Improving Treatment Completion Rates for Latent Tuberculosis Infection: A Review of Two Treatment Regimens at a Community Health Center

2015 ◽  
Vol 26 (4) ◽  
pp. 1428-1439 ◽  
Author(s):  
Gregory Lines ◽  
Paul Hunter ◽  
Sarah Bleything
Keyword(s):  
Community Health ◽  
Health Center ◽  
Latent Tuberculosis Infection ◽  
Community Health Center ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Tuberculosis Infection ◽  
Completion Rates ◽  
Treatment Regimens

scholarly journals 795. Review of Treatment of Latent Tuberculosis Infection at VA Portland Healthcare System

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S286-S286
Author(s):  
Teena Xu ◽  
Graeme N Forrest
Keyword(s):  
Adverse Events ◽  
Latent Tuberculosis Infection ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Completion Rate ◽  
Tuberculosis Infection ◽  
Tuberculin Skin Testing ◽  
Completion Rates ◽  
Directly Observed Therapy

Abstract Background Treatment of latent tuberculosis infection (LTBI) is important for tuberculosis elimination in low-incidence countries. Currently, the VA Portland Health Care System (VAPORHCS) offers both 3HP (12-dose rifapentine plus isoniazid directly observed therapy (DOT)) and 9H (9-month daily isoniazid) for treatment of LTBI. Majority of veterans are treated with 9H despite increasing evidence showing higher rates of completion with 3HP. We reviewed the rates of completion and adverse events (AE) between veterans treated with 3HP and 9H. Methods We performed a retrospective chart review on all patients within the VAPORHCS who initiated LTBI treatment with 9H or 3HP between January 2011 and December 2016. LTBI was diagnosed through tuberculin skin testing or interferon-γ release assay. 9H treatment was self administered while 3HP was under DOT. Collected data included demographics, co-morbid conditions, immunosuppression, treatment completion, and AE. Treatment completion was determined through chart documentation. Results A total of 93 patients were treated for LTBI. Most patients were white (71%) and male (86%). The median age was 57 years old. Seventy-two patients (77%) were treated with 9H, and 21 (23%) were treated with 3HP. The overall completion rate was 86%. Completion rates between 9H (91%) and 3HP (86%) were not significantly different (P = 0.46). Twenty-three patients (31.9%) on 9H and six patients (28.6%) on 3HP were on chronic immunosuppression with TNF inhibitors and/or corticosteroids (P = 0.78) with an overall completion rate of 86%. Nine patients (13%) on 9H and two patients (10%) on 3HP had HIV (P = 0.95). Overall rates of AEs were similar between the groups (4%, 14%, P = 0.11), including hepatotoxicity (2%, 0%, P = 0.57) and neurotoxicity (4%, 5%, P = 0.94). Conclusion The overall treatment completion rates were high and statistically similar between 9H and 3HP groups, even with immunosuppressive therapy. There were no significant differences in rates of adverse events. While the majority of patients were treated with 9H, these results suggest an opportunity for more use of the 3HP, possibly without the need for DOT regimen going forward. 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 Initiation and completion rates for latent tuberculosis infection treatment: a systematic review

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Andreas Sandgren ◽  
Marije Vonk Noordegraaf-Schouten ◽  
Femke van Kessel ◽  
Anke Stuurman ◽  
Anouk Oordt-Speets ◽  
...  
Keyword(s):  
Systematic Review ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Completion Rates ◽  
Infection Treatment

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 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.

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