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.

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 938Identification of High Risk Healthcare Workers with Latent Tuberculosis Infection (LTBI) in an Inner City Healthcare System

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S273-S273
Author(s):  
Sorabh Dhar ◽  
Anupama Neelakanta ◽  
Jisha John ◽  
Russell Grimshaw ◽  
Jim Russell ◽  
...  
Keyword(s):  
High Risk ◽  
Inner City ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection

scholarly journals Treatment with isoniazid or rifampin for latent tuberculosis infection: population-based study of hepatotoxicity, completion and costs

2020 ◽  
Vol 55 (3) ◽  
pp. 1902048 ◽  
Author(s):  
Lisa A. Ronald ◽  
J. Mark FitzGerald ◽  
Gillian Bartlett-Esquilant ◽  
Kevin Schwartzman ◽  
Andrea Benedetti ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Population Based ◽  
Direct Costs ◽  
Tuberculosis Infection ◽  
Cost Ratio ◽  
Liver Transplants ◽  
Health Administrative Data ◽  
Severe Hepatotoxicity

Clinical trials suggest less hepatotoxicity and better adherence with 4 months rifampin (4R) versus 9 months isoniazid (9H) for treating latent tuberculosis infection (LTBI). Our objectives were to compare frequencies of severe hepatic adverse events and treatment completion, and direct health system costs of LTBI regimens 4R and 9H, in the general population of the province of Quebec, Canada, using provincial health administrative data.Our retrospective cohort included all patients starting rifampin or isoniazid regimens between 2003 and 2007. We estimated hepatotoxicity from hospitalisation records, treatment completion from community pharmacy records and direct costs from billing records and fee schedules. We compared rifampin to isoniazid using logistic (hepatotoxicity), log-binomial (completion), and gamma (costs) regression, with adjustment for age, co-morbidities and other confounders.10 559 individuals started LTBI treatment (9684 isoniazid; 875 rifampin). Rifampin patients were older with more baseline co-morbidities. Severe hepatotoxicity risk was higher with isoniazid (n=15) than rifampin (n=1), adjusted OR=2.3 (95% CI: 0.3–16.1); there were two liver transplants and one death with isoniazid and none with rifampin. Overall, patients without co-morbidities had lower hepatotoxicity risk (0.1% versus 1.0%). 4R completion (53.5%) was higher than 9H (36.9%), adjusted RR=1.5 (95% CI: 1.3–1.7). Mean costs per patient were lower for rifampin than isoniazid: adjusted cost ratio=0.7 (95% CI: 0.5–0.9).Risk of severe hepatotoxicity and direct costs were lower, and completion was higher, for 4R than 9H, after adjustment for age and co-morbidities. Severe hepatotoxicity resulted in death or liver transplant in three patients receiving 9H, compared with no patients receiving 4R.

scholarly journals Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand

2020 ◽  
Vol 17 (18) ◽  
pp. 6876
Author(s):  
Patimaporn Chanpho ◽  
Naesinee Chaiear ◽  
Supot Kamsa-ard
Keyword(s):  
High Risk ◽  
Latent Tuberculosis Infection ◽  
Conditional Logistic Regression ◽  
Critical Role ◽  
Latent Tuberculosis ◽  
Tertiary Hospital ◽  
Tuberculosis Infection ◽  
P Value ◽  
Factors Associated ◽  
Northeastern Thailand

Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB—94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (p-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01–3.58, p = 0.041); among HCWs performing AGPs (crude OR = 2.04, 95% CI: 1.20, 3.48, p = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50–4.47, p = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04–3.20, p = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65–5.36, p = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, p = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGPs and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role.

scholarly journals Modeling the Impact of Recommendations for Primary Care–Based Screening for Latent Tuberculosis Infection in California

2020 ◽  
Vol 135 (1_suppl) ◽  
pp. 172S-181S
Author(s):  
Andrea Parriott ◽  
James G. Kahn ◽  
Haleh Ashki ◽  
Adam Readhead ◽  
Pennan M. Barry ◽  
...  
Keyword(s):  
Primary Care ◽  
Latent Tuberculosis Infection ◽  
Task Force ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
California Department ◽  
The Us ◽  
Almost All ◽  
The Impact ◽  
Ltbi Testing

Objective Targeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California. Methods We used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment. Results Implementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non–US-born persons. Conclusions By focusing on the non–US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.

scholarly journals Gender Disparities in Latent Tuberculosis Infection in High-Risk Individuals: A Cross-Sectional Study

PLoS ONE ◽  
2014 ◽  
Vol 9 (11) ◽  
pp. e110104 ◽  
Author(s):  
Wen-Ying Ting ◽  
Shiang-Fen Huang ◽  
Ming-Che Lee ◽  
Yung-Yang Lin ◽  
Yu-Chin Lee ◽  
...  
Keyword(s):  
High Risk ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Cross Sectional Study ◽  
Gender Disparities ◽  
Tuberculosis Infection ◽  
Sectional Study ◽  
Cross Sectional
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