuse (HR, 12.00; 95% CI, 2.20-69.00) and congregate living (HR, 21.00; 95% CI, 1.20-360.00) increased 4R discontinuation risk. Conclusions TPT discontinuation differed by regimen, with distinct risk factors. Addressing social determinants of health within TPT programs is critical to enhance completion rates and reduce TB disease risk in marginalized populations.
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Affiliation(s)
- Michael Asare-Baah
- Department of Epidemiology, University of Florida, Gainsville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainsville, Florida, USA
| | - LaTweika A T Salmon-Trejo
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, Gainsville, Florida, USA
- Institute of Public Health, Florida A & M University, Tallahassee, Florida, USA
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thara Venkatappa
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard S Garfein
- Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Kaylynn Aiona
- Public Health Institute at Denver Health, Denver, Colorado, USA
| | - Michelle Haas
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado, USA
| | - Marie Nancy Séraphin
- Emerging Pathogens Institute, University of Florida, Gainsville, Florida, USA
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, Gainsville, Florida, USA
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Liu Y, Posey DL, Weinberg MS, Phares CR. Tuberculosis in United States-Bound Follow-to-Join Asylees, 2014-2019. Am J Trop Med Hyg 2024; 110:999-1005. [PMID: 38531107 PMCID: PMC11066364 DOI: 10.4269/ajtmh.23-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/20/2023] [Indexed: 03/28/2024] Open
Abstract
Persons may seek asylum in the United States or at a U.S. port of entry. Principal asylees are those who are granted asylum status. Their spouse and unmarried children under 21 years of age may be granted asylum if accompanying, or following to join, the principal asylees. U.S.-bound follow-to-join asylees must undergo an overseas medical examination that includes tuberculosis (TB) screening. Culture-based overseas TB screening in U.S.-bound follow-to-join asylees has not been evaluated. We evaluated data from overseas TB screening in 19,088 arrivals of follow-to-join asylees during 2014-2019 and assessed data from their postarrival evaluation, which is recommended for those at risk for TB. Of 19,088 arrivals of follow-to-join asylees, 29 (152 cases/100,000 persons) met criteria for class B0 TB (recent completion of TB treatment overseas) and 340 (1,781 cases/100,000 persons) met criteria for class B1 pulmonary TB (chest radiograph/clinical symptoms suggestive of TB but negative sputum cultures overseas). Of 6,847 persons aged 2 to 14 years from countries with a WHO-estimated TB incidence of ≥20 cases/100,000 population/year, 408 (6.0%) were classified as class B2 latent TB infection (LTBI). Postarrival evaluations were completed in 44.8%, 51.5%, and 40.4% of persons with class B0 TB, class B1 TB, and class B2 LTBI, respectively. In conclusion, culture-based overseas TB screening in U.S.-bound follow-to-join asylees is effective in identifying those with TB (class B0 TB) or those at risk for TB (class B1 TB and class B2 LTBI). Completion of postarrival evaluation for newly arrived follow-to-join asylees was less frequent than that reported for immigrants and refugees.
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Affiliation(s)
- Yecai Liu
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Drew L. Posey
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle S. Weinberg
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina R. Phares
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Séraphin MN, Bellot J, Klann E, Ukhanova M, Saulsberry FG, Peloquin CA, Mai V. Gut microbiota composition and diversity before, during, and two months after rifamycin-based tuberculosis preventive therapy. Sci Rep 2023; 13:18933. [PMID: 37919333 PMCID: PMC10622450 DOI: 10.1038/s41598-023-44854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
Tuberculosis (TB) preventive therapy (TPT) is an effective strategy to eliminate TB in low-incidence settings. Shorter TPT regimens incorporating the antimicrobial class of rifamycins are designed to improve adherence and completion rates but carry the risk of modifications to the gut microbiota. We enrolled six subjects diagnosed with latent TB infection (LTBI) who accepted to initiate TPT. We also enrolled six healthy volunteers unexposed to the rifamycins. We profiled the gut microbiota using 16S rRNA amplicon sequencing (V1-V2 region) to document the immediate effect of rifamycin-based TPT on the gut microbiota composition and tracked recovery to baseline two months after TPT. Overall, TPT accounted for 17% of the variance in gut microbial community dissimilarity. This rifamycin-based TPT induced dysbiosis was characterized by a depletion of butyrate-producing taxa (Clostridium-XIVa and Roseburia) and expansion of potentially pathogenic taxa within the Firmicutes and Proteobacteria phyla. Recovery of the gut microbial composition was incomplete two months after TPT. Robust clinical studies are necessary to comprehensively catalogue TPT-induced gut microbiota dysbiosis to inform strategies to mitigate potential long-term sequelae of this important TB control intervention.
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Affiliation(s)
- Marie Nancy Séraphin
- Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
| | - Julia Bellot
- Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Emily Klann
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Maria Ukhanova
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Florence G Saulsberry
- Florida Department of Health in Alachua County, Disease Control Unit, Alachua County Health Department, Gainesville, FL, USA
| | - Charles A Peloquin
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Infectious Disease Pharmacokinetics Laboratory, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Volker Mai
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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Ortiz Laza N, Lopez Aranaga I, Toral Andres J, Toja Uriarte B, Santos Zorrozua B, Altube Urrengoechea L, Garros Garay J, Tabernero Huguet E. Latent tuberculosis infection treatment completion in Biscay: differences between regimens and monitoring approaches. Front Med (Lausanne) 2023; 10:1265057. [PMID: 38020141 PMCID: PMC10651218 DOI: 10.3389/fmed.2023.1265057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Contact tracing and treatment of latent tuberculosis infection (LTBI) is a key element of tuberculosis (TB) control in low TB incidence countries. A TB control and prevention program has been active in the Basque Country since 2003, including the development of the nurse case manager role and a unified electronic record. Three World Health Organization-approved LTBI regimens have been used: isoniazid for 6 months (6H), rifampicin for 4 months (4R), and isoniazid and rifampicin for 3 months (3HR). Centralized follow-up by a TB nurse case manager started in January 2016, with regular telephone follow-up, telemonitoring of blood test results, and monitoring of adherence by electronic review of drugs dispensed in pharmacies. Objective To estimate LTBI treatment completion and toxicity of different preventive treatment regimens in a real-world setting. Secondary objective: to investigate the adherence to different approaches to preventive treatment monitoring. Methods A multicentre retrospective cohort study was conducted using data collected prospectively on contacts of patients with TB in five hospitals in Biscay from 2003 to 2022. Results A total of 3,066 contacts with LTBI were included. The overall completion rate was 66.8%; 86.5% of patients on 3HR (n = 699) completed treatment vs. 68.3% (n = 1,260) of those on 6H (p < 0.0001). The rate of toxicity was 3.8%, without significant differences between the regimens. A total of 394 contacts were monitored by a TB nurse case manager. In these patients, the completion rate was 85% vs. 67% in those under standard care (p < 0.001). A multivariate logistic regression model identified three independent factors associated with treatment completion: being female, the 3HR regimen, and nurse telemonitoring. Conclusion 3HR was well tolerated and associated with a higher rate of treatment completion. Patients with nurse telemonitoring follow-up had better completion rates.
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Affiliation(s)
- N. Ortiz Laza
- Pulmonology Service, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - I. Lopez Aranaga
- Pulmonology Service, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - J. Toral Andres
- Pulmonology Service, Galdakao-Usansolo Hospital, Galdakao, Spain
| | | | | | | | | | - E. Tabernero Huguet
- Pulmonology Service, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
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Malhotra S, Dasgupta-Tsinikas S, Yumul J, Kaneta K, Lenz A, Kizzee R, Bihm D, Jung C, Neely M, Guevara RE, Higashi J, Bender JM. Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings. J Pediatr 2023; 259:113419. [PMID: 37044372 DOI: 10.1016/j.jpeds.2023.113419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county. STUDY DESIGN A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin. RESULTS We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9). CONCLUSIONS The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.
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Affiliation(s)
- Sanchi Malhotra
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA.
| | - Shom Dasgupta-Tsinikas
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Josephine Yumul
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Kelli Kaneta
- Children's Hospital Los Angeles, Pediatric Residency Program, Los Angeles, CA
| | - Annika Lenz
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Richard Kizzee
- Children's Hospital Los Angeles, Pediatric Residency Program, Los Angeles, CA
| | - Dustin Bihm
- Children's Hospital Los Angeles, Pediatric Residency Program, Los Angeles, CA
| | - Christina Jung
- Children's Hospital Los Angeles, Division of General Pediatrics, Los Angeles, CA
| | - Michael Neely
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ramon E Guevara
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Julie Higashi
- Los Angeles County Department of Public Health, Tuberculosis Control Program, Los Angeles, CA
| | - Jeffrey M Bender
- Children's Hospital Los Angeles, Division of Infectious Diseases, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
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Salamaikina S, Korchagin V, Kulabukhova E, Mironov K, Zimina V, Kravtchenko A, Akimkin V. Association of Toll-Like Receptor Gene Polymorphisms with Tuberculosis in HIV-Positive Participants. EPIGENOMES 2023; 7:15. [PMID: 37606452 PMCID: PMC10443360 DOI: 10.3390/epigenomes7030015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Genetic factors in the HIV-background may play a significant role in the susceptibility to secondary diseases, like tuberculosis, which is the leading cause in mortality of HIV-positive people. Toll-like receptors (TLRs) are considered to be receptors for adaptive immunity, and polymorphisms in TLR genes can influence the activity of the immune response to infection. We conducted a case-control study of the association of TLR gene polymorphisms with the risk of tuberculosis coinfection in a multi-country sample of HIV-positive participants. Our study revealed certain associations between TLR4 and TLR6 polymorphisms and HIV-tuberculosis coinfection. We also found that the analyzed TLR1 and TLR4 polymorphisms were linked with the decline in CD4+ cell count, which is a predictor of disease progression in HIV-infected individuals. Our findings confirm that TLR gene polymorphisms are factors that may contribute to development of HIV-tuberculosis coinfection. However, the essence of the observed associations remains unclear, since it can also include both environmental factors and epigenetic mechanisms of gene expression regulation.
