scholarly journals Predictors of Latent Tuberculosis Infection Treatment After Introduction of a New Regimen: A Retrospective Cohort Study at an Inner City Clinic

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Aliya Yamin ◽  
Ethan Bornstein ◽  
Rachel Hensel ◽  
Omar Mohamed ◽  
Russell R. Kempker
Keyword(s):  
High Risk ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Risk Groups ◽  
The United States ◽  
Incidence Rates ◽  
Completion Rates ◽  
Ltbi Treatment ◽  
Stable Housing ◽  
Significant Difference

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.

scholarly journals Use of a scoring strategy to determine clinical risk of progression and risk group-specific treatment adherence in subjects with latent tuberculosis infection

2017 ◽  
Author(s):  
Michael Scolarici ◽  
Ken Dekitani ◽  
Ling Chen ◽  
Marcia Sokol-Anderson ◽  
Daniel F Hoft ◽  
...  
Keyword(s):  
High Risk ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Standard Of Care ◽  
Treatment Completion ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
Current Standard ◽  
Clinical Risk ◽  
The Us

ABSTRACTBackgroundAnnual incidence of active tuberculosis (TB) cases has plateaued in the US from 2013-2015. Most cases are from reactivation of latent tuberculosis infection (LTBI). A likely contributor is suboptimal LTBI treatment completion rates in subjects at high risk of developing active TB. It is unknown whether these patients are adequately identified and treated under current standard of care.MethodsIn this study, we sought to retrospectively assess the utility of an online risk calculator (tstin3d.com) in determining probability of LTBI and defining the characteristics and treatment outcomes of Low: 0-<10%, Intermediate: 10-<50% and High: 50-100% risk groups of asymptomatic subjects with LTBI seen between 2010-2015.Results51(41%), 46 (37%) and 28 (22%) subjects were in Low, Intermediate and High risk groups respectively. Tstin3d.com was useful in determining the probability of LTBI in tuberculin skin test positive US born subjects. Of 114 subjects with available treatment information, overall completion rate was 61% and rates of completion in Low (60%), Intermediate (63%) and High (57%) risk groups were equivalent. 75% subjects in the 3HP group completed treatment compared to 58% in the INH group. Provider documentation of important clinical risk factors was often incomplete. Logistic regression analysis showed no clear trends of treatment completion being associated with assessment of a risk factor.ConclusionThese findings suggest tstin3d.com could be utilized in the US setting for risk stratification of patients with LTBI and select treatment based on risk. Current standard of care practice leads to subjects in all groups finishing treatment at equivalent rates.

scholarly journals 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 ◽  
Vol 15 (12) ◽  
pp. e0243102
Author(s):  
Erica L. Stockbridge ◽  
Abiah D. Loethen ◽  
Esther Annan ◽  
Thaddeus L. Miller
Keyword(s):  
United States ◽  
Interferon Gamma ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
The United States ◽  
Tuberculosis Infection ◽  
Healthcare Sector ◽  
Treatment Persistence ◽  
Ltbi Treatment

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.

Higher Completion Rates With Self-administered Once-weekly Isoniazid-rifapentine Versus Daily Rifampin in Adults With Latent Tuberculosis

2020 ◽  
Author(s):  
Michelle K Haas ◽  
Kaylynn Aiona ◽  
Kristine M Erlandson ◽  
Robert W Belknap
Keyword(s):  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Completion Rates ◽  
Multivariable Model ◽  
Ltbi Treatment ◽  
Adjusted Risk ◽  
Short Course ◽  
P 75 ◽  
Adjusted Risk Ratio ◽  
The Us

Abstract Background Treatment of latent tuberculosis (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 4 months of daily rifampin (4R). Methods Retrospective cohort study of adults ≥18 years of age initiating LTBI treatment with either 3HP-SAT or 4R in a United States (US)–based TB clinic between 11 April 2016 and 31 December 2018. We evaluated treatment completion through pharmacy fills and reviewed charts for reasons of noncompletion, including adverse events (AEs). The χ 2 test and a log-binomial multivariable model were used to compare treatment completion and AEs. Results Five hundred sixty individuals (42%) initiated 3HP-SAT and 773 (58%) initiated 4R. Median age was 38, 55% were female, and 89% were born outside of the US. Among those aged 18–49 years, treatment completion with 3HP-SAT was 79% compared to 68% with 4R (adjusted risk ratio [aRR], 1.17 [95% CI, 1.17–1.27]; P &lt; .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 &lt; .0001). Compared to 4R, there was no difference in risk of AEs in the 18–49 age group (aRR, 0.93 [95% CI, .58–1.48]; P = .75). Reduced risk of AEs was noted among patients aged ≥50 years who received 3HP-SAT (aRR, 0.37 [95% CI, .16–.85]; P = .02). Conclusions 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 US.

