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Bruxvoort KJ, Skarbinski J, Fischer H, Li Z, Eaton A, Qian L, Spence B, Wei R, Rieg G, Shaw S, Tartof SY. Latent Tuberculosis Infection Treatment Practices in Two Large Integrated Health Systems in California, 2009-2018. Open Forum Infect Dis 2023; 10:ofad219. [PMID: 37265669 PMCID: PMC10230566 DOI: 10.1093/ofid/ofad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023] Open
Abstract
Background Treatment of latent tuberculosis infection (LTBI) is highly effective at preventing active tuberculosis (TB) disease. Understanding LTBI treatment practices in US health system settings is critical to identify opportunities to improve treatment prescription, initiation, and completion, and thus to prevent TB disease. Methods We assessed LTBI treatment practices among a cohort of adults after their first positive LTBI test (tuberculin skin test [TST] or interferon gamma release assay [IGRA]) between 2009 and 2018 at 2 large integrated health systems in California. We described the prescription, initiation, and completion of LTBI treatment (isoniazid [INH], rifampin, and rifamycin-INH short-course combinations) by demographic and clinical characteristics. We used multivariable robust Poisson regression to examine factors that were independently associated with treatment prescription and completion. Results Among 79 302 individuals with a positive LTBI test, 33.0% were prescribed LTBI treatment, 28.3% initiated treatment, and 18.5% completed treatment. Most individuals were prescribed INH (82.0%), but treatment completion was higher among those prescribed rifamycin-INH short-course combinations (69.6% for INH + rifapentine and 70.3% for INH + rifampin) compared with those prescribed INH (56.3%) or rifampin (56.6%). In adjusted analyses, treatment prescription and completion were associated with older age, female sex, more comorbidities, immunosuppression, not being born in a high-TB incidence country, and testing positive with IGRA vs TST. Conclusions LTBI treatment is underutilized, requiring tailored interventions to support treatment prescription and completion for patients with LTBI.
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Affiliation(s)
- Katia J Bruxvoort
- Department of Epidemiology, School of Public Health,University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Heidi Fischer
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Zhuoxin Li
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Abigail Eaton
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lei Qian
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Brigitte Spence
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Rong Wei
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Gunter Rieg
- Department of Infectious Diseases, South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, California, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Sally Shaw
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
| | - Sara Y Tartof
- Division of Epidemiologic Research, Department of Research and Evaluation, Kaiser Permanente Southern California,Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Abstract
Three patients with granuloma faciale were successfully treated by argon laser therapy. The intense blue-green laser light is readily absorbed by these inflammatory lesions, resulting in resolution of the clinical and microscopic abnormalities. There were no recurrences during follow-up periods of 23, 21, and 5 months, respectively. Argon laser therapy appears to be an important addition to the treatment armamentarium for this uncommon, but difficult to treat, entity.
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