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Affiliation(s)
- Svetlana Salamaikina
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Vitaly Korchagin
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Ekaterina Kulabukhova
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
- Medical Institute, The Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Str. 6, 117198 Moscow, Russia
| | - Konstantin Mironov
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Vera Zimina
- Medical Institute, The Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Str. 6, 117198 Moscow, Russia
| | - Alexey Kravtchenko
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Vasily Akimkin
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
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Cola JP, do Prado TN, Campos BA, Borges BJP, Alves BMCS, de Jezus SV, Sales CMM, de Araújo WN, Tavares NUL, Noia Maciel EL. Protocol for pragmatic randomized clinical trial to evaluate the completion of treatment of latent Mycobacterium tuberculosis infection with Isoniazid in the 300 mg formulation. PLoS One 2023; 18:e0281638. [PMID: 36802383 PMCID: PMC9942980 DOI: 10.1371/journal.pone.0281638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/24/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION It is essential to strengthen the treatment of latent tuberculosis infection (LTBI) to break the chain of transmission. The drug used worldwide for the treatment of LTBI is Isoniazid. A clinical trial conducted in Brazil has demonstrated the bioequivalence of Isoniazid in the 300 mg formulation with 3 tablets in the 100 mg formulation. Further studies are needed to evaluate the completion of treatment with Isoniazid 300 mg single tablet. OBJECTIVE Describing a protocol for a clinical trial to evaluate the completion of treatment of LTBI with the drug Isoniazid in 300 mg tablet formulation compared to the use of Isoniazid in 100 mg tablet formulation. METHODS This is a pragmatic, multicenter, randomized, open-label clinical trial registered on the Rebec RBR-2wsdt6 platform. Individuals 18 years of age or older with an indication for treatment of LTBI will be included, with only 1 individual per family nucleus. Individuals whose index case of active TB is categorized as retreatment, multidrug-resistant and extremely resistant, individuals transferred from the original center two or more weeks after the onset of treatment, and persons deprived of liberty will be excluded. The study intervention will be the treatment of LTBI with 1 tablet of Isoniazid 300 mg. The control group will receive the treatment of LTBI with 3 tablets of Isoniazid 100 mg. Follow-up will be performed at month 1, month 2 and at the end of treatment. The primary outcome will be completion of treatment. CONCLUSION It is expected that with the treatment with the 300 mg formulation, more patients will complete the treatment based on the complexity index of pharmacotherapy. Our study intends to substantiate theoretical and operational strategies that respond to the demand for incorporation of a new formulation of the drug for the treatment of LTBI in the Unified Health System network.
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Affiliation(s)
- João Paulo Cola
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Thiago Nascimento do Prado
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Bárbara Almeida Campos
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Bárbara Juliana Pinheiro Borges
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Sonia Vivian de Jezus
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Carolina Maia Martins Sales
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Noemia Urruth Leão Tavares
- Postgraduate Program in Pharmaceutical Sciences, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Ethel Leonor Noia Maciel
- Postgraduate Program in Collective Health, Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- * E-mail:
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Dabitao D, Bishai WR. Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes. Curr Top Microbiol Immunol 2023; 441:139-183. [PMID: 37695428 DOI: 10.1007/978-3-031-35139-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Tuberculosis remains a daunting public health concern in many countries of the world. A consistent observation in the global epidemiology of tuberculosis is an excess of cases of active pulmonary tuberculosis among males compared with females. Data from both humans and animals also suggest that males are more susceptible than females to develop active pulmonary disease. Similarly, male sex has been associated with poor treatment outcomes. Despite this growing body of evidence, little is known about the mechanisms driving sex bias in tuberculosis disease. Two dominant hypotheses have been proposed to explain the predominance of active pulmonary tuberculosis among males. The first is based on the contribution of biological factors, such as sex hormones and genetic factors, on host immunity during tuberculosis. The second is focused on non-biological factors such as smoking, professional exposure, and health-seeking behaviors, known to be influenced by gender. In this chapter, we review the literature regarding these two prevailing hypotheses by presenting human but also experimental animal studies. In addition, we presented studies aiming at examining the impact of sex and gender on other clinical forms of tuberculosis such as latent tuberculosis infection and extrapulmonary tuberculosis, which both appear to have their own specificities in relation to sex. We also highlighted potential intersections between sex and gender in the context of tuberculosis and shared future directions that could guide in elucidating mechanisms of sex-based differences in tuberculosis pathogenesis and treatment outcomes.
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Affiliation(s)
- Djeneba Dabitao
- Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University Clinical Research Center (UCRC), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - William R Bishai
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
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Chiu TF, Yen MY, Shie YH, Huang HL, Chen CC, Yen YF. Determinants of latent tuberculosis infection and treatment interruption in long-term care facilities: A retrospective cohort study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1310-1317. [PMID: 34686442 DOI: 10.1016/j.jmii.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND/PURPOSE Latent tuberculosis infection (LTBI) treatment is challenging in long-term care facilities (LTCFs) residents due to the occurrence of medical complexities. However, factors associated with treatment interruption have not been extensively studied. This retrospective cohort study aimed to determine LTBI-associated factors and treatment interruption in LTCF residents and employees in Taiwan. METHODS From May 2017 through September 2020, the residents and employees of 20 LTCFs in Taipei, Taiwan, were screened for LTBI by using QuantiFERON-TB Gold In-Tube test. The LTBI individuals underwent directly observed preventive therapy (DOPT), including regimens of 9-month daily isoniazid (9H) and 3-month weekly isoniazid plus rifapentine (3HP). All the LTBI cases were followed up till treatment completion, death, or treatment interruption. RESULTS Among 2207 LTCF subjects, 16.8% had LTBI. After controlling for other covariates, residents of public facilities had a significantly higher LTBI prevalence than those of private facilities (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI]: 1.08-1.88). Among 264 LTBI cases receiving preventive therapy, 52 (19.7%) had treatment interruption. LTBI cases receiving 3HP were less likely to have treatment interruption than those receiving 9H (AOR = 0.22; 95% CI: 0.07-0.71). CONCLUSIONS LTCF residents, particular those living in public facilities, had a high LTBI prevalence. 3HP with DOPT is considered the priority regimen for preventive therapy among LTBI cases in LTCFs.
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Affiliation(s)
- Ting-Fang Chiu
- Department of Education and Research, Taipei City Hospital, Taiwan; Department of Pediatrics, Taipei City Hospital, Zhongxiao Branch, Taiwan; University of Taipei, Taipei, Taiwan
| | - Muh-Yong Yen
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan; Division of Infectious Diseases, Cheng Hsin General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Huei Shie
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Hui-Lan Huang
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, Taiwan; University of Taipei, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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10
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Güner AE, Kiziltas S, Babalik A, Sahin E, Sibel A, Safak M, Kiliçaslan Z. Outcomes of latent tuberculosis infection treatment in Istanbul. Int J Mycobacteriol 2022; 11:442-447. [PMID: 36510932 DOI: 10.4103/ijmy.ijmy_196_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Aim Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018. Methods The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. Results 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). Conclusion In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.
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Affiliation(s)
- Abdullah Emre Güner
- Department of Public Health, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, Turkey
| | - Sule Kiziltas
- Department of Chest Diseases, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Aylin Babalik
- Department of Chest Diseases, University of Health Sciences, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Esra Sahin
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Al Sibel
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Mine Safak
- Department of Public Health Services, Provincial Directorate of Health, Istanbul, Turkey
| | - Zeki Kiliçaslan
- Department of Chest Diseases, Istanbul University Faculty of Medicine, Istanbul, Turkey
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11
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Rangaka MX, Hamada Y, Duong T, Bern H, Calvert J, Francis M, Clarke AL, Ghanouni A, Layton C, Hack V, Owen-Powell E, Surey J, Sanders K, Booth HL, Crook A, Griffiths C, Horne R, Kunst H, Lipman M, Mandelbaum M, White PJ, Zenner D, Abubakar I. Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial. BMJ Open 2022; 12:e057717. [PMID: 36691120 PMCID: PMC9454004 DOI: 10.1136/bmjopen-2021-057717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and treatment support based on behavioural science theory may improve treatment adherence and completion. METHODS AND ANALYSIS A pragmatic multicentre, open-label, randomised controlled trial assessing the effect of novel short-course rifapentine-based regimens for TB prevention and additional theory-based treatment support on treatment adherence against standard-of-care. Participants aged between 16 and 65 who are eligible to start TB preventive therapy will be recruited in England. 920 participants will be randomised to one of six arms with allocation ratio of 5:5:6:6:6:6: daily isoniazid +rifampicin for 3 months (3HR), routine treatment support (control); 3HR, additional treatment support; weekly isoniazid +rifapentine for 3 months (3HP), routine treatment support; weekly 3HP, additional treatment support ; daily isoniazid +rifapentine for 1 month (1HP), routine treatment support; daily 1HP, additional treatment support. Additional treatment support comprises reminders using an electronic pillbox, a short animation, and leaflets based on the perceptions and practicalities approach. The primary outcome is adequate treatment adherence, defined as taking ≥90% of allocated doses within the pre-specified treatment period, measured by electronic pillboxes. Secondary outcomes include safety and TB incidence within 12 months. We will conduct process evaluation of the trial interventions and assess intervention acceptability and fidelity and mechanisms for effect and estimate the cost-effectiveness of novel regimens. The protocol was developed with patient and public involvement, which will continue throughout the trial. ETHICS AND DISSEMINATION Ethics approval has been obtained from The National Health Service Health Research Authority (20/LO/1097). All participants will be required to provide written informed consent. We will share the results in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2020-004444-29.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- School of Public Health, and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Trinh Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Joanna Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Marie Francis
- Institute for Global Health, University College London, London, UK
| | | | - Alex Ghanouni
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Charlotte Layton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Ellen Owen-Powell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Helen L Booth
- North Central London Tuberculosis Service, Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust, London, UK
| | - Angela Crook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Chris Griffiths
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College, London, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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12
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Wada PY, Costa AG, Araújo-Pereira M, Barreto-Duarte B, Souza AB, Rocha MS, Figueiredo MC, Turner MM, Rolla VC, Kritski AL, Cordeiro-Santos M, Andrade BB, Sterling TR, Rebeiro PF. Possible sex difference in latent tuberculosis infection risk among close tuberculosis contacts. Int J Infect Dis 2022; 122:685-692. [PMID: 35843494 PMCID: PMC10041676 DOI: 10.1016/j.ijid.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES More men than women develop and die of tuberculosis (TB). Fewer data exist on sex differences in latent TB infection (LTBI). We assessed for potential sex differences in LTBI acquisition among close TB contacts. METHODS Regional Prospective Observational Research for TB-Brazil is an observational multi-center cohort of individuals with culture-confirmed pulmonary TB and their close contacts. Participants were enrolled from five sites in Brazil from June 2015 - June 2019. Close contacts were followed for 24 months after enrollment, with LTBI defined as a positive interferon-γ release assay (IGRA; QuantiFERON 3rd or 4th generation) at baseline or 6 months. We performed univariate, bivariate, and multivariable logistic regression and propensity-score weighted models to assess odds ratios (OR) and 95% confidence intervals (CI) for LTBI acquisition by birth sex among close contacts. RESULTS Of 1093, 504 (46%) female close contacts were IGRA positive compared to 295 of 745 (40%) men. The unadjusted OR for IGRA positivity among women vs men was 1.31 (95% CI: 1.08-1.58). Bivariate adjustments yielded ORs in women vs men ranging from 1.19 to 1.33 (P-value range: <0.01-0.07). Multivariable regression and weighted models yielded similar ORs in women vs men, of 1.14 (95% CI: 0.92-1.41) and 1.15 (95% CI: 0.94-1.40), respectively. CONCLUSION The point estimate for LTBI among close TB contacts in Brazil was higher in women, though less pronounced in multivariable models. If the sex difference in LTBI is confirmed in additional settings, studies of possible underlying differences in socio-behavioral factors or TB pathogenesis are warranted.
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Affiliation(s)
- Paul Y Wada
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA.
| | - Allyson G Costa
- Fundação Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Alexandra B Souza
- Fundação Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Brazil; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Michael S Rocha
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - Marina C Figueiredo
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Megan M Turner
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Valeria C Rolla
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Afrânio L Kritski
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Brazil; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA; Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil; Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil; Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA; Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA.
