Pulmonary and Latent Tuberculosis Screening in Opiate Drug Users

2013 ◽  
Vol 7 (4) ◽  
pp. 230-235 ◽  
Author(s):  
Behnam Honarvar ◽  
Kamran Bagheri Lankarani ◽  
Neda Odoomi ◽  
Amir Roudgari ◽  
Mohsen Moghadami ◽  
...  
Keyword(s):  
Drug Users ◽  
Latent Tuberculosis ◽  
Tuberculosis Screening ◽  
Opiate Drug

scholarly journals Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

2020 ◽  
Vol 8 (9) ◽  
pp. 1-76
Author(s):  
Alistair Story ◽  
Elizabeth Garber ◽  
Robert W Aldridge ◽  
Catherine M Smith ◽  
Joe Hall ◽  
...  
Keyword(s):  
Drug Users ◽  
Latent Tuberculosis Infection ◽  
Controlled Trial ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Peer Educators ◽  
Tuberculosis Screening ◽  
Radiographic Screening ◽  
Directly Observed Treatment ◽  
Randomised Controlled

Background Socially complex groups, including people experiencing homelessness, prisoners and drug users, have very high levels of tuberculosis, often complicated by late diagnosis and difficulty in adhering to treatment. Objective To assess a series of interventions to improve tuberculosis control in socially complex groups. Design A series of observational surveys, evaluations and trials of interventions. Setting The pan-London Find&Treat service, which supports tuberculosis screening and case management in socially complex groups across London. Participants Socially complex groups with tuberculosis or at risk of tuberculosis, including people experiencing homelessness, prisoners, drug users and those at high risk of poor adherence to tuberculosis treatment. Interventions and main outcome measures We screened 491 people in homeless hostels and 511 people in prison for latent tuberculosis infection, human immunodeficiency virus, hepatitis B and hepatitis C. We evaluated an NHS-led prison radiographic screening programme. We conducted a cluster randomised controlled trial (2348 eligible people experiencing homelessness in 46 hostels) of the effectiveness of peer educators (22 hostels) compared with NHS staff (24 hostels) at encouraging the uptake of mobile radiographic screening. We initiated a trial of the use of point-of-care polymerase chain reaction diagnostics to rapidly confirm tuberculosis alongside mobile radiographic screening. We undertook a randomised controlled trial to improve treatment adherence, comparing face-to-face, directly observed treatment with video-observed treatment using a smartphone application. The primary outcome was completion of ≥ 80% of scheduled treatment observations over the first 2 months following enrolment. We assessed the cost-effectiveness of latent tuberculosis screening alongside radiographic screening of people experiencing homelessness. The costs of video-observed treatment and directly observed treatment were compared. Results In the homeless hostels, 16.5% of people experiencing homelessness had latent tuberculosis infection, 1.4% had current hepatitis B infection, 10.4% had hepatitis C infection and 1.0% had human immunodeficiency virus infection. When a quality-adjusted life-year is valued at £30,000, the latent tuberculosis screening of people experiencing homelessness was cost-effective provided treatment uptake was ≥ 25% (for a £20,000 quality-adjusted life-year threshold, treatment uptake would need to be > 50%). In prison, 12.6% of prisoners had latent tuberculosis infection, 1.9% had current hepatitis B infection, 4.2% had hepatitis C infection and 0.0% had human immunodeficiency virus infection. In both settings, levels of latent tuberculosis infection and blood-borne viruses were higher among injecting drug users. A total of 1484 prisoners were screened using chest radiography over a total of 112 screening days (new prisoner screening coverage was 43%). Twenty-nine radiographs were reported as potentially indicating tuberculosis. One prisoner began, and completed, antituberculosis treatment in prison. In the cluster randomised controlled trial of peer educators to increase screening uptake, the median uptake was 45% in the control arm and 40% in the intervention arm (adjusted risk ratio 0.98, 95% confidence interval 0.80 to 1.20). A rapid diagnostic service was established on the mobile radiographic unit but the trial of rapid diagnostics was abandoned because of recruitment and follow-up difficulties. We randomly assigned 112 patients to video-observed treatment and 114 patients to directly observed treatment. Fifty-eight per cent of those recruited had a history of homelessness, addiction, imprisonment or severe mental health problems. Seventy-eight (70%) of 112 patients on video-observed treatment achieved the primary outcome, compared with 35 (31%) of 114 patients on directly observed treatment (adjusted odds ratio 5.48, 95% confidence interval 3.10 to 9.68; p < 0.0001). Video-observed treatment was superior to directly observed treatment in all demographic and social risk factor subgroups. The cost for 6 months of treatment observation was £1645 for daily video-observed treatment, £3420 for directly observed treatment three times per week and £5700 for directly observed treatment five times per week. Limitations Recruitment was lower than anticipated for most of the studies. The peer advocate study may have been contaminated by the fact that the service was already using peer educators to support its work. Conclusions There are very high levels of latent tuberculosis infection among prisoners, people experiencing homelessness and drug users. Screening for latent infection in people experiencing homelessness alongside mobile radiographic screening would be cost-effective, providing the uptake of treatment was 25–50%. Despite ring-fenced funding, the NHS was unable to establish static radiographic screening programmes. Although we found no evidence that peer educators were more effective than health-care workers in encouraging the uptake of mobile radiographic screening, there may be wider benefits of including peer educators as part of the Find&Treat team. Utilising polymerase chain reaction-based rapid diagnostic testing on a mobile radiographic unit is feasible. Smartphone-enabled video-observed treatment is more effective and cheaper than directly observed treatment for ensuring that treatment is observed. Future work Trials of video-observed treatment in high-incidence settings are needed. Trial registration Current Controlled Trials ISRCTN17270334 and ISRCTN26184967. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