scholarly journals 1407. The Latent Tuberculosis Infection Cascade of Care during the COVID-19 Pandemic Response in a Mid-Sized US City

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S787-S787
Author(s):  
Trevor M Stantliff ◽  
Lauren Houshel ◽  
Rinki Goswami ◽  
Serenity Millow ◽  
Gabrielle Cook ◽  
...  
Keyword(s):  
Public Health ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Completion Rates ◽  
Ltbi Treatment ◽  
Response Period ◽  
Cascade Of Care ◽  
Pandemic Response ◽  
Treatment Acceptance

Abstract Background The COVID-19 pandemic response may unintendedly disrupt multiple public health services, including tuberculosis control programs. We aimed to assess the cascade of care of latent tuberculosis infection (LTBI) in an urban US city during the COVID-19 pandemic response. Methods We conducted a retrospective cohort study of adult patients who presented for LTBI evaluation at the Hamilton County Public Health Tuberculosis Clinic in Ohio between 2019 and 2020. We defined 01/2019 to 02/2020 as the pre-COVID-19 response period, and 04/2020 to 12/2020 as the COVID-19 pandemic response period. We reviewed electronic medical records and extracted sociodemographic information, medical history, and follow-up and treatment data to define steps within the LTBI cascade of care. Logistic regressions were used to assess factors associated with LTBI treatment acceptance and completion, adjusted by potential confounders and COVID-19 period. Results Data from 312 patients were included. There was a significant decrease in the number of monthly LTBI referrals (median, 18 vs. 8, p=0.02) and LTBI evaluations (median, 17.5 vs. 7, p&lt; 0.01) during COVID-19. There was a decrease in the proportion of immigrants as indication for LTBI testing (30% vs. 9%; p&lt; 0.01), and an increase in LTBI diagnoses based on interferon-gamma release assay (IGRA; 30% vs. 49%; p&lt; 0.01) during COVID-19. The proportion of people who were recommended LTBI treatment was similar before and during COVID-19 (76% vs. 81%, p=0.41), as well as the LTBI treatment acceptance rates (56% vs. 64%, p=0.28), and LTBI treatment completion rates (65% vs. 63%, p=0.85). In multivariate analysis, LTBI treatment acceptance was associated with Hispanic ethnicity, younger age, male sex, IGRA use, no comorbidities, and non-healthcare occupation, independent of COVID-19 period. LTBI treatment completion was associated with taking a rifamycin-containing regimen, independent of COVID-19 period. Conclusion We observed a significant decline in the number of monthly LTBI referrals and evaluations during COVID-19. Our findings indicate an unintended negative impact of the COVID-19 response in LTBI screening efforts in our region. LTBI treatment acceptance and completion rates were not affected during COVID-19. Disclosures All Authors: No reported disclosures

scholarly journals Factors Associated with Noncompletion of Latent Tuberculosis Infection Treatment in an Inner-City Population in Edmonton, Alberta

2014 ◽  
Vol 25 (5) ◽  
pp. 281-284 ◽  
Author(s):  
Kathy Malejczyk ◽  
Jennifer Gratrix ◽  
Avril Beckon ◽  
Danusia Moreau ◽  
Gwenna Williams ◽  
...  
Keyword(s):  
Inner City ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Retrospective Chart Review ◽  
Treatment Completion ◽  
Tuberculosis Infection ◽  
Completion Rates ◽  
Ltbi Treatment ◽  
Infection Treatment ◽  
City Population

A limited number of studies have been published that examine treatment completion rates and interventions used to increase treatment completion within an inner-city population. The purpose of the present study was to determine the rate of latent tuberculosis infection (LTBI) treatment completion in an inner-city population in Edmonton, Alberta, and to identify factors that correlated with treatment completion. A retrospective chart review was conducted involving patients who started LTBI treatment between January 1, 2005 and December 31, 2010 in Edmonton’s inner city. A total of 77 patients started treatment and 57 (74%) patients completed LTBI treatment. Homelessness was the only variable that was significantly associated with incomplete treatment (OR 8.0 [95% CI 1.4 to 45.6]) and it remained significant when controlling for drug use (adjusted OR 6.5 [95% CI 1.1 to 38.8]). While the present study demonstrated treatment completion rates comparable with or better than those described in the general population, it highlighted the need for continued emphasis on interventions aimed at improving outcomes within homeless populations.

scholarly journals Assessing Diazinon Pollution in the Three Major Rivers Flowing into the Caspian Sea (Iran)