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
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13
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Oh CE, Menzies D. Four months of rifampicin monotherapy for latent tuberculosis infection in children. Clin Exp Pediatr 2022; 65:214-221. [PMID: 34727494 PMCID: PMC9082252 DOI: 10.3345/cep.2021.01186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
Diagnosing and treating latent tuberculosis infection (LTBI) is an important part of efforts to combat tuberculosis (TB). The Korean guidelines for TB published in 2020 recommend 2 LTBI regimens for children and adolescents: 9 months of daily isoniazid (9H) and 3 months of daily isoniazid plus rifampicin. Isoniazid for 6-12 months has been used to effectively treat LTBI in children for over 50 years. However, a long treatment period results in poor patient compliance. This review summarizes pediatric data on the treatment completion rate, safety, and efficacy of 4 months of daily rifampicin (4R) and evaluates the pharmacokinetics and pharmacodynamics of rifampicin in children. The 4R regimen has a higher treatment completion rate than the 9H regimen and equivalent safety in children. The efficacy of preventing TB is also consistent with that of 9H when summarizing reports published to date. A shorter treatment period could increase patient compliance and, therefore, prevent TB in more patients. By using an effective, safe, and highly compliant regimen for the treatment of children with LTBI, we would become one step closer to our goal of eradicating TB.
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Affiliation(s)
- Chi Eun Oh
- Department of Pediatrics, Kosin University College of Medicine, Busan, Korea
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montreal, QC, Canada
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14
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Lee JY, Kwon N, Goo GY, Cho SI. Inadequate housing and pulmonary tuberculosis: a systematic review. BMC Public Health 2022; 22:622. [PMID: 35354400 PMCID: PMC8966856 DOI: 10.1186/s12889-022-12879-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is a global health issue that has long threatened and continues to threaten human health. While previous studies are important in the search for a cure for TB, to eradicate the disease it is also crucial to analyze environmental influences. Therefore, this study determined the potential effect of inadequate housing on TB and the magnitude of the effect. Methods This is a systematic review of the effects of inadequate housing on TB. Between Jan 1, 2011 and Oct 25, 2020, we searched four electronic databases using the search terms “housing AND tuberculosis” or “housing AND TB”. The target population comprised residents of inadequate housing and the homeless. Results We found 26 eligible studies. The distribution of the studies across continents was uneven, and the housing issues of interest seemed to vary depending on the economic level of the country. The eight steps identified in TB development and the consequences thereof were more strongly associated with housing affordability than with housing quality. Conclusions This is the first systematic review to identify the effects of inadequate housing on TB and to categorize inadequate-housing-related exposure to TB in terms of affordability and quality. The steps identified in TB development and the consequences thereof had a greater association with housing affordability than with housing quality. Therefore, public health interventions regarding housing affordability could be more diverse, and interventions that support affordable housing for residents of inadequate housing and the homeless should proceed simultaneously to improve housing quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12879-6.
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Affiliation(s)
- Ju-Yeun Lee
- The Department of Public Health, Graduate School of Public Health, Building 220, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Namhee Kwon
- The Department of Health Care Management and Policy, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ga-Yeon Goo
- The Department of Public Administration, Graduate School of Public Administration, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- The Department of Public Health, Graduate School of Public Health, Building 220, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea. .,Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
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15
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Lodi S, Emenyonu NI, Marson K, Kwarisiima D, Fatch R, McDonell MG, Cheng DM, Thirumurthy H, Gandhi M, Camlin CS, Muyindike WR, Hahn JA, Chamie G. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial among heavy drinkers living with HIV in Uganda: study protocol of a 2×2 factorial trial. Trials 2021; 22:355. [PMID: 34016158 PMCID: PMC8136096 DOI: 10.1186/s13063-021-05304-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background The risk of tuberculosis (TB) is high among people with HIV (PWH). Heavy alcohol drinking independently increases TB risk and approximately 25% of PWH globally engage in heavy drinking. While isoniazid (INH) preventive therapy decreases TB incidence and mortality among PWH, heavy drinking during INH is associated with liver toxicity and poor adherence. Interventions are, therefore, urgently needed to decrease alcohol use and improve adherence to INH in this population in settings with high prevalence of HIV and TB like Uganda. Methods The Drinkers’ Intervention to Prevent TB (DIPT) study is a 2×2 factorial randomized controlled trial among HIV/TB co-infected adults (≥18 years) who engage in heavy alcohol drinking and live in Uganda. The trial will allocate 680 participants with a 1:1:1:1 individual randomization to receive 6 months of INH and one of the following interventions: (1) no incentives (control), (2) financial incentives contingent on low alcohol use, (3) financial incentives contingent on high adherence to INH, and (4) escalating financial incentives for both decreasing alcohol use and increasing adherence to INH. Incentives will be in the form of escalating lottery-based monetary rewards. Participants will attend monthly visits to refill isoniazid medications, undergo liver toxicity monitoring, and, except for controls, determine eligibility for prizes. We will estimate (a) the effect of incentives contingent on low alcohol use on reduction in heavy drinking, measured via a long-term objective and self-reported metric of alcohol use, at 3- and 6-month study visits, and (b) the effect of incentives contingent on high adherence to INH, measured as >90% pill-taking days by medication event monitoring system cap opening. We will use qualitative methods to explore the mechanisms of any influence of financial incentives on HIV virologic suppression. Discussion This study will provide new information on low-cost strategies to both reduce alcohol use and increase INH adherence among people with HIV and TB infection who engage in heavy drinking in low-income countries with high HIV and TB prevalence. Trial registration ClinicalTrials.gov NCT03492216. Registered on April 10, 2018
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Affiliation(s)
- Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Nneka I Emenyonu
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Kara Marson
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | | | - Robin Fatch
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Monica Gandhi
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Winnie R Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda.,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Judith A Hahn
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
| | - Gabriel Chamie
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, USA
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16
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Malik AA, Farooq S, Jaswal M, Khan H, Nasir K, Fareed U, Shahbaz S, Amanullah F, Safdar N, Khan AJ, Keshavjee S, Becerra MC, Hussain H. Safety and feasibility of 1 month of daily rifapentine plus isoniazid to prevent tuberculosis in children and adolescents: a prospective cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:350-356. [PMID: 33770510 DOI: 10.1016/s2352-4642(21)00052-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Shorter regimens for tuberculosis prevention can improve completion rates and protection against developing active tuberculosis disease after tuberculosis exposure. We aimed to assess the safety and feasibility of 1 month of daily isoniazid and rifapentine (1HP) in children and adolescents in a low-resource setting in south Asia with low prevalence of HIV. METHODS This prospective cohort study was done in eight tuberculosis facilities in Karachi, Pakistan. Eligible participants were aged 2-19 years and were household contacts of patients with drug-susceptible tuberculosis infection. After clinical, radiological, and laboratory evaluation to rule out tuberculosis disease, participants were prescribed 1HP as a preventive regimen. Isoniazid was administered as 100 mg or 300 mg oral tablets and rifapentine was administered as 150 mg oral tablets. Dosing was according to participant bodyweight. The primary endpoints were the cumulative probability of a household contact completing all stages of the preventive care cascade, assessed in all eligible participants, and the proportion of household contacts completing 1HP, assessed among all those who initiated the regimen. Safety was assessed in all household contacts who initiated the 1HP regimen. FINDINGS Between Dec 21, 2019, and March 20, 2020, 1395 household contacts of 253 patients with tuberculosis were identified, including 678 household contacts who were eligible to participate. 628 (93%) completed evaluation, of whom ten (2%) had active tuberculosis disease. Of the 618 individuals eligible for tuberculosis prevention, 408 (66%) initiated 1HP, 385 (94%) of whom completed the regimen. The median duration of 1HP was 31 days (IQR 30-32) in those who completed the regimen. The cumulative probability of completing all steps of the tuberculosis prevention cascade was 58%. A girl aged 11 years developed tuberculosis disease within 6 months of completing 1HP. A boy aged 14 years developed a burning sensation during 1HP therapy and discontinued the regimen. No other adverse events were observed. INTERPRETATION 1HP can be safely and feasibly implemented as tuberculosis prevention in children and adolescents in programmatic settings. FUNDING The Global Fund to Fight AIDS, Tuberculosis and Malaria.
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Affiliation(s)
- Amyn A Malik
- Global Health Directorate, Indus Health Network, Karachi, Pakistan; Interactive Research and Development Global, Singapore; Yale School of Medicine and Yale Institute for Global Health, Yale University, New Haven, CT, USA.
| | - Saira Farooq
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Maria Jaswal
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Hiba Khan
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Kumail Nasir
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Usama Fareed
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Shumail Shahbaz
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | | | - Nauman Safdar
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Aamir J Khan
- Interactive Research and Development Global, Singapore; Harvard Medical School, Boston, MA, USA; Harvard Medical School Center for Global Health Delivery, Boston, MA, USA
| | - Salmaan Keshavjee
- Harvard Medical School, Boston, MA, USA; Harvard Medical School Center for Global Health Delivery, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mercedes C Becerra
- Harvard Medical School, Boston, MA, USA; Harvard Medical School Center for Global Health Delivery, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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17
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Tibbetts KK, Ottoson RA, Tsukayama DT. Public Health Response to Tuberculosis Outbreak among Persons Experiencing Homelessness, Minneapolis, Minnesota, USA, 2017-2018. Emerg Infect Dis 2021; 26:420-426. [PMID: 32091365 PMCID: PMC7045824 DOI: 10.3201/eid2603.190643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Tuberculosis (TB) is a greater risk for populations experiencing homelessness. When a TB exposure occurs in a homeless shelter, evaluation of contacts is both urgent and challenging. In 2017, local public health workers initiated a response to a TB outbreak in homeless shelters in Minneapolis, Minnesota, USA. In this contact investigation, we incorporated multiple techniques to identify, evaluate, and manage patients, including the concentric-circle method to characterize amount of contact, identifying the most frequent sites of sporadic medical care, using electronic medical records, and engaging with medical providers treating this population. Of 298 contacts evaluated, 41 (14%) had latent TB infection and 2 had active TB disease. Our analysis indicated a significant relationship between duration of exposure and positive TB test result (p = 0.001). We encourage local public health departments to expand beyond traditional contact tracing techniques by leveraging partnerships and existing systems to reach contacts exposed in shelters.
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18
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Stockbridge EL, Loethen AD, Annan E, Miller TL. Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data. PLoS One 2020; 15:e0243102. [PMID: 33270737 PMCID: PMC7714216 DOI: 10.1371/journal.pone.0243102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background Risk-targeted testing and treatment of latent tuberculosis infection (LTBI) is a critical component of the United States’ (US) tuberculosis (TB) elimination strategy, but relatively low treatment completion rates remain a challenge. Both treatment persistence and completion may be facilitated by diagnosing LTBI using interferon gamma release assays (IGRA) rather than tuberculin skin tests (TST). Methods We used a national sample of administrative claims data to explore associations diagnostic test choice (TST, IGRA, TST with subsequent IGRA) and treatment persistence and completion in persons initiating a daily dose isoniazid LTBI treatment regimen in the US private healthcare sector between July 2011 and March 2014. Associations were analyzed with a generalized ordered logit model (completion) and a negative binomial regression model (persistence). Results Of 662 persons initiating treatment, 327 (49.4%) completed at least the 6-month regimen and 173 (26.1%) completed the 9-month regimen; 129 (19.5%) persisted in treatment one month or less. Six-month completion was least likely in persons receiving a TST (42.2%) relative to persons receiving an IGRA (55.0%) or TST then IGRA (67.2%; p = 0.001). Those receiving an IGRA or a TST followed by an IGRA had higher odds of completion compared to those receiving a TST (aOR = 1.59 and 2.50; p = 0.017 and 0.001, respectively). Receiving an IGRA or a TST and subsequent IGRA was associated with increased treatment persistence relative to TST (aIRR = 1.14 and 1.25; p = 0.027 and 0.009, respectively). Conclusions IGRA use is significantly associated with both higher levels of LTBI treatment completion and treatment persistence. These differences are apparent both when IGRAs alone were administered and when IGRAs were administered subsequent to a TST. Our results suggest that IGRAs contribute to more effective LTBI treatment and consequently individual and population protections against TB.
