scholarly journals Targeted Screening for Latent TB Infection prior to Biologic Therapy to Improve Patient Safety and Reduce Costs: A Prospective Observational Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
R. Hassanzadeh ◽  
J. France ◽  
S. Bawa
Keyword(s):  
Risk Factors ◽  
Chest Radiograph ◽  
Improve Patient Safety ◽  
Cost Savings ◽  
British Thoracic Society ◽  
Potential Cost ◽  
Drug Induced ◽  
Negative Results ◽  
Latent Tb ◽  
Latent Tb Infection

Objective. Our current practice of screening for latent TB infection (LTBI) using universal T-SPOT assays is not in line with British Thoracic Society (BTS) recommendations. We set out to determine the clinical benefit and cost effectiveness of blanket TSPOT.TB (T-SPOT) testing as a screening tool for patients awaiting anti-TNF-α therapy. Methods. 130 consecutive rheumatology patients were investigated for LTBI before commencing anti-TNFα therapy at Gartnavel General Hospital, Glasgow, an area of low TB prevalence and high BCG vaccination. Chest radiograph and clinical interview were used to identify risk factors for LTBI. The annual risk of TB was calculated using tables from BTS recommendations and then compared to the risk of drug-induced hepatitis. All patients were given a T-SPOT according to current local policy. Indeterminate T-SPOTs were recorded and repeated. Results. For 130 patients, a total of 160 tests were required resulting in a cost of £24,000. 99 (76%) patients had no TB risk factors and a total of 22 repeat tests were required before returning negative results. This equates 121 T-SPOTs and potential cost savings of £18,150. Conclusion. In the absence of risk factors for TB and an abnormal chest radiograph, the use of T-SPOT as a first line test for LTBI may result in unnecessary risk of TB chemoprophylaxis-induced hepatitis, increased costs, and a delay in early anti-TNFα therapy.

scholarly journals Evaluating the potential costs and impact of digital health technologies for tuberculosis treatment support

2018 ◽  
Vol 52 (5) ◽  
pp. 1801363 ◽  
Author(s):  
Ntwali Placide Nsengiyumva ◽  
Benjamin Mappin-Kasirer ◽  
Olivia Oxlade ◽  
Mayara Bastos ◽  
Anete Trajman ◽  
...  
Keyword(s):  
Digital Health ◽  
Cost Savings ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Potential Cost ◽  
Health Technologies ◽  
Life Years ◽  
Message Service ◽  
Latent Tb ◽  
Latent Tb Infection

Ensuring adherence and support during treatment of tuberculosis (TB) is a major public health challenge. Digital health technologies could help improve treatment outcomes. We considered their potential cost and impact on treatment for active or latent TB in Brazil.Decision analysis models simulated two adult cohorts with 1) drug-susceptible active TB, and 2) multidrug-resistant TB, and two cohorts treated with isoniazid for latent TB infection (LTBI): 1) close contacts of persons with active TB, and 2) others newly diagnosed with LTBI. We evaluated four digital support strategies: two different medication monitors, synchronous video-observed therapy (VOT), and two-way short message service (SMS). Comparators were standard directly observed treatment for active TB and self-administered treatment for LTBI. Projected outcomes included costs (2016 US dollars), plus active TB cases and disability-adjusted life years averted among persons with LTBI.For individuals with active TB, medication monitors and VOT are projected to lead to substantial (up to 58%) cost savings, in addition to alleviating inconvenience and cost to patients of supervised treatment visits. For LTBI treatment, SMS and medication monitors are projected to be the most cost-effective interventions. However, all projections are limited by the scarcity of published estimates of clinical effect for the digital technologies.

scholarly journals SAT0573 TUBERCULOSIS INFECTION IN MOROCCAN PATIENTS WITH RHEUMATIC DISEASES UNDER BIOLOGIC THERAPY: A MULTICENTER NATIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1245.2-1245
Author(s):  
I. Aachari ◽  
T. Latifa ◽  
T. Fatima Zahrae ◽  
S. Afilal ◽  
F. Safaa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rheumatic Diseases ◽  
Biologic Therapy ◽  
Demographic Characteristics ◽  
Tuberculosis Infection ◽  
Major Health Problem ◽  
Tnf Α ◽  
Latent Tb ◽  
Latent Tb Infection ◽  
Moroccan Patients

