S147 Yield and cost of screening for active and latent tuberculosis among high-risk groups attending london emergency departments

2018 ◽  
Author(s):  
RK Gupta ◽  
L Gosce ◽  
N Green ◽  
J Southern ◽  
M Lipman ◽  
...  
Keyword(s):  
High Risk ◽  
Emergency Departments ◽  
Latent Tuberculosis ◽  
Risk Groups

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 Negative latent tuberculosis at time of incarceration: identifying a very high-risk group for infection

2017 ◽  
Vol 145 (12) ◽  
pp. 2491-2499 ◽  
Author(s):  
L. ARROYAVE ◽  
Y. KEYNAN ◽  
L. LÓPEZ ◽  
D. MARIN ◽  
M. P. ARBELÁEZ ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Latent Tuberculosis ◽  
Risk Groups ◽  
High Risk Group ◽  
World Health ◽  
Formerly Incarcerated ◽  
Adjusted Risk ◽  
Number Needed To Screen ◽  
Health Organization

SUMMARYThe main aim was to measure the incidence of latent tuberculosis infection (LTBI) and identify risk factors associated with infection. In addition, we determined the number needed to screen (NNS) to identify LTBI and active tuberculosis. We followed 129 prisoners for 2 years following a negative two-step tuberculin skin test (TST). The cumulative incidence of TST conversion over 2 years was 29·5% (38/129), among the new TST converters, nine developed active TB. Among persons with no evidence of LTBI, the NNS to identify a LTBI case was 3·4 and an active TB case was 14·3. The adjusted risk factors for LTBI conversion were incarceration in prison number 1, being formerly incarcerated, and overweight. In conclusion, prisoners have higher risk of LTBI acquisition compared with high-risk groups, such as HIV-infected individuals and children for whom LTBI testing should be performed according to World Health Organization guidance. The high conversion rate is associated with high incidence of active TB disease, and therefore we recommend mandatory LTBI screening at the time of prison entry. Individuals with a negative TST at the time of entry to prison are at high risk of acquiring infection, and should therefore be followed in order to detect convertors and offer LTBI treatment. This approach has a very low NNS for each identified case, and it can be utilized to decrease development of active TB disease and transmission.

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 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.

scholarly journals Fourth-Generation QuantiFERON-TB Gold Plus: What Is the Evidence?

2020 ◽  
Vol 58 (9) ◽  
Author(s):  
Arena Shafeque ◽  
Jacob Bigio ◽  
Catherine A. Hogan ◽  
Madhukar Pai ◽  
Niaz Banaei
Keyword(s):  
T Cells ◽  
High Risk ◽  
Latent Tuberculosis ◽  
Risk Groups ◽  
Low Risk ◽  
T Cell Subsets ◽  
Superior Performance ◽  
Fourth Generation ◽  
The Difference ◽  
Immunocompromised Hosts

ABSTRACT QuantiFERON-TB Gold Plus (QFT-Plus) is the latest generation of interferon gamma release assays (IGRAs) to receive approval from the U.S. FDA, replacing its predecessor, QuantiFERON-TB Gold In-Tube (QFT-GIT). The novelty of QFT-Plus is that it elicits a response from CD8 T cells, in addition to CD4 T cells, thus collecting a broader response from T-cell subsets than QFT-GIT. It was developed with the aim to improve the detection of latent tuberculosis infection (LTBI), especially among recently exposed contacts, immunocompromised hosts, and young children. In this minireview, we summarize the performance of QFT-Plus compared with that of QFT-GIT among active tuberculosis (TB) patients (a surrogate for LTBI patients), high-risk populations, and low-risk individuals based on recent publications. Studies comparing QFT-Plus to QFT-GIT currently do not support the superior performance of QFT-Plus in individuals with active TB and LTBI. The difference in sensitivity between QFT-Plus and QFT-GIT in active TB patients was not significant in nearly all studies and ranged from −4.0 to 2.0%. Among high-risk groups, the agreement between QFT-Plus and QFT-GIT was 89.9 to 96.0% (kappa coefficient range, 0.80 to 0.91). The specificity in the low-risk population was slightly lower for QFT-Plus than for QFT-GIT, with the difference ranging from −7.4 to 0%. Further studies are needed to accurately evaluate the sensitivity of QFT-Plus in immunocompromised hosts and children. In addition, further evidence is required to validate a modified interpretation of QFT-Plus for the identification of false-positive results in low-risk health care workers.

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