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Affiliation(s)
- Erica L Stockbridge
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, United States of America.,Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Abiah D Loethen
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, United States of America
| | - Esther Annan
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Thaddeus L Miller
- Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
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Stewart RJ, Wortham J, Parvez F, Morris SB, Kirking HL, Cameron LH, Cruz AT. Tuberculosis Infection in Children. J Nurse Pract 2020; 16:673-678. [DOI: 10.1016/j.nurpra.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Garfin DR, Morisky D, Shin SS, Salem B, Yadav K, Deguzman R, Harvey G, Adams I, Halas K, Chang A, White K, Wu J, Nyamathi AM. Correlates of depression and anxiety among homeless adults with latent tuberculosis infection. J Health Psychol 2020; 27:494-501. [PMID: 32951464 DOI: 10.1177/1359105320956693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Homeless persons have disproportionate rates of latent tuberculosis infection (LTBI). LTBI treatment can prevent and reduce active tuberculosis spread. We examined associations between mental health, social support, and perceptions of general health in 50 LTBI-positive, homeless adults enrolled in LTBI treatment. Depression and anxiety prevalence were 40% and 48%, respectively. Depression was negatively associated with general health, positive social interaction, and tangible, emotional/informational, and total social support, and positively associated with severe substance use (ps < 0.05). Anxiety was negatively associated with emotional/informational, tangible and total social support, and positively associated with severe substance use (ps < 0.05). Mental health services may help improve LTBI interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alicia Chang
- Los Angeles County Department of Public Health, USA
| | | | - Jesse Wu
- Los Angeles County Department of Public Health, USA
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21
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Haas MK, Aiona K, Erlandson KM, Belknap RW. Higher Completion Rates with Self-administered Once-weekly Isoniazid-Rifapentine versus Daily Rifampin in Adults with Latent Tuberculosis. Clin Infect Dis 2020; 73:e3459-e3467. [PMID: 32915203 DOI: 10.1093/cid/ciaa1364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment of latent tuberculosis infection (LTBI) is important for tuberculosis (TB) prevention, and short course rifamycin-based therapies are preferred. Once-weekly isoniazid-rifapentine by self-administered therapy (3HP-SAT) has never been compared with four months of daily rifampin (4R). METHODS Retrospective cohort study of adults >18 initiating LTBI treatment with either 3HP-SAT or 4R in a United States (US)-based TB clinic between April 11, 2016-December 31 st, 2018. We evaluated treatment completion through pharmacy fills and reviewed charts for reasons of non-completion, including adverse events. Chi-square tests and a log-binomial multivariable model were used to compare treatment completion and adverse events (AEs). RESULTS 560 individuals (42%) initiated 3HP-SAT and 773 (58%) initiated 4R. Median age was 38, 55% were female, and 89% were born outside of the U.S. Among those aged 18-49, treatment completion with 3HP-SAT was 79% compared to 68% with 4R (adjusted risk ratio (aRR) of 1.17 [95% CI 1.17-1.27, p<0.0001]). Among Individuals aged >=50 years, treatment completion with 3HP-SAT was 87% compared to 64% with 4R (aRR 1.35 [95% CI 1.19-1.52, p<0.0001]). Compared to 4R, there was no difference in risk of AEs in the 18-49 age group (aRR 0.93 [95% CI 1.48-0.75] p=0.75). Reduced risk of AEs was noted among patients aged >=50 who received 3HP-SAT (aRR 0.37 [0.16-0.85] p=0.02). CONCLUSION 3HP-SAT was associated with higher LTBI treatment completion and lower rates of AEs compared to 4R in individuals aged 50 and older. Expanding 3HP-SAT as an option for patients with LTBI may enhance TB prevention strategies in the U.S.
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Affiliation(s)
- Michelle K Haas
- Denver Health and Hospital Authority, Denver Public Health, Denver, Colorado.,Division of Infectious Diseases, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| | - Kaylynn Aiona
- Denver Health and Hospital Authority, Denver Public Health, Denver, Colorado
| | - Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado.,Division of Geriatric Medicine, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| | - Robert W Belknap
- Denver Health and Hospital Authority, Denver Public Health, Denver, Colorado.,Division of Infectious Diseases, Department of Medicine, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
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22
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Manful A, Waller L, Katz B, Cummins J, Warkentin J, Reagon B, Shaw-Kaikai J, Zhu Y, van der Heijden YF. Gaps in the care cascade for screening and treatment of refugees with tuberculosis infection in Middle Tennessee: a retrospective cohort study. BMC Infect Dis 2020; 20:592. [PMID: 32778060 PMCID: PMC7418421 DOI: 10.1186/s12879-020-05311-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of tuberculosis infection (TBI) in individuals at high risk for tuberculosis (TB) disease is a priority for TB elimination in the US. Newly arrived refugees in Middle Tennessee are screened for TBI, but factors associated with gaps in the TBI care cascade are not well characterized. METHODS We assessed the TBI care cascade from US entry to completion of treatment for refugees who resettled in Middle Tennessee from 2012 through 2016. We assessed factors associated with treatment initiation and completion using logistic regression models. RESULTS Of 6776 refugees who completed initial health screening, 1681 (25%) screened positive for TBI, 1208 were eligible for treatment, 690 started treatment, and 432 completed treatment. Male sex (Odds Ratio [OR]: 1.42; 95% Confidence Interval [CI]: 1.06, 1.89) and screening with interferon gamma release assay compared to tuberculin skin test (OR: 2.89; 95% CI: 1.59, 5.27) were associated with increased treatment initiation; living farther away from TB clinic was associated with decreased treatment initiation (OR: 0.91; 95% CI: 0.83, 0.99). Existing diabetes (OR: 7.27; 95% CI: 1.93, 27.30), receipt of influenza vaccination (OR: 1.65; 95% CI: 1.14, 2.40) and region of origin from South-Eastern or Southern Asia (ORSEAsia: 2.30; 95% CI: 1.43, 3.70; ORSAsia: 1.64; 95% CI: 1.02, 2.64) were associated with increased treatment completion. Six refugees developed TB disease after declining (n = 4) or partially completing (n = 2) TBI treatment; none who completed treatment developed TB disease. CONCLUSIONS We determined gaps in the TBI care cascade among refugees in Middle Tennessee. Further assessment of barriers to treatment initiation and completion and interventions to assist refugees are warranted to improve these gaps and prevent TB disease.
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Affiliation(s)
- Adoma Manful
- Vanderbilt University School of Medicine, Nashville, USA
| | - Leslie Waller
- Tuberculosis Elimination Program, Metro Public Health Department, Nashville, USA
| | - Ben Katz
- Tuberculosis Elimination Program, Tennessee Department of Health, Nashville, USA
| | - Jason Cummins
- Tuberculosis Elimination Program, Tennessee Department of Health, Nashville, USA
| | - Jon Warkentin
- Tuberculosis Elimination Program, Tennessee Department of Health, Nashville, USA
| | - Billy Reagon
- Tuberculosis Elimination Program, Metro Public Health Department, Nashville, USA
| | - Joanna Shaw-Kaikai
- Tuberculosis Elimination Program, Metro Public Health Department, Nashville, USA
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Yuri F van der Heijden
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA.
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, A2200 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232, USA.
- The Aurum Institute, Johannesburg, South Africa.
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Abstract
Rationale: U.S. health departments routinely conduct post-arrival evaluation of immigrants and refugees at risk for tuberculosis (TB), but this important intervention has not been thoroughly studied.Objectives: To assess outcomes of the post-arrival evaluation intervention.Methods: We categorized at-risk immigrants and refugees as having had recent completion of treatment for pulmonary TB disease overseas (including in Mexico and Canada); as having suspected TB disease (chest radiograph/clinical symptoms suggestive of TB) but negative culture results overseas; or as having latent TB infection (LTBI) diagnosed overseas. Among 2.1 million U.S.-bound immigrants and refugees screened for TB overseas during 2013-2016, 90,737 were identified as at risk for TB. We analyzed a national data set of these at-risk immigrants and refugees and calculated rates of TB disease for those who completed post-arrival evaluation.Results: Among 4,225 persons with recent completion of treatment for pulmonary TB disease overseas, 3,005 (71.1%) completed post-arrival evaluation within 1 year of arrival; of these, TB disease was diagnosed in 22 (732 cases/100,000 persons), including 4 sputum culture-positive cases (133 cases/100,000 persons), 13 sputum culture-negative cases (433 cases/100,000 persons), and 5 cases with no reported sputum-culture results (166 cases/100,000 persons). Among 55,938 with suspected TB disease but negative culture results overseas, 37,089 (66.3%) completed post-arrival evaluation; of these, TB disease was diagnosed in 597 (1,610 cases/100,000 persons), including 262 sputum culture-positive cases (706 cases/100,000 persons), 281 sputum culture-negative cases (758 cases/100,000 persons), and 54 cases with no reported sputum-culture results (146 cases/100,000 persons). Among 30,574 with LTBI diagnosed overseas, 18,466 (60.4%) completed post-arrival evaluation; of these, TB disease was diagnosed in 48 (260 cases/100,000 persons), including 11 sputum culture-positive cases (60 cases/100,000 persons), 22 sputum culture-negative cases (119 cases/100,000 persons), and 15 cases with no reported sputum-culture results (81 cases/100,000 persons). Of 21,714 persons for whom treatment for LTBI was recommended at post-arrival evaluation, 14,977 (69.0%) initiated treatment and 8,695 (40.0%) completed treatment.Conclusions: Post-arrival evaluation of at-risk immigrants and refugees can be highly effective. To optimize the yield and impact of this intervention, strategies are needed to improve completion rates of post-arrival evaluation and treatment for LTBI.
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Programmatic Effectiveness of Latent Tuberculosis Care Cascade in a Community Health Center. J Immigr Minor Health 2020; 23:566-573. [PMID: 32705451 DOI: 10.1007/s10903-020-01047-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our aim was to quantify successful completion of steps of the latent tuberculosis (LTBI) care cascade in a community health center (CHC) with a large foreign-born population. We conducted a retrospective cohort study of individuals with a positive test for tuberculosis (TB) infection from 2015 to 2017 at Baltimore Medical Systems (BMS). During the study period, 3,984 individuals were tested for TB. Of the 418 individuals with positive tests, 152 (36%) were referred elsewhere for care, whereas 266 (64%) were retained in care at BMS. Treatment was prescribed for 157 of the 214 (73%) diagnosed with LTBI and retained in care at BMS (125/157 [80%] four months of rifampin; 32/157 [20%] nine months of isoniazid). One hundred forty-one patients (141/157, 90%) initiated treatment, of which 119 completed therapy (119/141, 84%). Our study identified several gaps in the LTBI care cascade in a CHC. Nonetheless, a large proportion of those treated for LTBI at the CHC completed therapy.
