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

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.

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Change in the Prevalence of Testing for Latent Tuberculosis Infection in the United States: 1999–2012

Canadian Respiratory Journal ◽

10.1155/2016/1850879 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Nicholas T. Vozoris ◽

Jane Batt

Keyword(s):

United States ◽

Hispanic Americans ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

The United States ◽

Tuberculosis Infection ◽

Vulnerable Groups ◽

Interferon Gamma Release Assay ◽

The Us ◽

Ltbi Testing

Purpose. There is no information on the change in prevalence of latent tuberculosis infection (LTBI) testing in the United States (US) following the introduction of the interferon gamma release assay (IGRA), a new and alternative diagnostic method for LTBI. The purpose of this study was to evaluate potential changes in the prevalence of LTBI testing in the US following the introduction of IGRA.Methods. This was a multiyear cross-sectional study using nationally representative data from the 1999-2000 and 2011-2012 US National Health and Nutrition Examination Surveys. Self-reported prevalence of LTBI testing was estimated among groups known to have increased LTBI risk. Descriptive statistics were used.Results. Compared to 1999-2000, significantly fewer individuals self-reported being tested for LTBI in 2011-2012 among Hispanic Americans (68.0% versus 60.7%,p<0.0001) and among those with comorbidities (74.7% versus 72.0%,p=0.02). There were also nonsignificant trends towards less self-reported LTBI testing in 2011-2012 versus 1999-2000 among household contacts of active TB cases, foreign-born individuals, and African Americans.Conclusions. Despite the introduction of IGRA, LTBI testing occurs less frequently in the US among vulnerable groups. Possibly inadequate targeted LTBI testing could result in increased active TB in the US in the future.

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PRS27 A Systematic Review on the Impact of Digital Health Technologies in Latent Tuberculosis Infection Management

Value in Health ◽

10.1016/j.jval.2021.04.1091 ◽

2021 ◽

Vol 24 ◽

pp. S217-S218

Author(s):

Y.J. Wong ◽

K.Y. Ng ◽

S. Lee

Keyword(s):

Systematic Review ◽

Latent Tuberculosis Infection ◽

Digital Health ◽

Latent Tuberculosis ◽

Tuberculosis Infection ◽

Health Technologies ◽

Infection Management ◽

The Impact

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Use of a scoring strategy to determine clinical risk of progression and risk group-specific treatment adherence in subjects with latent tuberculosis infection

10.1101/207852 ◽

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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COVID-19 and BCG vaccine: is there a link?

Russian Journal of Infection and Immunity ◽

10.15789/2220-7619-cab-1472 ◽

2020 ◽

Vol 10 (3) ◽

pp. 459-468

Author(s):

I. V. Lyadova ◽

A. A. Starikov

Keyword(s):

Clinical Trials ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Risk Groups ◽

Bcg Vaccine ◽

Tuberculosis Infection ◽

Antiviral Immune Response ◽

Epidemiological Modeling ◽

Bcg Vaccination ◽

The Impact

The spread of the novel coronavirus infection (COVID-19) makes the search for new approaches to prevent the infection of great importance. As one of the relevant approaches, the vaccination of risk groups with BCG vaccine has recently been suggested. BCG (Mycobacterium bovis, Bacillus Calmette–Guérin) is a live vaccine for tuberculosis, which is used in many countries with a high tuberculosis prevalence and helps preventing childhood tuberculosis, primarily, military disease and tuberculosis meningitis. Whether BCG may be used to increase the protection against COVID-19 is currently a question of debates. The review considers scientific background underlying possible impact of BCG in increased protection against COVID-19. BCG is able of inducing the heterologous and trained immunity, and its capacity to stimulate antiviral immune response has been demonstrated in experimental animals and humans. Our comparison of the dynamics of COVID-19 morbidity and mortality in countries with different BCG vaccination policies has demonstrated a milder course of COVID-19 (i.e., a slower increase in disease cases and mortality) in countries where BCG vaccination is mandatory for all children. However, an association between BCG vaccination and a milder COVID-19 course is not obligatory direct. Other factors that may affect the association, such as the level of virus testing, the rigidity and the speed of quarantine implementation and others are discussed. An important argument against a role of BCG in the protection against COVID-19 is that BCG is given in childhood and may hardly induce long-lasting immunity. Because mandatory BCG vaccination is implemented in countries with high TB burden and because in these countries latent tuberculosis infection is widely spread, we suggest a hypothesis that latent tuberculosis infection may contribute to the maintenance of heterologous/trained antiviral immunity in countries with mandatory BCG vaccination. Four countries have recently initiated clinical trials to investigate whether BCG vaccination can increase the level of protection against COVID-19 in risk groups. The results of these studies, as well as COVID-19 epidemiological modeling will help understanding the impact of BCG in the level of the protection against COVID-19. Performing analogous clinical trials in Russia seems appropriate and scientifically sound.

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