Water ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 335
Author(s):  
Reza Dahmardeh Behrooz ◽  
Abbas Esmaili-sari ◽  
Magdalena Urbaniak ◽  
Paromita Chakraborty
Keyword(s):  
High Risk ◽  
Organophosphorus Pesticides ◽  
Aquatic Organisms ◽  
The United States ◽  
The Caspian Sea ◽  
Worst Case ◽  
Pollution Levels ◽  
Haraz River ◽  
Significant Difference ◽  
Medium Risk

The aim of this study was to investigate the seasonal and spatial variations in the concentrations of a widely used organophosphorous pesticide (OPP), diazinon, and the associated risk posed by this OPP in the surface water from the three largest rivers located in the northern province of Iran: the Haraz, the Talar and the Babolrood rivers. These rivers are located in the agriculture province of Mazandaran, and are exposed to high doses of organophosphorus pesticides, especially diazinon. The concentration of diazinon was determined using gas chromatography, while the potential risk posed by diazinon was elucidated using a Risk Quotient (RQ) calculated for general (RQm) and worst-case (RQex) scenarios. The obtained results demonstrated that the average diazinon concentrations ranged from 41 ± 76 ng/L in the Talar River and 57 ± 116 ng/L in the Haraz River, to 76.5 ± 145 ng/L in the Babolrood River, with a significant difference noted between summer and autumn seasons for all three rivers. For some stations, the concentration of diazinon is higher than the standard guidelines of Australian/New Zealand Guidelines for Fresh and Marine Water Quality (FMWQ) and the United States Criteria Maximum Concentration (CMC). The calculated RQs indicated a medium risk of diazinon, RQm = 0.73 and RQex = 2.27, in the Talar River; RQm = 1.02 and RQex = 2.49 in the Haraz River; and RQm = 1.35 and RQex = 4.54 in the Babolrood River. The overall exposure of diazinon was defined to have a high risk (RQm and RQex > 1); however, the summer sampling revealed a high risk (RQm and RQex > 1), while the autumn had a medium risk (RQm and RQex < 1). The obtained results revealed not only elevated concentrations of diazinon in the studied rivers but most importantly the high risk posed by this OPP for the aquatic organisms and the wellbeing of the whole river ecosystem. The current study showed that development and implementation of appropriate standards and regulations toward diazinon in countries such as Iran are required to reduce the pollution levels and risks related to elevated concentrations of the studied pesticide.

scholarly journals PIN41 INFLUENZA VACCINATION RATES AMONG HIGH RISK GROUPS IN THE UNITED STATES

2011 ◽  
Vol 14 (3) ◽  
pp. A121
Author(s):  
M. DiBonaventura ◽  
J.S. Wagner ◽  
A. Goren
Keyword(s):  
United States ◽  
High Risk ◽  
Influenza Vaccination ◽  
Risk Groups ◽  
The United States ◽  
Vaccination Rates

Pharmacoeconomical aspects of chemotherapy in children at high risk of tuberculosis

2021 ◽  
Vol 19 (2) ◽  
pp. 229-235
Author(s):  
Vasiliy E. Novikov ◽  
Natalia E. Usacheva ◽  
Natalia S. Ponamareva ◽  
Tatyana V. Myakisheva
Keyword(s):  
High Risk ◽  
Latent Tuberculosis ◽  
Preventive Treatment ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
Practical Significance ◽  
Preventive Chemotherapy ◽  
Source Of Infection ◽  
Scientific Papers ◽  
Tuberculosis In Children

AIM: of the study is to analyze the results of pharmacoeconomical studies of preventive chemotherapy in children from high-risk groups of tuberculosis to optimize measures for the prevention of tuberculosis infection in children. MATERIALS AND METHODS: Collection, systematization and analysis of data from the scientific literature and the results of their own research on the relevant problem. RESULTS: On the problem of chemoprophylaxis of tuberculosis infection in children from high-risk groups, there is insufficient information on the pharmacoeconomical aspects of this problem. Most studies include a pharmacoeconomical assessment of the management of adult patients with tuberculosis infection. There are isolated scientific papers devoted to the pharmacoeconomical analysis of the preventive treatment of latent tuberculosis infection (LTI) in children. Different clinical and economic efficiency of the applied methods of immunodiagnostics and regimens of chemoprophylaxis of tuberculosis in children is shown. To improve the epidemic situation of tuberculosis among children, it is important to improve preventive chemotherapy regimens. Their effectiveness is largely determined by the sensitivity of Mycobacterium tuberculosis (MBT) to anti-tuberculosis drugs (PTP) and the rational choice of a chemotherapy regimen. The current chemoprophylaxis regimens for children with LTI do not take into account the sensitivity of MBT to PTP at a possible source of infection. CONCLUSION: The analysis shows the high relevance of pharmacoeconomical studies and the practical significance of the results of such studies for optimizing preventive chemotherapy in children from high-risk groups for tuberculosis. Scientific research on the assessment of the clinical and economic effectiveness of various regimens of chemoprophylaxis of tuberculosis in children allows us to identify the most effective and least expensive ways to prevent tuberculosis through the rational use of medicines and methods of immunodiagnostics.