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25
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Screening for latent tuberculosis infection by an Aboriginal Community Controlled Health Service, New South Wales, Australia, 2015. Western Pac Surveill Response J 2020; 10:24-30. [PMID: 32133208 PMCID: PMC7043091 DOI: 10.5365/wpsar.2018.9.2.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Ongoing transmission of tuberculosis (TB) continues in Indigenous communities in New South Wales (NSW), Australia. In a pilot project, a Public Health Unit TB team partnered with an Aboriginal Community Controlled Health Service (ACCHS) in a community with a cluster of TB to augment screening for latent TB infection (LTBI) using interferon-gamma release assay (IGRA). This study examined screening data and programme outcomes at 12 months post hoc to advise practice and policy formulation. Methods We conducted a retrospective, cross-sectional analysis of demographic and clinical data of ACCHS patients, stratified by IGRA testing status. Differences in sex and age distribution between the groups and cases of a genetically and epidemiologically linked TB cluster in Aboriginal people in NSW were assessed using non-parametric tests. Results Of 2019 Aboriginal and Torres Strait Islander people seen by general practitioners during the study period, 135 (6.7%) participated in the screening. Twenty-four (17.8%) participants were IGRA positive. One person was diagnosed with active TB. Twelve participants received a chest X-ray at the time of the positive test, and six participants had an additional chest X-ray within 12 months. None commenced preventive treatment for LTBI. Discussion ACCHS screening for LTBI reached individuals in the age group most commonly affected by TB in these Aboriginal communities. No conclusions can be made regarding the population prevalence due to the low screening rate. Further strategies need to be developed to increase appropriate follow-up and preventive treatment.
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26
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Schluger NW. Tuberculosis Elimination, Research, and Respect for Persons. Am J Respir Crit Care Med 2020; 199:560-563. [PMID: 30339459 DOI: 10.1164/rccm.201809-1623ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Neil W Schluger
- 1 Division of Pulmonary, Allergy and Critical Care Medicine Columbia University Medical Center New York, New York
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27
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Sentís A, Vasconcelos P, Machado RS, Caylà JA, Guxens M, Peixoto V, Duarte R, Carvalho I, Carvalho C. Failure to complete treatment for latent tuberculosis infection in Portugal, 2013-2017: geographic-, sociodemographic-, and medical-associated factors. Eur J Clin Microbiol Infect Dis 2019; 39:647-656. [PMID: 31797155 DOI: 10.1007/s10096-019-03765-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
There is conflicting evidence about factors associated with failure to complete treatment (FCT) for latent tuberculosis infection (LTBI). We aim to identify the geographic, sociodemographic, and medical factors associated with FCT in Portugal, highlighting the two main metropolitan areas of Porto and Lisbon. We performed a retrospective cohort study including LTBI patients that started treatment in Portugal between 2013 and 2017. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using multivariable logistic regression to identify geographic, sociodemographic, and medical factors associated with FCT. Data on completion of treatment were available for 15,478 of 17,144 patients (90.3%). Of those, 2132 (13.8%) failed to complete treatment. Factors associated with FCT were being older than 15 years (aOR, 1.65 (95% CI = 1.34-2.05) for those aged 16 to 29), being born abroad (aOR, 2.04 (95% CI = 1.19-3.50) for Asia; aOR, 1.57 (95% CI = 1.24-1.98) for Africa), having a chronic disease (aOR, 1.29 (95% CI = 1.04-1.60)), alcohol abuse (aOR, 2.24 (95% CI = 1.73-2.90)), and being intravenous drug user (aOR, 1.68 (95% CI = 1.05-2.68)). Three-month course treatment with isoniazid plus rifampicin was associated with decreased FCT when compared with 6- or 9-month courses of isoniazid-only (aOR, 0.59 (95% CI = 0.45-0.77)). In Lisbon metropolitan area, being born in Africa, and in Porto metropolitan area, alcohol abusing and being intravenous drug user were distinctive factors associated with FCT. Sociodemographic and medical factors associated with FCT may vary by geographical area and should be taken into account when planning interventions to improve LTBI treatment outcomes. This study reinforces that shorter course treatment for LTBI might reduce FCT.
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Affiliation(s)
- Alexis Sentís
- Directorate-General of Health, Lisbon, Portugal.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.,ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Vasconcelos
- Directorate-General of Health, Lisbon, Portugal.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Rita Sá Machado
- Directorate-General of Health, Lisbon, Portugal.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Joan A Caylà
- Foundation of Tuberculosis Research Unit of Barcelona, Barcelona, Spain
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vasco Peixoto
- Directorate-General of Health, Lisbon, Portugal.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Raquel Duarte
- Directorate-General of Health, Lisbon, Portugal.,Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Pulmonology Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | | | - Carlos Carvalho
- Directorate-General of Health, Lisbon, Portugal. .,Department of Public Health, Northern Regional Health Administration, Porto, Portugal. .,Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.
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Macaraig MM, Jalees M, Lam C, Burzynski J. Improved treatment completion with shorter treatment regimens for latent tuberculous infection. Int J Tuberc Lung Dis 2019; 22:1344-1349. [PMID: 30355415 DOI: 10.5588/ijtld.18.0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Four New York City (NYC) Health Department tuberculosis (TB) clinics. OBJECTIVE To assess the effectiveness of preferentially offering two shorter treatment regimens-4 months of daily rifampin (4R) and 3 months of once-weekly isoniazid and rifapentine (3HP)-as an alternative to 9 months of daily isoniazid (9H) for the treatment of latent tuberculous infection (LTBI). DESIGN Retrospective analysis of patients treated for LTBI from January to June 2015. Poisson regression with robust standard error was used to examine the factors associated with treatment completion. RESULTS Of the patients on 9H, 49% (27/55) completed treatment compared with 70% (187/269) of patients on 4R (P = 0.003) and 79% (99/125) of patients on 3HP (P < 0.001). When adjusting for age, sex, and TB risk factors, patients on 4R (adjusted risk ratio [aRR] 1.39, 95%CI 1.07-1.81) and 3HP (aRR 1.67, 95%CI 1.27-2.19) were more likely to complete treatment than patients on 9H. Treatment was discontinued due to side effects in 1% (3/269) of patients on 4R, 2% (2/125) of patients on 3HP, and 4% (2/55) of patients on 9H. CONCLUSIONS Most patients were placed on shorter regimens for LTBI treatment, and higher treatment completion was observed. Encouraging community providers to use shorter regimens for LTBI treatment would reduce the TB disease burden in NYC.
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Affiliation(s)
- M M Macaraig
- New York City Department of Health and Mental Hygiene, New York, New York
| | - M Jalees
- New York City Department of Health and Mental Hygiene, New York, New York, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C Lam
- New York City Department of Health and Mental Hygiene, New York, New York, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J Burzynski
- New York City Department of Health and Mental Hygiene, New York, New York
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Xin YJ, Xiang L, Jiang JN, Lucas H, Tang SL, Huang F. The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients. Infect Dis Poverty 2019; 8:67. [PMID: 31370909 PMCID: PMC6676612 DOI: 10.1186/s40249-019-0575-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) is still a major public health problem in China. To scale up TB control, an innovative programme entitled the ‘China-Gates Foundation Collaboration on TB Control in China was initiated in 2009. During the second phase of the project, a policy of increased reimbursement rates under the New Cooperative Medical Scheme (NCMS) was implemented. In this paper, we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data. Methods In two cross-sectional surveys, quantitative data were collected before (January 2010 to December 2012) and after (April 2014 to June 2015) the intervention in the existing NCMS routine data system. Information on all 313 TB inpatients, among which 117 inpatients in the project was collected. Qualitative data collection included 11 focus group discussions. Three main indicators, non-reimbursable expenses rate (NER), effective reimbursement rate (ERR), and out-of-pocket payment (OOP) as a percentage of per capita household income, were used to measure the impact of intervention by comprising post-intervention data with baseline data. The quantitative data were analysed by descriptive analysis and non-parametric tests (Mann-Whitney U test) using SPSS 22.0, and qualitative data were subjected to thematic framework analysis using Nvivo10. Results The nominal reimbursement rates for inpatient care were no less than 80% for services within the package. Total inpatient expenses greatly increased, with an average growth rate of 11.3%. For all TB inpatients, the ERR for inpatient care increased from 52 to 66%. Compared with inpatients outside the project, for inpatients covered by the new policy, the ERR was higher (78%), and OOP showed a sharper decline. In addition, their financial burden decreased significantly. Conclusions Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy, inpatient OOP expenditure was still a major financial problem for patients. Limited diagnosis and treatment options in county general hospitals and inadequate implementation of the new policy resulted in higher inpatient expenditures and limited reimbursement. Comprehensive control models are needed to effectively decrease the financial burden on all TB patients. Electronic supplementary material The online version of this article (10.1186/s40249-019-0575-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan-Jiao Xin
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Nan Jiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Henry Lucas
- Institute of Development Studies, Brighton, UK
| | - Sheng-Lan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Fei Huang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China.
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30
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Plourde PJ, Basham CA, Derksen S, Schultz J, McCulloch S, Larcombe L, Kinew KA, Lix LM. Latent tuberculosis treatment completion rates from prescription drug administrative data. Canadian Journal of Public Health 2019; 110:705-713. [PMID: 31297736 DOI: 10.17269/s41997-019-00240-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In the province of Manitoba, Canada, given that latent tuberculosis infection (LTBI) treatment is provided at no cost to the patient, treatment completion rates should be optimal. The objective of this study was to estimate LTBI treatment completion using prescription drug administrative data and identify patient characteristics associated with completion. METHODS Prescription drug data (1999-2014) were used to identify individuals dispensed isoniazid (INH) or rifampin (RIF) monotherapy. Treatment completion was defined as being dispensed INH for ≥ 180 days (INH180) or ≥ 270 days (INH270) or RIF for ≥ 120 days (RIF120). Logistic regression models tested socio-demographic and comorbidity characteristics associated with treatment completion. RESULTS The study cohort comprised 4985 (90.4%) persons dispensed INH and 529 (9.6%) RIF. Overall treatment completion was 60.2% and improved from 43.1% in 1999-2003 to 67.3% in 2009-2014. INH180 showed the highest completion (63.8%) versus INH270 (40.4%) and RIF120 (27.0%). INH180 completion was higher among those aged 0-18 years (68.5%) compared with those aged 19+ (61.0%). Sex, geography, First Nations status, income quintile, and comorbidities were not associated with completion. CONCLUSIONS Benchmark 80% treatment completion rates were not achieved in Manitoba. Factors associated with non-completion were older age, INH270, and RIF120. Access to shorter LTBI treatments, such as rifapentine/INH, may improve treatment completion.