Background:Tuberculosis (TB) is a major health problem worldwide, occurring mainly in low income countries. Therefore, screening for latent TB infection (LTBI) before initiating biologic therapy is mandated by current guidelines.Objectives:The aim of this study was to evaluate the prevalence of tuberculosis infection (TB) in Moroccan patients with rheumatic diseases under biologic therapy, and to describe the demographic characteristics of these patients as well as to explore potential risk factors.Methods:This fourteen-year nationally representative multicenter study enrolled Moroccan patients with rheumatic diseases who had been treated with biologic therapy. Patient medical records were reviewed retrospectively for demographic characteristics, underlying rheumatic diseases, associated co-morbidities, and TB related data.Results:In total, 1407 eligible patients were studied; 31 cases with active TB were identified at an estimated prevalence rate of 2.3%. The mean age was 42.9±12 years and 75.8% were males. Ankylosing spondylitis (AS) accounted for 84.8% of active TB cases and the majority of cases (31/33) occurred among anti TNF-α users. A total of 8 out of 33 patients were positive at initial Latent TB infection (LTBI) screening by tuberculin skin test (TST) and/ or interferon gamma release assay (IGRA). Consumption of unpasteurized dairy products (odds ratio [OR], 34,841; 95% CI, 3,1-389,7; p=0,04), diabetes (OR, 38,468; 95% CI, 1,6-878,3; p=0,022), smoking (OR, 3,941; 95% CI, 1-159,9; p=0,047) and long biologic therapy duration (OR, 1,991; 95% CI, 1,4-16,3; p=0,001) were identified as risk factors for developing active TB.Conclusion:Moroccan patients with rheumatic diseases under anti TNF- α agents are at an increased TB risk especially when risk factors are present. Strict initial screening and regular monitoring of LTBI is recommended for patients living in high TB prevalence areas.Table 1.Risk factors by univariate and multivariate logistic regression.    Disclosure of Interests:None declared

scholarly journals High Latent TB Infection Rate and Associated Risk Factors in the Eastern China of Low TB Incidence

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0141511 ◽  
Author(s):  
Cheng Chen ◽  
Tao Zhu ◽  
Zhijian Wang ◽  
Hong Peng ◽  
Wen Kong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Eastern China ◽  
Latent Tb ◽  
Latent Tb Infection ◽  
Associated Risk Factors

scholarly journals Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Caroline Corbett ◽  
Aizat Kulzhabaeva ◽  
Tatjana Toichkina ◽  
Gulmira Kalmambetova ◽  
Sevim Ahmedov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Central Asia ◽  
Significant Risk ◽  
Contact Tracing ◽  
Smear Microscopy ◽  
Kyrgyz Republic ◽  
Latent Tb ◽  
Household Density ◽  
Latent Tb Infection

Abstract Background Effective active case finding (ACF) activities are essential for early identification of new cases of active tuberculosis (TB) and latent TB infection (LTBI). Accurate diagnostics as well as the ability to identify contacts at high risk of infection are essential for ACF, and have not been systematically reported from Central Asia. The objective was to implement a pilot ACF program to determine the prevalence and risk factors for LTBI and active TB among contacts of individuals with TB in Kyrgyz Republic using Quantiferon-TB Gold plus (QuantiFERON). Methods An enhanced ACF project in the Kyrgyz Republic was implemented in which close and household (home) contacts of TB patients from the Issyk-Kul Oblast TB Center were visited at home. QuantiFERON and the tuberculin skin test (TST) alongside clinical and bacteriological examination were used to identify LTBI and active TB cases among contacts. The association for QuantiFERON positivity and risk factors were analysed and compared to TST results. Results Implementation of ACF with QuantiFERON involved close collaboration with the national sanitary and epidemiological services (SES) and laboratories in the Kyrgyz Republic. From 67 index cases, 296 contacts were enrolled of whom 253 had QuantiFERON or TST results; of those 103 contacts had LTBI (positive TST or IGRA), and four (1.4%) active TB cases were detected. Index case smear microscopy (OR 1.76) and high household density (OR 1.97) were significant risk factors for QuantiFERON positivity for all contacts. When stratified by age, association with smear positivity disappeared for children below 15 years. TST was not associated with any risk factor. Conclusions This is the first time that ACF activities have been reported for Central Asia, and provide insight for implementation of effective ACF in the region. These ACF activities using QuantiFERON led to increase in the detection of LTBI and active cases, prior to patients seeking treatment. Household density should be taken into consideration as an important risk factor for the stratification of future ACF activities.