scholarly journals Testing practices and incidence of chlamydial and gonococcal infection in the Veterans Health Administration, 2009-2019

2020 ◽  
Author(s):  
Lauren A Beste ◽  
Marissa M Maier ◽  
Joleen Borgerding ◽  
Elliott Lowy ◽  
Ronald G Hauser ◽  
...  
Keyword(s):  
Risk Groups ◽  
Veterans Health Administration ◽  
The United States ◽  
Incidence Rates ◽  
Veterans Health ◽  
Health Administration ◽  
Hiv Status ◽  
Demographic Group ◽  
Immunodeficiency Virus ◽  
Testing Practices

Abstract Background Chlamydia trachomatis and Neisseria gonorrhoeae cases reached a record high in the United States in 2018. Although active duty military servicemembers have high rates of chlamydia and gonorrhea infection, trends in chlamydia and gonorrhea in the Veterans Health Administration (VHA) system have not been previously described, including among patients with human immunodeficiency virus (HIV) and young women. Methods We identified all Veterans in VHA care from 2009-2019. Tests and cases of chlamydia and gonorrhea were defined based on lab results in the electronic health record. Chlamydia and gonorrhea incidence rates were calculated each year by demographic group and HIV status. Results In 2019, testing for chlamydia and gonorrhea occurred in 2.3% of patients, 22.6% of women ages 18-24, and 34.1% of persons with HIV. 2019 incidence of chlamydia and gonorrhea was 100.8 and 56.3 cases per 100,000 VHA users, an increase of 267% and 294%, respectively, since 2009. Veterans aged &lt;34 years accounted for 9.5% of the VHA population but 66.9% of chlamydia and 42.9% of gonorrhea cases. Chlamydia and gonorrhea incidence rates in persons with HIV were 1,432 and 1,687 per 100,000, respectively. Conclusions The incidence of chlamydia and gonorrhea rose dramatically from 2009-2019. Among tested persons, those with HIV had a 15.2-fold higher unadjusted incidence of chlamydia and 34.9-fold higher unadjusted incidence of gonorrhea compared to those without HIV. VHA-wide adherence to chlamydia and gonorrhea testing in high-risk groups merits improvement.

scholarly journals The effect of text messaging on latent tuberculosis treatment adherence: a randomised controlled trial

2018 ◽  
Vol 51 (2) ◽  
pp. 1701488 ◽  
Author(s):  
James C. Johnston ◽  
Mia L. van der Kop ◽  
Kirsten Smillie ◽  
Gina Ogilvie ◽  
Fawziah Marra ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Treatment Adherence ◽  
Text Messaging ◽  
Controlled Trial ◽  
Latent Tuberculosis ◽  
Completion Rates ◽  
Ltbi Treatment ◽  
Data Analyst ◽  
Randomised Controlled ◽  
And Control

There is limited high-quality evidence available to inform the use of text messaging to improve latent tuberculosis infection (LTBI) treatment adherence.We performed a parallel, randomised controlled trial at two sites to assess the effect of a two-way short message service on LTBI adherence. We enrolled adults initiating LTBI therapy from June 2012 to September 2015 in British Columbia, Canada. Participants were randomised in a 1:1 ratio to standard LTBI treatment (control) or standard LTBI treatment plus two-way weekly text messaging (intervention). The primary outcome was treatment completion, defined as taking ≥80% prescribed doses within 12 months (isoniazid) or 6 months (rifampin) of enrolment. The trial was unblinded except for the data analyst.A total of 358 participants were assigned to the intervention (n=170) and control (n=188) arms. In intention-to-treat analysis, the proportion of participants completing LTBI therapy in the intervention and control arms was 79.4% and 81.9%, respectively (RR 0.97, 95% CI 0.88–1.07; p=0.550). Results were similar for pre-specified secondary end-points, including time-to-completion of LTBI therapy, completion of >90% of prescribed LTBI doses and health-related quality of life.Weekly two-way text messaging did not improve LTBI completion rates compared to standard LTBI care; however, completion rates were high in both treatment arms.

Sign in / Sign up

Export Citation Format

Share Document