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Affiliation(s)
- Pierre J Plourde
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Integrated Tuberculosis Services, Winnipeg Regional Health Authority, 490 Hargrave Street, Winnipeg, Manitoba, R3A 0X7, Canada.
| | - Christopher A Basham
- British Columbia Centre for Disease Control and School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | | | | | - Linda Larcombe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kathi Avery Kinew
- Nanaandawewigamig, First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, Winnipeg, Canada
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Affiliation(s)
- Peter J Holmberg
- Division of Pediatric Hospital Medicine, Department of General Pediatric and Adolescent Medicine, and
| | | | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Nwana N, Marks SM, Lan E, Chang AH, Holcombe M, Morris SB. Treatment of latent Mycobacterium tuberculosis infection with 12 once weekly directly-observed doses of isoniazid and rifapentine among persons experiencing homelessness. PLoS One 2019; 14:e0213524. [PMID: 30865724 PMCID: PMC6415837 DOI: 10.1371/journal.pone.0213524] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives To investigate treatment outcomes and associated characteristics of persons experiencing homelessness who received 12-weekly doses of directly observed isoniazid and rifapentine (3HP/DOT) treatment for latent TB infection (LTBI). Methods Among homeless persons treated with 3HP/DOT during July 2011 –June 2015 in 11 U.S. TB programs, we conducted descriptive analyses of observational data, and identified associations between sociodemographic factors and treatment outcomes. Qualitative interviews were conducted to understand programmatic experiences. Results Of 393 persons experiencing homelessness (median age: 50 years; range: 13–74 years), 301 (76.6%) completed treatment, 55 (14.0%) were lost to follow-up, 18 (4.6%) stopped because of an adverse event (AE), and 19 (4.8%) stopped after relocations or refusing treatment. Eighty-one (20.6%) had at least one AE. Persons aged ≥65 were more likely to discontinue treatment than persons aged 31–44 years. Programs reported difficulty in following up with persons experiencing homelessness because of relocations, mistrust, and alcohol or drug use. Conclusions This study demonstrates the feasibility of administering the 3HP/DOT LTBI regimen to persons experiencing homelessness, a high-risk population.
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Affiliation(s)
- Nwabunie Nwana
- ORISE Research Participation Program at Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Suzanne M Marks
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward Lan
- Los Angeles County Department of Public Health Tuberculosis Control Program, Los Angeles, California, United States of America
| | - Alicia H Chang
- Los Angeles County Department of Public Health Tuberculosis Control Program, Los Angeles, California, United States of America
| | - Michael Holcombe
- Mississippi State Department of Health Tuberculosis Program, Jackson, Mississippi, United States of America
| | - Sapna Bamrah Morris
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Olsson O, Winqvist N, Olsson M, Olsson P, Björkman P. High rate of latent tuberculosis treatment completion in immigrants seeking asylum in Sweden. Infect Dis (Lond) 2018; 50:678-686. [PMID: 29620426 DOI: 10.1080/23744235.2018.1459046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND/AIM Treatment of latently infected individuals at increased risk of reactivation is a cornerstone in tuberculosis control. Although asylum seekers without residence permit in Sweden are offered screening for both active tuberculosis and latent tuberculosis infection (LTBI), treatment for LTBI is often not initiated due to anticipated low rates of treatment completion. We aimed to compare completion rates for LTBI treatment between asylum seekers and other patients, and between asylum seekers with and without residence permit. METHODS Data were collected retrospectively from tuberculosis clinic registers and medical records. For comparison of treatment completion rates, relative risks (RR) and confidence intervals (CI) were calculated. Predictors of completion were assessed by logistic regression multivariate analysis. RESULTS Treatment completion was achieved in 506/606 subjects (83%). RR of non-completion for asylum seekers (n = 297) compared to other subjects (n = 309) was 1.13 (95% CI: 0.79-1.61; p = .51), and 0.91 (95% CI: 0.53-1.56; p = .72) for asylum seekers without residence permit (n = 217) compared to asylum seekers with residence permit (n = 80). Completion rates increased from 53% in 2008 to 92% in 2015-2016. The following factors were associated with completion: scheduled interpreter-assisted appointments throughout the course of therapy, shorter treatment duration (6 vs. 9 months), and being treated in connection with immunosuppressive therapy. CONCLUSION Treatment completion rates were similar between asylum seekers and other subjects, supporting initiation of latent tuberculosis treatment in immigrants with recent arrival to low-endemic countries.
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Affiliation(s)
- O Olsson
- a Department of Translational Medicine, Clinical Infection Medicine , Lund University , Sweden
| | - N Winqvist
- a Department of Translational Medicine, Clinical Infection Medicine , Lund University , Sweden.,b Skane Regional Office for Infectious Disease Control , Malmö , Sweden
| | - M Olsson
- c Department of Infectious Diseases , Skane University Hospital , Malmö , Sweden
| | - P Olsson
- c Department of Infectious Diseases , Skane University Hospital , Malmö , Sweden
| | - P Björkman
- a Department of Translational Medicine, Clinical Infection Medicine , Lund University , Sweden
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Barriers to treatment adherence for individuals with latent tuberculosis infection: A systematic search and narrative synthesis of the literature. Int J Health Plann Manage 2018; 33:e416-e433. [DOI: 10.1002/hpm.2495] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 11/07/2022] Open
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Cruz AT, Starke JR. Completion Rate and Safety of Tuberculosis Infection Treatment With Shorter Regimens. Pediatrics 2018; 141:peds.2017-2838. [PMID: 29363561 DOI: 10.1542/peds.2017-2838] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The traditional treatment of tuberculosis (TB) infection (9 months of daily isoniazid [9H]) is safe but completion rates of <50% are reported. Shorter regimens (3 months of once-weekly isoniazid and rifapentine [3HP] or 4 months of daily rifampin [4R]) are associated with improved adherence in adults. METHODS This was a retrospective cohort study (2014-2017) of children (0-18 years old) seen at a children's TB clinic in a low-incidence nation. We compared the frequency of completion and adverse events (AEs) in children receiving 3HP, 4R, and 9H; the latter 2 regimens could be administered by families (termed self-administered therapy [SAT]) or as directly observed preventive therapy (DOPT); 3HP was always administered under DOPT. RESULTS TB infection treatment was started in 667 children: 283 (42.4%) 3HP, 252 (37.8%) 9H, and 132 (19.8%) 4R. Only 52% of children receiving 9H via SAT completed therapy. Children receiving 3HP were more likely to complete therapy than the 9H (SAT) group (odds ratio [OR] 27.4, 95% confidence interval [CI]: 11.8-63.7). Multivariate analyses found receipt of medication under DOPT (OR: 5.72, 95% CI: 3.47-9.43), increasing age (OR: 1.09, 95% CI: 1.02-1.17), and the absence of any AE (OR: 1.70, 95% CI: 0.26-0.60) to be associated with completing therapy. AEs were more common in the 9H group (OR: 2.51, 95% CI: 1.48-4.32). Two (0.9%) children receiving 9H developed hepatotoxicity; no child receiving 3HP or 4R developed hepatotoxicity. CONCLUSIONS Shorter regimens are associated with increased completion rates and fewer AEs than 9H.
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Affiliation(s)
- Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Belknap R, Holland D, Feng PJ, Millet JP, Caylà JA, Martinson NA, Wright A, Chen MP, Moro RN, Scott NA, Arevalo B, Miró JM, Villarino ME, Weiner M, Borisov AS. Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection: A Randomized Trial. Ann Intern Med 2017; 167:689-697. [PMID: 29114781 PMCID: PMC5766341 DOI: 10.7326/m17-1150] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Expanding latent tuberculosis treatment is important to decrease active disease globally. Once-weekly isoniazid and rifapentine for 12 doses is effective but limited by requiring direct observation. OBJECTIVE To compare treatment completion and safety of once-weekly isoniazid and rifapentine by self-administration versus direct observation. DESIGN An open-label, phase 4 randomized clinical trial designed as a noninferiority study with a 15% margin. Seventy-five percent or more of study patients were enrolled from the United States for a prespecified subgroup analysis. (ClinicalTrials.gov: NCT01582711). SETTING Outpatient tuberculosis clinics in the United States, Spain, Hong Kong, and South Africa. PARTICIPANTS 1002 adults (aged ≥18 years) recommended for treatment of latent tuberculosis infection. INTERVENTION Participants received once-weekly isoniazid and rifapentine by direct observation, self-administration with monthly monitoring, or self-administration with weekly text message reminders and monthly monitoring. MEASUREMENTS The primary outcome was treatment completion, defined as 11 or more doses within 16 weeks and measured using clinical documentation and pill counts for direct observation, and self-reports, pill counts, and medication event-monitoring devices for self-administration. The main secondary outcome was adverse events. RESULTS Median age was 36 years, 48% of participants were women, and 77% were enrolled at the U.S. sites. Treatment completion was 87.2% (95% CI, 83.1% to 90.5%) in the direct-observation group, 74.0% (CI, 68.9% to 78.6%) in the self-administration group, and 76.4% (CI, 71.3% to 80.8%) in the self-administration-with-reminders group. In the United States, treatment completion was 85.4% (CI, 80.4% to 89.4%), 77.9% (CI, 72.7% to 82.6%), and 76.7% (CI, 70.9% to 81.7%), respectively. Self-administered therapy without reminders was noninferior to direct observation in the United States; no other comparisons met noninferiority criteria. A few drug-related adverse events occurred and were similar across groups. LIMITATION Persons with latent tuberculosis infection enrolled in South Africa would not routinely be treated programmatically. CONCLUSION These results support using self-administered, once-weekly isoniazid and rifapentine to treat latent tuberculosis infection in the United States, and such treatment could be considered in similar settings when direct observation is not feasible. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Robert Belknap
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - David Holland
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Pei-Jean Feng
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Joan-Pau Millet
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Joan A Caylà
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Neil A Martinson
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Alicia Wright
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Michael P Chen
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Ruth N Moro
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Nigel A Scott
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Bert Arevalo
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - José M Miró
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Margarita E Villarino
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Marc Weiner
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
| | - Andrey S Borisov
- From Denver Health and Hospital Authority and the University of Colorado Health Sciences Center, Denver, Colorado; Emory University and Fulton County Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand, Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat, Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and University of Texas Health Science Center and Veterans Administration Medical Center, San Antonio, Texas
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Hayward KL, Valery PC, Martin JH, Karmakar A, Patel PJ, Horsfall LU, Tallis CJ, Stuart KA, Wright PL, Smith DD, Irvine KM, Powell EE, Cottrell WN. Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis. World J Gastroenterol 2017; 23:7321-7331. [PMID: 29142479 PMCID: PMC5677197 DOI: 10.3748/wjg.v23.i40.7321] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/18/2017] [Accepted: 09/05/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To investigate the impact of medication beliefs, illness perceptions and quality of life on medication adherence in people with decompensated cirrhosis.
METHODS One hundred adults with decompensated cirrhosis completed a structured questionnaire when they attended for routine outpatient hepatology review. Measures of self-reported medication adherence (Morisky Medication Adherence Scale), beliefs surrounding medications (Beliefs about Medicines Questionnaire), perceptions of illness and medicines (Brief Illness Perception Questionnaire), and quality of life (Chronic Liver Disease Questionnaire) were examined. Clinical data were obtained via patient history and review of medical records. Least absolute shrinkage and selection operator and stepwise backwards regression techniques were used to construct the multivariable logistic regression model. Statistical significance was set at alpha = 0.05.
