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 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 PREDICTING THE RISK OF LOCAL TUBERCULOSIS IN CHILDREN WITH LATENT TUBERCULOSIS INFECTION

2021 ◽  
Vol 29 (4) ◽  
pp. 5-9
Author(s):  
O. I. Bilogortseva ◽  
◽  
Y. I. Dotsenko ◽  
O. Y. Sivachenko ◽  
L. V. Arefyeva ◽  
...  
Keyword(s):  
High Risk ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Diagnostic Methods ◽  
Tuberculosis Infection ◽  
Mantoux Test ◽  
Local Form ◽  
Additional Tool ◽  
Prognosis Model ◽  
Tuberculosis In Children

O. I. Bilogortseva, Y. I. Dotsenko, O. Y. Sivachenko, L. V. Arefyeva, V. V. Gorbenko, V. A. Ovsyanitskaya Abstract Children with LTBI represent a large risk group for reactivation of the tuberculosis process at any time. The available diagnostic methods do not answer the question regarding the risk of local TB formation in them. Aim: to present a model for predicting the risk of developing localized tuberculosis (TB) in children with latent tuberculosis infection (LTBI). Materials and methods: 275 children with LTBI and 116 children with newly diagnosed TB were examined. After ranking 57 clinical signs and risk factors, the most significant of them were identified and their diagnostic coefficients (DC) were determined. The essence of the model is to calculate DCs with further calculation of their sum, based on the numerical value of which it is possible to predict a low and high risk of developing a local form of TB in children with LTBI. Results: The effectiveness of the prognosis model was confirmed by the results of observation of 228 children with LTBI. Using this model, it is possible to predict the low and high risk of developing localized TB in children with LTBI. The values of the diagnostic coefficients can independently predict the course of LTBI in a child. Conclusions: The use of the proposed prognosis model increases the accuracy of predicting the risk of developing a local form of tuberculosis in children with latent tuberculosis infection by 29.4%, compared with the Mantoux test, and to determine the contingents that need additional examination, preventive treatment and dynamic observation by a pediatric phthisiatrician in order to prevent the progression of LTBI into active tuberculosis. In conditions of quarantine and limited access of patients to medical services, the proposed model for predicting the risk of developing localized TB in children with LTBI can serve as an additional tool in the practice of a pediatric phthisiatrician. Key words: children, latent tuberculosis infection, predicting the risk

scholarly journals Identifying components for programmatic latent tuberculosis infection control in the European Union

2016 ◽  
Vol 21 (34) ◽  
Author(s):  
Andreas Sandgren ◽  
Jannigje M Vonk Noordegraaf-Schouten ◽  
Anouk M Oordt-Speets ◽  
Gerarda B van Kessel ◽  
Sake J de Vlas ◽  
...  
Keyword(s):  
European Union ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Preventive Treatment ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
European Economic Area ◽  
The European Union ◽  
Political Commitment ◽  
Member States

Individuals with latent tuberculosis infection (LTBI) are the reservoir of Mycobacterium tuberculosis in a population and as long as this reservoir exists, elimination of tuberculosis (TB) will not be feasible. In 2013, the European Centre for Disease Prevention and Control (ECDC) started an assessment of benefits and risks of introducing programmatic LTBI control, with the aim of providing guidance on how to incorporate LTBI control into national TB strategies in European Union/European Economic Area (EU/EEA) Member States and candidate countries. In a first step, experts from the Member States, candidate countries, and international and national organisations were consulted on the components of programmatic LTBI control that should be considered and evaluated in literature reviews, mathematical models and cost-effectiveness studies. This was done through a questionnaire and two interactive discussion rounds. The main components identified were identification and targeting of risk groups, determinants of LTBI and progression to active TB, optimal diagnostic tests for LTBI, effective preventive treatment regimens, and to explore the potential for combining LTBI control with other health programmes. Political commitment, a solid healthcare infrastructure, and favourable economic situation in specific countries were identified as essential to facilitate the implementation of programmatic LTBI control.

scholarly journals Risk of developing tuberculosis disease among persons diagnosed with latent tuberculosis infection in the Netherlands

2016 ◽  
Vol 48 (5) ◽  
pp. 1420-1428 ◽  
Author(s):  
Connie G.M. Erkens ◽  
Erika Slump ◽  
Maurits Verhagen ◽  
Henrieke Schimmel ◽  
Frank Cobelens ◽  
...  
Keyword(s):  
The Netherlands ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Preventive Treatment ◽  
Risk Groups ◽  
Incidence Rates ◽  
Tuberculosis Infection ◽  
Foreign Born ◽  
Target Groups ◽  
Associated Risk Factors

