Latent TB Infection Treatment Acceptance and Completion in the United States and Canada

Horsburgh, C. Robert; Goldberg, Stefan; Bethel, James; Chen, Shande; Colson, Paul W.; Hirsch‐Moverman, Yael; Hughes, Stephen; Shrestha-Kuwahara, Robin; Sterling, Timothy R.; Wall, Kirsten; Weinfurter, Paul

doi:10.1378/chest.09-0394

Cited by 190 publications

(183 citation statements)

References 21 publications

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“…7 In 32 US and Canadian clinics that performed skin testing and offered treatment, of 720 infected patients, 123 (17.1%) declined initiation of treatment; employees at a health-care facility were more likely to refuse treatment, whereas contacts of a case of TB were less likely to decline. 13 Results indicate that usual completion rates obtained in the field leave much to be desired and are considerably lower than the objective of 80% established by the Canadian Tuberculosis Standards. daily INH for one year provided 93% protection, and daily INH for six months provided 69% protection.…”

Section: Discussionmentioning

confidence: 84%

“…In one retrospective cross-sectional study of 68 clinics in 19 regions in the United States and Canada, only 57.1% of patients who had been prescribed nine months of INH treatment had taken it for at least six months. 13 In a study that used RAMQ data to assess adverse effects associated with LTBI treatment from 1998 to 2003, 54.1% of patients had completed six months of INH treatment; in this study, 56.2% of patients had completed four months of RMP treatment.…”

Section: Discussionmentioning

confidence: 85%

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Completion Rates of Treatment for Latent Tuberculosis Infection in Quebec, Canada From 2006 to 2010

Rivest

Street

Allard

2013

Can J Public Health

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 85%

Completion Rates of Treatment for Latent Tuberculosis Infection in Quebec, Canada From 2006 to 2010

Rivest

Street

Allard

2013

Can J Public Health

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“…In contrast, the present study was performed after a period of 50 years of effective TB chemotherapy. Thus, it is likely that there were few persons in the current study sample of persons with LTBI who had old healed but untreated TB; a recent national survey showed that only 1.4% of persons with LTBI in the United States and Canada have old healed TB (27). Although molecular tools to accurately differentiate primary from reactivation TB were not available in 1964, Grzybowski and Allen noted that among cases of presumed reactivation TB in their study, 46% were seen in persons known to have previously had old, healed, but untreated disease (13).…”

Section: Discussionmentioning

confidence: 95%

Revisiting Rates of Reactivation Tuberculosis

Horsburgh¹,

O’Donnell²,

Chamblee³

et al. 2010

Am J Respir Crit Care Med

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131

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Rationale: Reactivation tuberculosis (TB) occurs as a result of reactivation of latent TB infection (LTBI), and was reported to occur in the United States at a rate of 0.10 to 0.16 cases per 100 person-years in the 1950s; it has not been measured since. Objectives: To calculate the rate of reactivation TB in a U.S. community. Methods: A population-based tuberculin skin test survey for LTBI was performed in western Palm Beach County, Florida, from 1998 to 2000 along with a cluster analysis of TB case isolates in the same area from 1997 to 2001. Reactivation (unclustered) TB was presumed to have arisen from the population with LTBI. Measurements and Main Results: The rate of reactivation TB among persons with LTBI without HIV infection was 0.040 cases per 100 person-years (95% confidence interval ½CI, 0.024-0.067) using the n method and 0.058 cases per 100 person-years (95% CI, 0.038-0.089) using the n-1 method. HIV infection was the strongest risk factor for reactivation (rate ratio ½RR, 57; 95% CI, 27-120; P , 0.001). Among persons without HIV infection, reactivation was increased among those older than 50 years (RR, 3.8; 95% CI, 1.3-11) and among those born in the United States (RR, 3.2; 95% CI, 1.1-9.3). Conclusions: Rates of reactivation TB in this area have declined substantially since the 1950s. The greatest part of this decline may be attributed to the disappearance of old, healed TB in the population. If similar declines are seen in other areas of the United States, the cost-effectiveness of screening and treatment of LTBI may be substantially less than previously estimated.

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“…In a study in the USA and Canada, 17% of those who were offered treatment for LTBI declined to accept it. The study found that among healthcare workers, 52% rejected treatment [4]. Another American study also showed poor uptake of treatment for LTBI among healthcare workers, possibly suggesting that they might have some doubts about whether treatment of LTBI is beneficial to them personally [5].…”

Section: Introductionmentioning

confidence: 97%

Benefit of treatment of latent tuberculosis infection in individual patients

2015

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We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an individual.A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients.LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100 000 to 93/100 000 for females aged 10-75 years and 15/100 000 to 119/100 000 for males aged 10-75 years; the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels.LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit. @ERSpublications Personalised analysis showed that most people with latent tuberculosis infection benefit from preventive treatment

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Latent TB Infection Treatment Acceptance and Completion in the United States and Canada

Cited by 190 publications

References 21 publications

Completion Rates of Treatment for Latent Tuberculosis Infection in Quebec, Canada From 2006 to 2010

Completion Rates of Treatment for Latent Tuberculosis Infection in Quebec, Canada From 2006 to 2010

Revisiting Rates of Reactivation Tuberculosis

Benefit of treatment of latent tuberculosis infection in individual patients

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