RESULTS Medication adherence was “High” in 42% of participants, “Medium” in 37%, and “Low” in 21%. Compared to patients with “High” adherence, those with “Medium” or “Low” adherence were more likely to report difficulty affording their medications (P < 0.001), lower perception of treatment helpfulness (P = 0.003) and stronger medication concerns relative to medication necessity beliefs (P = 0.003). People with “Low” adherence also experienced greater symptom burden and poorer quality of life, including more frequent abdominal pain (P = 0.023), shortness of breath (P = 0.030), and emotional disturbances (P = 0.050). Multivariable analysis identified having stronger medication concerns relative to necessity beliefs (Necessity-Concerns Differential ≤ 5, OR = 3.66, 95%CI: 1.18-11.40) and more frequent shortness of breath (shortness of breath score ≤ 3, OR = 3.87, 95%CI: 1.22-12.25) as independent predictors of “Low”adherence.
CONCLUSION The association between “Low” adherence and patients having strong concerns or doubting the necessity or helpfulness of their medications should be explored further given the clinical relevance.
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Affiliation(s)
- Kelly L Hayward
- Pharmacy Department, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Patricia C Valery
- Cancer and Chronic Disease Research Group, QIMR Berghofer Medical Research Institute, Herston, Queensland 4006, Australia
| | - Jennifer H Martin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Antara Karmakar
- The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Preya J Patel
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Leigh U Horsfall
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Caroline J Tallis
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Penny L Wright
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - David D Smith
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland 4006, Australia
| | - Katharine M Irvine
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia
| | - W Neil Cottrell
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland 4102, Australia
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Eastment MC, McClintock AH, McKinney CM, Narita M, Molnar A. Factors That Influence Treatment Completion for Latent Tuberculosis Infection. J Am Board Fam Med 2017; 30:520-527. [PMID: 28720633 PMCID: PMC10939079 DOI: 10.3122/jabfm.2017.04.170070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The aim of this study is to describe factors associated with noncompletion of latent tuberculosis infection (LTBI) therapy. METHODS We conducted a retrospective cohort study of adults who initiated LTBI treatment with isoniazid, rifampin, or isoniazid-rifapentine at 5 clinics. Demographic, treatment, and monitoring characteristics were abstracted. We estimated descriptive statistics and compared differences between completers and noncompleters using t tests and χ2 tests. RESULTS The rate of completion across LTBI regimens was 66% (n = 393). A greater proportion of noncompleters were unmarried, used tobacco and/or alcohol, and had more medical problems than completers (all P < .05). A larger proportion of noncompleters received charity care compared with completers (P < .001). The most common reason for treatment discontinuation was loss to follow-up; the majority of these participants were treated with the longest isoniazid-only regimen. CONCLUSIONS Patients at risk of progression to active tuberculosis with factors associated with noncompletion may benefit from interventions that enhance adherence to LTBI therapy. These interventions could include enhanced outreach, incentive programs, or home visits.
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Affiliation(s)
- McKenna C Eastment
- From the Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle (ME); the Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (AHM, AM); the Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle (CMM); the Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (MN); and the Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, Washington (MN).
| | - Adelaide H McClintock
- From the Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle (ME); the Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (AHM, AM); the Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle (CMM); the Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (MN); and the Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, Washington (MN)
| | - Christy M McKinney
- From the Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle (ME); the Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (AHM, AM); the Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle (CMM); the Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (MN); and the Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, Washington (MN)
| | - Masahiro Narita
- From the Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle (ME); the Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (AHM, AM); the Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle (CMM); the Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (MN); and the Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, Washington (MN)
| | - Alexandra Molnar
- From the Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle (ME); the Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (AHM, AM); the Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle (CMM); the Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (MN); and the Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, Washington (MN)
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Abstract
There are approximately 56 million people who harbor Mycobacterium tuberculosis that may progress to active tuberculosis (TB) at some point in their lives. Modeling studies suggest that if only 8% of these individuals with latent TB infection (LTBI) were treated annually, overall global incidence would be 14-fold lower by 2050 compared to incidence in 2013, even in the absence of additional TB control measures. This highlights the importance of identifying and treating latently infected individuals, and that this intervention must be scaled up to achieve the goals of the Global End TB Strategy. The efficacy of LTBI treatment is well established, and the most commonly used regimen is 9 months of daily self-administered isoniazid. However, its use has been hindered by limited provider awareness of the benefits, concern about potential side effects such as hepatotoxicity, and low rates of treatment completion. There is increasing evidence that shorter rifamycin-based regimens are as effective, better tolerated, and more likely to be completed compared to isoniazid. Such regimens include four months of daily self-administered rifampin monotherapy, three months of once weekly directly observed isoniazid-rifapentine, and three months of daily self-administered isoniazid-rifampin. The success of LTBI treatment to prevent additional TB disease relies upon choosing an appropriate regimen individualized to the patient, monitoring for potential adverse clinical events, and utilizing strategies to promote adherence. Safer, more cost-effective, and more easily completed regimens are needed and should be combined with interventions to better identify, engage, and retain high-risk individuals across the cascade from diagnosis through treatment completion of LTBI.
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Oren E, Bell ML, Garcia F, Perez-Velez C, Gerald LB. Promoting adherence to treatment for latent TB infection through mobile phone text messaging: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2017; 3:15. [PMID: 28293431 PMCID: PMC5346839 DOI: 10.1186/s40814-017-0128-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/02/2017] [Indexed: 12/31/2022] Open
Abstract
Background An estimated two billion people, over one third of the world’s population, have latent infection with Mycobacterium tuberculosis (LTBI). Patient adherence to LTBI treatment is currently poor given that individuals show no symptoms of illness and may not feel that they are at risk of developing active tuberculosis (TB). Short text messages can serve as a simple reminder to take medications and address barriers to adherence such as forgetfulness and lack of social support. Methods/design We aim to determine the feasibility and acceptability of text reminders for improving adherence in latent TB patients using a randomized controlled single-blinded trial, measuring adherence through an increase in treatment completion rates. Forty adult LTBI participants will be randomized to either text messages plus phone call reminders or phone call reminders only (usual care). Recruitment, retention, and study acceptability will be assessed as primary outcomes. Discussion This pilot study will examine the feasibility of using text messaging for increasing adherence to treatment for latent tuberculosis infection. The study will allow for evaluation of process measures and challenges and development of a model for scaling up an effectiveness trial for increasing treatment adherence. Trial registration NCT02690818 (Clinical Trials.gov) Electronic supplementary material The online version of this article (doi:10.1186/s40814-017-0128-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eyal Oren
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA.,Asthma and Airways Disease Research Center, University of Arizona Health Sciences, Tucson, AZ USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA
| | - Francisco Garcia
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA.,Pima County Health Department, University of Arizona Health Sciences, Tucson, AZ USA
| | - Carlos Perez-Velez
- Pima County Health Department, University of Arizona Health Sciences, Tucson, AZ USA
| | - Lynn B Gerald
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245211, Tucson, AZ 85724 USA.,Asthma and Airways Disease Research Center, University of Arizona Health Sciences, Tucson, AZ USA
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Polis S, Zang L, Mainali B, Pons R, Pavendranathan G, Zekry A, Fernandez R. Factors associated with medication adherence in patients living with cirrhosis. J Clin Nurs 2016; 25:204-12. [PMID: 26769208 DOI: 10.1111/jocn.13083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES Medication adherence in people with cirrhosis is largely unknown. This study aims to determine adherence patterns and factors associated with adherence in patients with cirrhosis. BACKGROUND Prescribed medications are a pivotal component in the clinical management of cirrhosis with potential to retard disease progression and reduce complication risks. Medication adherence is necessary to optimise health outcomes. Understanding why medications are missed may help to develop strategies and inform nursing practice. DESIGN Prospective cohort study. METHODS Participants (n = 29) diagnosed with cirrhosis attending a tertiary hospital consented to complete a self-reported survey. Demographic information, adherence to medications, patient knowledge and quality of life data were collected, collated, checked and analysed using SPSS version 21. RESULTS Less than half of the 28 patients who completed the adherence questionnaire (n = 13, 46%) reported that they had never missed medication. Being forgetful, being away from home and falling asleep contributed to nonadherence. Having less abdominal symptoms, less fatigue and increased emotional well-being were significantly associated with patients never missing medications. CONCLUSIONS To our knowledge this is the first published study to describe adherent behaviour and the reasons medications are missed in this population. The percentage of nonadherent participants is of concern considering the potential morbidity risk that is associated with missed medications and rebound symptoms of cirrhosis. Strategies to improve and sustain adherence levels are required including enhanced adherence counselling offered to patients who are deteriorating or experience periodic exacerbation of symptoms. RELEVANCE TO CLINICAL PRACTICE Study findings have the potential to change clinical practice especially the way nurses target motivational adherence counselling, key treatment messages, education and adherence monitoring. The results presented here provide a basis for developing adherence strategies and nursing management plans to improve adherence and health outcomes in people with cirrhosis.
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Affiliation(s)
- Suzanne Polis
- Centre for Research in Nursing and Health, Kogarah, New South Wales, Australia.,The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
| | - Ling Zang
- Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia
| | - Bhawana Mainali
- Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia
| | - Rachel Pons
- Department of Nutrition and Dietetics, St George Hospital, Kogarah, New South Wales, Australia
| | | | - Amany Zekry
- Department of Gastroenterology, St George Hospital, Kogarah, New South Wales, Australia.,Clinical School of Medicine, St George Hospital, UNSW, Australia
| | - Ritin Fernandez
- Centre for Research in Nursing and Health, Kogarah, New South Wales, Australia.,School of Nursing and Midwifery, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Affiliation(s)
- Henry M Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia2Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia3Department of Global Health, Emory Rollins School of Public Health, Atlanta, Georgia
| | - Joel D Ernst
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, New York5Department of Pathology, New York University School of Medicine, New York, New York6Department of Microbiology, New York University School of Medicine, New York, New York
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Safety and Adherence for 12 Weekly Doses of Isoniazid and Rifapentine for Pediatric Tuberculosis Infection. Pediatr Infect Dis J 2016; 35:811-3. [PMID: 27088582 DOI: 10.1097/inf.0000000000001164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Traditional treatment of tuberculosis infection (TBI) is efficacious, but adherence is low. Eighty children with TBI received a 12-dose once-weekly isoniazid/rifapentine regimen; 79 (99%) completed therapy, 94% reported no adverse events, 1 child had mildly elevated transaminases but 1 adolescent later developed pulmonary TB. Isoniazid/rifapentine is safe, is well tolerated and has much higher completion rates than traditional TBI regimens.