Diagnosis and preventive treatment of latent tuberculosis infection (LTBI) among high-risk groups is recommended to achieve tuberculosis (TB) elimination in low-incidence countries.We studied TB incidence rates among those notified with LTBI in the Netherlands from 2005 to 2013 and analysed associated risk factors. We stratified analyses by target group for screening, and by initiation and completion of preventive treatment.The incidence for those completing, stopping and not receiving preventive treatment was 187, 436 and 355 per 100 000 person-years for contacts of TB patients, respectively, and 63, 96 and 110 per 100 000 person-years for other target groups. The rate ratio for TB development among contacts compared to other target groups was 3.1 (95% CI 2.0–4.9). In both groups, incidence was highest in the first year after diagnosis. Independent factors associated with progression to TB among contacts were age <5 years and stopping preventive treatment within 28 days compared to those not receiving preventive treatment. Among other target groups, being foreign born was the only risk factor associated with the risk of developing TB.We conclude that the epidemiological impact of preventive treatment is highest in contacts of TB patients and limited in other target groups for LTBI management in the Netherlands.

scholarly journals 938Identification of High Risk Healthcare Workers with Latent Tuberculosis Infection (LTBI) in an Inner City Healthcare System

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S273-S273
Author(s):  
Sorabh Dhar ◽  
Anupama Neelakanta ◽  
Jisha John ◽  
Russell Grimshaw ◽  
Jim Russell ◽  
...  
Keyword(s):  
High Risk ◽  
Inner City ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection

scholarly journals Latent tuberculosis infection and tuberculosis in children and adolescents

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Cassia Satsuki Ishikawa ◽  
Olivia Mari Matsuo ◽  
Flavio Sarno
Keyword(s):  
Computed Tomography ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Infection ◽  
Gastric Aspirate ◽  
X Ray ◽  
Qualitative Variables ◽  
Chest X Ray ◽  
Tuberculosis In Children

ABSTRACT Objective: To describe the characteristics of patients diagnosed with tuberculosis and latent tuberculosis infection. Methods: A retrospective study, between 2012 and 2015, with data from patients of Programa Einstein na Comunidade de Paraisópolis. To evaluate possible factors associated with patient's sex and diagnoses of tuberculosis and latent tuberculosis infection, χ2 or Fisher's exact tests were used for qualitative variables, and Mann-Whitney test for quantitative or ordinal qualitative variables. Results: A total of 77 patients were evaluated. Age ranged from 6 months to 13.4 years, with a majority of males (54.5%), aged zero to 4 years (54.5%), diagnosed with latent tuberculosis infection (64.9%), and classified as eutrophic (71.2%). The tuberculin test was positive in 92% and in most cases the values were above 10mm (68.0%). Approximately three-quarters of chest X-ray tests were normal (72.7%). After chest X-ray, computed tomography of thorax was the most ordered exam (29.9%), followed by smear and culture for Mycobacterium tuberculosis in the gastric aspirate (28.6%). The frequencies of altered chest X-ray (70.4% versus 4.0%), computed tomography of thorax requests (55.6% versus 16.0%) and other tests requested (81.5% versus 38.0%) were significantly higher in patients with a diagnosis of tuberculosis, relative to those with latent tuberculosis infection, respectively. Conclusion: In our sample, proportions of altered chest X-ray, and performing computed tomography of thorax and other tests in patients diagnosed with tuberculosis were higher than in those with latent tuberculosis infection.

scholarly journals Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand

2020 ◽  
Vol 17 (18) ◽  
pp. 6876
Author(s):  
Patimaporn Chanpho ◽  
Naesinee Chaiear ◽  
Supot Kamsa-ard
Keyword(s):  
High Risk ◽  
Latent Tuberculosis Infection ◽  
Conditional Logistic Regression ◽  
Critical Role ◽  
Latent Tuberculosis ◽  
Tertiary Hospital ◽  
Tuberculosis Infection ◽  
P Value ◽  
Factors Associated ◽  
Northeastern Thailand

Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB—94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (p-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01–3.58, p = 0.041); among HCWs performing AGPs (crude OR = 2.04, 95% CI: 1.20, 3.48, p = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50–4.47, p = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04–3.20, p = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65–5.36, p = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, p = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGPs and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role.

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.

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