Comparison of Screening Procedures for Mycobacterium tuberculosis Infection Among Patients with Inflammatory Diseases

2009 ◽  
Vol 36 (9) ◽  
pp. 1876-1884 ◽  
Author(s):  
BOLETTE SOBORG ◽  
MORTEN RUHWALD ◽  
MERETE LUND HETLAND ◽  
SØREN JACOBSEN ◽  
AASE BENGAARD ANDERSEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mycobacterium Tuberculosis ◽  
Inflammatory Diseases ◽  
Interferon Γ ◽  
Mycobacterium Tuberculosis Infection ◽  
Tb Treatment ◽  
Latent Tb ◽  
Latent Tb Infection ◽  
High Degree

Objective.To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression.Methods.The interferon-γ response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests.Results.QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5–18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6–13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1–11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6–10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1–1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02–0.3, p = 0.002).Conclusion.The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.

Routine proteinuria monitoring for bevacizumab in patients with gynecologic malignancies

2016 ◽  
Vol 22 (6) ◽  
pp. 771-776 ◽  
Author(s):  
Catherine S Lee ◽  
Laura M Alwan ◽  
Xiaocui Sun ◽  
Katherine A McLean ◽  
Renata R Urban
Keyword(s):  
Risk Factors ◽  
Gynecologic Oncology ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Creatinine Ratio ◽  
Gynecologic Malignancies ◽  
Urine Protein ◽  
Potential Cost ◽  
Bevacizumab Treatment ◽  
Grade 3

Background Proteinuria leading to nephrotic syndrome is a rare adverse event arising from treatment with bevacizumab. There is limited evidence to guide the frequency and appropriate test for monitoring for proteinuria. The purpose of this study was to determine the prevalence and severity of proteinuria during bevacizumab administration to patients with gynecologic malignancies, and to evaluate risk factors associated with this toxicity; a secondary objective was to evaluate the cost of routine proteinuria monitoring to assess for opportunities of cost containment that could change clinical practice. Methods A retrospective chart review was performed at an academic gynecologic oncology clinic. Women over 18 years of age with a diagnosed gynecologic malignancy were evaluated for the development of proteinuria while receiving bevacizumab treatment as measured by a urine protein-to-creatinine ratio. Patient and disease-specific risk factors were evaluated using logistic regression to determine correlations of risk factors to development of proteinuria. Cost assessment was performed using institution-specific data for urine laboratory tests. Results Eighty-nine patients were identified, and the overall prevalence of proteinuria of any grade was 35%. The mean number of bevacizumab cycles was 13 (2–64 cycles). The majority of patients experienced grade 1 proteinuria (70%, 62 patients). Grade 3 proteinuria was observed in two patients (2%). There was a trend toward increased bevacizumab cycles associated with increased grade proteinuria ( p = 0.053), however there were no factors significantly associated with the development of proteinuria as measured by urine protein-to-creatinine ratio. Conclusion Monitoring of urine protein-to-creatinine ratios with each cycle may be unnecessary due to the low prevalence of grade 3 proteinuria observed. Additionally, urine protein-to-creatinine ratios may not provide adequate assessment of proteinuria toxicity associated with bevacizumab therapy. Potential cost savings opportunities for the institution can be realized with a cost-reductive monitoring algorithm that will utilize less costly laboratory techniques for patients at high risk of developing proteinuria.

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