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Eisenbeis L, Gao Z, Heffernan C, Yacoub W, Long R, Verma G. Contact investigation outcomes of Canadian-born adults with tuberculosis in Indigenous and non-Indigenous populations in Alberta. Canadian Journal of Public Health 2016; 107:e106-e111. [PMID: 27348096 DOI: 10.17269/cjph.107.5255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/18/2016] [Accepted: 12/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Contact investigations are a critical component of tuberculosis control in high-income countries. However, the relative success of conventional methods by population group and place of residence is unknown. This study compares outcomes of contact investigations of Canadian-born Indigenous tuberculosis cases living on- and off-reserve with other Canadian-born cases. METHODS In a retrospective analysis, Canadian-born adult culture-positive pulmonary TB cases (2001-2010) were identified. Characteristics of source cases and their contacts were compared by population group. Outcomes of contact investigations, including completion of recommended investigations and preventive therapy, were compared in multivariable analysis. RESULTS Of 171 cases of tuberculosis identified, 49 (29%) were Indigenous on-reserve, 62 (36%) Indigenous off-reserve, and 60 (35%) non-Indigenous or Canadian-born, "other". Indigenous people had more contacts identified per case compared to non-Indigenous patients. Case population group and smear status were the main predictors of the success of contact investigations. Of those recommended preventive therapy, close contacts of Indigenous cases on-reserve had the highest rate of completion, at 54%, vs. 41% and 37% for close contacts of Indigenous living off-reserve and Canadian-born "other" respectively (p = 0.02). Contacts of Indigenous cases living off-reserve had the greatest delay in assessment and the lowest rates of completion of assessment and preventive therapy. In multivariable analysis, population group, smear status of source case and proximity of contact were predictors of preventive therapy acceptance and/or completion. CONCLUSIONS Significant differences in outcomes of contact investigations were observed between population groups. The higher priority of contacts of smear-positive cases appears to influence efficiency of service delivery, regardless of population group. Jurisdictional differences in program delivery, resource availability and perceived risk of transmission likely influence outcomes of contact investigations.
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Affiliation(s)
- Lisa Eisenbeis
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Zhiwei Gao
- Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Wadieh Yacoub
- First Nations Inuit Health Branch, Health Canada, Alberta Region, Canada
| | - Richard Long
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Geetika Verma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Cruz AT, Starke JR. Managing tuberculosis infection in children in the USA: an update. Future Microbiol 2016; 11:669-84. [PMID: 27164182 DOI: 10.2217/fmb-2016-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The rate of tuberculosis (TB) disease has steadily declined in the last two decades in the USA, and over two-thirds of all cases now occur in foreign-born persons. Further declines in the incidence of TB will be most impacted by identifying and treating persons with TB infection. However, difficulties in accessing care, poor specificity of diagnostic tests and long courses of therapy historically have led to suboptimal screening of groups at high risk for infection, false-positive test results from cross-reaction with the bacille Calmette-Guérin vaccine and low treatment completion rates, respectively. This article reviews newer testing and treatment strategies for TB infection emphasizing risk and benefits of testing and treating.
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Affiliation(s)
- Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey R Starke
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Yamin A, Bornstein E, Hensel R, Mohamed O, Kempker RR. Predictors of Latent Tuberculosis Infection Treatment After Introduction of a New Regimen: A Retrospective Cohort Study at an Inner City Clinic. Open Forum Infect Dis 2016; 3:ofw082. [PMID: 27757409 PMCID: PMC5066457 DOI: 10.1093/ofid/ofw082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/19/2016] [Indexed: 11/14/2022] Open
Abstract
Background. Despite the low and decreasing prevalence of tuberculosis (TB) in the United States, there remain certain high-risk groups with high incidence rates. The targeted screening and treatment of latent TB infection (LTBI) among these high-risk groups are needed to achieve TB elimination; however, by most accounts, LTBI treatment completion rates remain low. Methods. We retrospectively studied all patients accepting treatment for LTBI at the Fulton County Health Department TB clinic over 2 years. Medical chart abstraction was performed to collect information on sociodemographics, medical, and LTBI treatment history. Treatment completion was defined as finishing ≥88% of the prescribed regimen. Logistic regression analysis was performed to identify predictors of treatment completion. Results. Among 547 adults offered LTBI treatment, 424 (78%) accepted treatment and 298 of 424 (70%) completed treatment. The median age was 42 years, most patients were black (77%), and close to one third did not have stable housing. No significant difference in completion rates was found between the 3 regimens of 9 months isoniazid (65%), 4 months rifampin (71%), and 3 months of weekly rifapentine and isoniazid (79%). In multivariate analysis, having stable housing increased the odds of finishing treatment, whereas tobacco use and an adverse event decreased the odds. Conclusion. Utilizing comprehensive case management, we demonstrated high rates of LTBI treatment completion, including among those receiving a 3-month regimen. Completion rates were higher among persons with stable housing, and this finding highlights the need to develop strategies that will improve adherence among homeless persons.
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Affiliation(s)
- Aliya Yamin
- Fulton County Health Department, Atlanta, Georgia
| | | | - Rachel Hensel
- Emory University School of Medicine , Atlanta, Georgia
| | - Omar Mohamed
- Fulton County Health Department, Atlanta, Georgia
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Moro RN, Borisov AS, Saukkonen J, Khan A, Sterling TR, Villarino ME, Scott NA, Shang N, Kerrigan A, Goldberg SV. Factors Associated With Noncompletion of Latent Tuberculosis Infection Treatment: Experience From the PREVENT TB Trial in the United States and Canada. Clin Infect Dis 2016; 62:1390-1400. [PMID: 26951571 DOI: 10.1093/cid/ciw126] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/08/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Overall rates of noncompletion of treatment (NCT) for latent tuberculosis infection (LTBI) in the PREVENT TB trial were 18% for 3 months of directly observed once-weekly rifapentine (maximum dose, 900 mg) plus isoniazid (maximum dose, 900 mg) (3HP-DOT) and 31% for 9 months of daily self-administered isoniazid (maximum dose, 300 mg; 9H-SAT). NCT for LTBI reduces its effectiveness. The study objective was to assess factors associated with NCT for LTBI among adult participants enrolled at US and Canadian sites of the PREVENT TB trial. METHODS This was a post hoc exploratory analysis of the randomized, open-label PREVENT TB trial. Factors were analyzed by univariate and multivariate logistic regression (with enrollment site as a random effect). RESULTS From 6232 participants analyzed, 1406 (22.6%) did not complete LTBI treatment (317 NCT attributed to an adverse event [NCT-AE] and 1089 NCT attributed to reasons other than an adverse event [NCT-O]). The proportion of NCT-AE was similar with both regimens (3HP-DOT = 6.4% vs 9H-SAT = 5.9%; P = .23); NCT-O was higher among participants enrolled in 9H-SAT (9H-SAT = 24.5% vs 3HP-DOT = 12.7%; P = .02). Among those in the NCT-AE group, being non-Hispanic and receiving 3HP-DOT, having cirrhosis and receiving 9H-SAT, alcohol consumption among men, and use of concomitant medication were associated with NCT-AE. Among those in the NCT-O group, receiving 9H-SAT, missing ≥1 early visit, men receiving 9H-SAT, men with a history of incarceration, alcohol abuse, use ever of intravenous drugs, younger age receiving 9H-SAT, and smoking were associated with NCT-O. CONCLUSIONS Factors associated with NCT, such as missing a clinic visit early during treatment, might help identify persons for whom tailored interventions could improve completion of LTBI treatment. CLINICAL TRIALS REGISTRATION NCT00023452.
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Affiliation(s)
- Ruth N Moro
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention.,CDC Foundation Research Collaboration, Atlanta, Georgia
| | - Andrey S Borisov
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
| | - Jussi Saukkonen
- Pulmonary Center, Department of Internal Medicine, Boston University School of Medicine, Massachusetts
| | - Awal Khan
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
| | - Timothy R Sterling
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - M Elsa Villarino
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
| | - Nigel A Scott
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention.,CDC Foundation Research Collaboration, Atlanta, Georgia
| | - Nong Shang
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
| | - Amy Kerrigan
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stefan V Goldberg
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
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Xiang L, Pan Y, Hou S, Zhang H, Sato KD, Li Q, Wang J, Tang S. The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China. Infect Dis Poverty 2016; 5:8. [PMID: 26818723 PMCID: PMC4730613 DOI: 10.1186/s40249-015-0094-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/30/2015] [Indexed: 12/05/2022] Open
Abstract
Background Tuberculosis (TB) patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China’s health insurance systems affect the alleviation of this burden under the integrated approach. This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme (NCMS) in rural China and to evaluate changes in catastrophic health expenditure (CHE) caused by the reimbursement policies. Methods Reimbursement data were obtained from routine data systems for the NCMS in Yichang (YC) and Hanzhong (HZ). 1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included. Household surveys were conducted. A total of 494 TB patients under the NCMS were selected in this paper. 12 Focus Group Discussions (FGDs) were held. We measured the impact of the NCMS by counterfactual analysis, which analyzed the financial burden alleviation. Equity was assessed by Concentration Index (CI), and disaggregated by project sites. Results TB inpatients were reimbursed with an effective reimbursement rate of 57.3 %. Average out-of-pocket (OOP) payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan, and 3572 yuan and 3013 yuan in YC and HZ, respectively. The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota. TB patients in HZ incurred higher effective reimbursement rates, but the incidence of CHE remained higher. The reduction of CHE incidence after the NCMS showed no difference statistically (P > 0.05). The severity of CHE was alleviated slightly. CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement. Conclusions Low reimbursement for TB patients could lead to heavy financial burden. Poor TB patients incurred high rates of CHE. The NCMS was found to be a protective factor for CHE, but the impact was modest and the equity of CHE did not improve. The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage of care. Supplemental programs may be necessary to expand coverage for TB care. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0094-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
| | - Yao Pan
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Shuangyi Hou
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China.
| | - Hongwei Zhang
- Shaanxi Provincial Institute for TB Control and Prevention, Xi'an, China.
| | - Kaori D Sato
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Qiang Li
- School of Public Health, Xi'an Jiaotong University, Xi'an, China.
| | - Jing Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Global Health Research Center, Duke Kunshan University, Kunshan, China.
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Crossa A, Kessler J, Harris TG. Enhanced Tuberculosis Infection Treatment Outcomes after Implementation of QuantiFERON®-Gold Testing. PLoS One 2015; 10:e0138349. [PMID: 26371760 PMCID: PMC4570766 DOI: 10.1371/journal.pone.0138349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/28/2015] [Indexed: 12/02/2022] Open
Abstract
Background Use of the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection (LTBI) among individuals who received the Bacille Calmette-Guérin (BCG) vaccine is complicated by its potential cross-reaction with TST antigens which may cause false-positive results and lead to patient and physician reluctance to initiate LTBI treatment. QuantiFERON®-TB Gold (QFT-G) lacks this cross-reaction. We sought to study the impact of implementing QFT-G testing in 2006 on LTBI treatment initiation and completion at NYC chest clinics. Methods QFT-G results from 10/2006–12/2008 in NYC Department of Health and Mental Hygiene chest clinics were obtained from the electronic medical record system. The proportions of patients who initiated and completed treatment among patients tested with QFT-G were compared to those tested with TST from 10/2004–9/2006. Results Among 36,167 patients tested with QFT-G, 2,300 (6%) tested positive, 33,327 (93%) tested negative, and 540 (1%) had an indeterminate result. Among those who had a positive QFT-G test and deemed eligible, 985 (80%) initiated LTBI treatment and 490 (40%) completed treatment. Historically, among patients tested with TST, 7,073 (19%) tested positive (p<0.0001 compared to QFT-G); 3,182 (79%) of those eligible initiated LTBI treatment and 1,210 (30%) completed treatment (p<0.0001 compared to QFT-G). Conclusions QFT-G implementation increased the proportion of patients completing LTBI treatment. Additional studies are needed in more settings to determine whether using QFT-G leads to a sustained increase in treatment completion.
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Affiliation(s)
- Aldo Crossa
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
- * E-mail:
| | - Jason Kessler
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Tiffany G. Harris
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
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