scholarly journals S39 Preliminary Results of a Latent Tuberculosis Screening and Treatment Project and the Role of TB Services in Secondary Care

Thorax ◽  
2015 ◽  
Vol 70 (Suppl 3) ◽  
pp. A26.2-A26
Author(s):  
MGK Burman ◽  
G Ahmed ◽  
JL Potter ◽  
VLC White ◽  
N Jayasekera ◽  
...  
Keyword(s):  
Secondary Care ◽  
Latent Tuberculosis ◽  
Tuberculosis Screening ◽  
Preliminary Results

scholarly journals Active and latent tuberculosis among HIV-positive injecting drug users in Indonesia

2015 ◽  
Vol 18 (1) ◽  
pp. 19317 ◽  
Author(s):  
Hinta Meijerink ◽  
Rudi Wisaksana ◽  
Mery Lestari ◽  
Intan Meilana ◽  
Lydia Chaidir ◽  
...  
Keyword(s):  
Drug Users ◽  
Latent Tuberculosis ◽  
Injecting Drug Users ◽  
Hiv Positive

Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting

2015 ◽  
Vol 144 (4) ◽  
pp. 703-711 ◽  
Author(s):  
C. WYNDHAM-THOMAS ◽  
K. SCHEPERS ◽  
V. DIRIX ◽  
F. MASCART ◽  
J.-P. VAN VOOREN ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Screening Tools ◽  
Hiv Care ◽  
Screening Methods ◽  
Tuberculosis Screening ◽  
Ltbi Treatment ◽  
Ltbi Screening ◽  
Multiple Choice Questionnaire ◽  
Targeted Approach

SUMMARYThe screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.

The Investigation of HIV and HCV Infection and Risk Factors among Opiate Drug Users in Beijing, China

2011 ◽  
Vol 38 (2) ◽  
pp. 140-145 ◽  
Author(s):  
Yan-ping Bao ◽  
Cun Du ◽  
Hong-yan Lu ◽  
Zhi Lian ◽  
Yi Qiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Users ◽  
Hcv Infection ◽  
Beijing China ◽  
Opiate Drug

scholarly journals Tuberculosis Screening and Active Tuberculosis among HIV-Infected Persons in a Canadian Tertiary Care Centre

2009 ◽  
Vol 20 (2) ◽  
pp. 51-57 ◽  
Author(s):  
Paul Brassard ◽  
Travis Salway Hottes ◽  
Richard G Lalonde ◽  
Marina B Klein
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Tertiary Care ◽  
Latent Tuberculosis ◽  
Clinic Visit ◽  
Skin Tests ◽  
Country Of Birth ◽  
Hiv Diagnosis ◽  
Tertiary Care Centre ◽  
Tuberculosis Screening

RATIONALE: HIV infection increases the risk of reactivation of latent tuberculosis (TB). The present study evaluates how latent TB is detected and treated to determine the effectiveness of screening in HIV-infected patients with diverse risk profiles.METHOD: A retrospective medical record database review (1988 to 2007) was conducted at a tertiary care HIV clinic. The proportion of patients receiving tuberculin skin tests (TSTs) and the rate of active TB at each stage of screening and prevention were estimated. Predictors of receiving a TST at baseline, testing positive by TST and developing active TB were evaluated.RESULTS: In the present study, 2123 patients were observed for a total of 9412 person-years. Four hundred seventy-six (22.4%) patients were tested by TST within 90 days of first clinic visit. Having a first clinic visit during the highly active antiretroviral therapy era (OR 3.64; 95% CI 2.66 to 4.99), country of birth (ORs: Africa 3.11, Asia 2.79, Haiti 3.14, and Latin America and the Caribbean 2.38), time between HIV diagnosis and first visit (OR per one-year change 0.97; 95% CI 0.94 to 0.99) and previous antiretroviral exposure (OR 0.61; 95% CI 0.45 to 0.81) were independent predictors of receiving a TST at baseline. Of the 17 patients who developed active TB during follow-up, nine (53%) had no documented TSTs at baseline or during follow-up. Forty-one per cent of all TB patients and 56% of TB patients who were not screened were born in Canada.CONCLUSION: The administration of TSTs to newly diagnosed HIV patients was inconsistent and differential according to country of birth, among other factors, resulting in missed opportunities for TB prevention.

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