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< 0.01) during COVID-19. There was a decrease in the proportion of immigrants as indication for LTBI testing (30% vs. 9%; p< 0.01), and an increase in LTBI diagnoses based on interferon-gamma release assay (IGRA; 30% vs. 49%; p< 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 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 Enhancing the public health impact of latent tuberculosis infection diagnosis and treatment (ACT4): protocol for a cluster randomised trial

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025831 ◽  
Author(s):  
Olivia Oxlade ◽  
Anete Trajman ◽  
Andrea Benedetti ◽  
Mênonli Adjobimey ◽  
Victoria J Cook ◽  
...  
Keyword(s):  
Public Health ◽  
Randomised Trial ◽  
Latent Tuberculosis ◽  
Health Facilities ◽  
Cluster Randomised Trial ◽  
Primary Study ◽  
Newly Diagnosed ◽  
Ltbi Treatment ◽  
Cluster Randomised ◽  
Cascade Of Care

IntroductionTreatment of latent tuberculosis (TB) infection (LTBI) is an important component of the End-TB strategy. However, the number of individuals who successfully complete LTBI treatment remains low as there are losses at all steps in the LTBI ‘cascade-of-care’. The reasons for these losses are variable and highly dependent on the setting. We have planned a trial of a standardised public health approach to strengthen the management of household contacts (HHCs) of newly diagnosed patients with pulmonary TB. Assessing costs related to approach is a secondary objective of the study.Methods and analysisA cluster randomised trial will be conducted in 24 randomisation units (health facilities or groups of health facilities) in five countries. In Phase 1, at intervention sites, we will conduct a standardised assessment of the current LTBI programme, with a focus on cascade-of-care endpoints. Standardised open-ended questionnaires on practices, knowledge, attitudes and beliefs regarding TB prevention are then administered to key patient groups and healthcare workers. At each site, local stake-holders will review study findings and select solutions based on their acceptability, cost and effectiveness. In Phase 2, intervention clinics will implement the selected solutions, along with contact measurement registries and regular in-service LTBI management training. Control sites will continue their usual LTBI care with no explicit evaluation, strengthening or training activities. The primary study outcome is the number of HHC initiating LTBI treatment per newly diagnosed active TB patient, within 3 months of diagnosis of the index patient. An intention-to-treat analysis will be performed, using a Poisson regression approach.Ethics and disseminationEthics approval from the MUHC ethical review board (ERB) was obtained in November 2015. During the study standardised tools will be developed and made publicly available. Key study findings and novel methodologic contributions will be detailed in publications and other dissemination activities.Trial registration numberNCT02810678; Pre-Results.

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 < .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 < .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 The latent tuberculosis infection cascade of care in Iqaluit, Nunavut, 2012–2016

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Christopher Pease ◽  
Alice Zwerling ◽  
Ranjeeta Mallick ◽  
Mike Patterson ◽  
Patricia Demaio ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Multivariable Analysis ◽  
Latent Tuberculosis ◽  
Arctic Region ◽  
Older Age ◽  
Tuberculosis Infection ◽  
Older Individuals ◽  
Ltbi Treatment ◽  
Employment Screening ◽  
Cascade Of Care

Abstract Background A remote arctic region of Canada predominantly populated by Inuit with the country’s highest incidence of tuberculosis. Methods The study was undertaken to describe the latent tuberculosis infection (LTBI) cascade of care and identify factors associated with non-initiation and non-completion of LTBI treatment. Data were extracted retrospectively from medical records for all patients with a tuberculin skin test (TST) implanted in Iqaluit, Nunavut between January 2012 and March 2016. Associations between demographic and clinical factors and both treatment non-initiation among and treatment non-completion were identified using log binomial regression models where convergence could be obtained and Poisson models with robust error variance where convergence was not obtained. Results Of 2303 patients tested, 439 (19.1%) were diagnosed with LTBI. Treatment was offered to 328 patients, was initiated by 246 (75.0% of those offered) and was completed by 186 (75.6% of initiators). In multivariable analysis, older age (adjust risk ratio [aRR] 1.17 per 5-year increase, 95%CI:1.09–1.26) and undergoing TST due to employment screening (aRR 1.63, 95%CI:1.00–2.65, compared to following tuberculosis exposure) were associated with increased non-initiation of treatment. Older age (aRR 1.13, 95%CI: 1.03–1.17, per 5-year increase) was associated with increased non-completion of treatment. Conclusions A similar rate of treatment initiation and higher rate of treatment completion were found compared to previous North American studies. Interventions targeting older individuals and those identified via employment screening may be considered to help to address the largest losses in the cascade of care.

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.

Evaluation of 3 Months of Once-Weekly Rifapentine and Isoniazid for Latent Tuberculosis Infection

2019 ◽  
Vol 54 (5) ◽  
pp. 457-463
Author(s):  
Ramara E. Walker ◽  
Stephanie Bass ◽  
Pavithra Srinivas ◽  
Cyndee Miranda ◽  
Lucileia Johnson ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Cleveland Clinic ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
High Rate ◽  
Completion Rates ◽  
Directly Observed Therapy ◽  
Ltbi Treatment ◽  
Control And Prevention ◽  
Low Incidence

Background: Centers for Disease Control and Prevention recommends 3 months of once-weekly rifapentine/isoniazid (3HP) for latent tuberculosis infection (LTBI) treatment given by directly observed therapy (DOT) or self-administered therapy (SAT) in patients ≥2 years old. 3HP has been associated with increased incidence of hepatic, gastrointestinal, flu-like, and cutaneous adverse drug reactions (ADRs) compared with isoniazid monotherapy. Objective: This study evaluated 3HP completion rates and tolerability for LTBI treatment in a real-world setting. Methods: A single-center retrospective cohort with a nested case-control study, comparing patients experiencing ADRs with those who did not, evaluated patients ≥18 years old receiving 3HP by DOT or SAT for LTBI at Cleveland Clinic from October 2011 through July 2018. Information on baseline characteristics, 3HP administrations, and ADRs were collected. Results: Of 199 patients screened, 144 were included (111 DOT, 33 SAT). 3HP completion rates were high at 82.6% and similar between DOT and SAT groups. During treatment, 92/144 (63.9%) patients experienced any ADR. The most common ADR included flu-like symptoms (38.2%) and gastrointestinal (31.9%) and hepatic (2.1%) reactions. Despite high rate of overall ADRs, rates of significant ADRs (grade 2 or higher) were 4.2%. Overall, 9% of patients discontinued 3HP because of ADRs. After adjusting for other factors associated with ADRs at baseline, SAT was not associated with increased incidence of ADRs, but female sex was a significant predictor (odds ratio = 2.61 [95% CI, 1.23 to 5.56]). Conclusion and Relevance: This study observed high 3HP treatment completion rates, low incidence of significant ADRs, and low discontinuation rates resulting from ADRs.

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