Missed opportunities to prevent tuberculosis in foreign-born persons, Connecticut, 2005–2008

A, Guh; Sosa, Lynn; Jl, Hadler; Mn, Lobato

doi:10.5588/ijtld.10.0518

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…Nearly one-third of foreignborn persons with skin tests placed and read had a positive TST result, and initiation and treatment rates were highest among this group. This is consistent with national data highlighting the very high TB risk among foreign-born persons and strongly suggests that this population target will likely maximize the number of cases prevented for the resources invested (9,23,41,42).…”

Section: Discussionsupporting

confidence: 87%

Moving toward Tuberculosis Elimination

Cain

Garman

Laserson³

et al. 2012

Am J Respir Crit Care Med

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Section: Discussionsupporting

confidence: 87%

Moving toward Tuberculosis Elimination

Cain

Garman

Laserson³

et al. 2012

Am J Respir Crit Care Med

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“…[3] Though directly observed therapy (DOT) is the standard of care for treating active TB, adherence to treatment and completion rates for LTBI remain low, particularly for medically and socially vulnerable patient populations and for newly arrived immigrants. [4],[5] With a 10% lifetime reactivation risk of progression to active TB, and with most active TB cases occurring in foreign-born populations within five years after arrival to the US,[6] it is imperative to maintain effective LTBI testing and treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Latent Tuberculosis Infection: Screening and Treatment in an Urban Setting

et al. 2013

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Background Despite its benefit for treating active tuberculosis, directly observed therapy (DOT) for latent tuberculosis infection (LTBI) has been largely understudied among challenging inner city populations. Methods Utilizing questionnaire data from a comprehensive mobile healthcare clinic in New Haven, CT from 2003 to July 2011, a total of 2523 completed tuberculin skin tests (TST’s) resulted in 357 new LTBIs. Multivariate logistic regression correlated covariates of the two outcomes 1) initiation of isoniazid preventative therapy (IPT) and 2) completion of 9-months IPT. Results Of 357 new LTBIs, 86.3% (n=308) completed screening CXRs: 90.3% (n=278) were normal and 0.3% (n=1) with active tuberculosis. Of those completing CXR screening, 44.0% (n=135) agreed to IPT: 69.6% (n=94) selected DOT, and 30.4% (n=41) selected SAT. Initiating IPT was correlated with undocumented status (AOR=3.43; p<0.001) and being born in a country of highest and third highest tuberculosis prevalence (AOR=14.09; p=0.017 and AOR=2.25; p=0.005, respectively). Those selecting DOT were more likely to be Hispanic (83.0% vs 53.7%; p<0.0001), undocumented (57.4% vs 41.5%; p=0.012), have stable housing (p=0.002), employed (p<0.0001), uninsured (p=0.014), no prior cocaine or crack use (p=0.013) and no recent incarceration (p=0.001). Completing 9-months of IPT was correlated with no recent incarceration (AOR 5.95; p=0.036) and younger age (AOR 1.03; p=0.031). SAT and DOT participants did not significantly differ for IPT duration (6.54 vs 5.68 months; p=0.216) nor 9-month completion (59.8% vs 46.3%; p=0.155). Conclusions In an urban mobile healthcare sample, screening completion for LTBI was high with nearly half initiating IPT. Undocumented, Hispanic immigrants from high prevalence tuberculosis countries were more likely to self-select DOT at the mobile outreach clinic, potentially because of more culturally, linguistically, and logistically accessible services and self-selection optimization phenomena (SSOP). Within a diverse, urban environment, DOT and SAT IPT models for LTBI treatment resulted in similar outcomes, yet outcomes were hampered by differential measurement bias between DOT and SAT participants.

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“…15 Providers should not assume that latent TB infection has been assessed or adequately treated earlier in life, and should continue to assess TB exposure during patient encounters. 1,13,22 US-born children diagnosed with TB are younger than foreign-born patients, reflecting high TB rates among young children. 15 Similar to national surveillance for all US-born patients with TB, 2 pediatric patients with TB with only USborn parents are predominantly black (43%).…”

Section: International Residence History Among Pediatric Patients Witmentioning

confidence: 99%

Pediatric and Adolescent Tuberculosis in the United States, 2008–2010

Winston

Menzies

2012

Pediatrics

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OBJECTIVE: We examined heterogeneity among children and adolescents diagnosed with tuberculosis (TB) in the United States, and we investigated potential international TB exposure risk. METHODS: We analyzed demographic and clinical characteristics by origin of birth for persons <18 years with verified case of incident TB disease reported to National TB Surveillance System from 2008 to 2010. We describe newly available data on parent or guardian countries of origin and history of having lived internationally for pediatric patients with TB (<15 years of age). RESULTS: Of 2660 children and adolescents diagnosed with TB during 2008–2010, 822 (31%) were foreign-born; Mexico was the most frequently reported country of foreign birth. Over half (52%) of foreign-born patients diagnosed with TB were adolescents aged 13 to 17 years who had lived in the United States on average >3 years before TB diagnosis. Foreign-born pediatric patients with foreign-born parents were older (mean, 7.8 years) than foreign-born patients with US-born parents (4.2 years) or US-born patients (3.6 years). Among US-born pediatric patients, 66% had at least 1 foreign-born parent, which is >3 times the proportion in the general population. Only 25% of pediatric patients with TB diagnosed in the United States had no known international connection through family or residence history. CONCLUSIONS: Three-quarters of pediatric patients with TB in the United States have potential TB exposures through foreign-born parents or residence outside the United States. Missed opportunities to prevent TB disease may occur if clinicians fail to assess all potential TB exposures during routine clinic visits.

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Missed opportunities to prevent tuberculosis in foreign-born persons, Connecticut, 2005–2008

Cited by 10 publications

References 4 publications

Moving toward Tuberculosis Elimination

Moving toward Tuberculosis Elimination

Latent Tuberculosis Infection: Screening and Treatment in an Urban Setting

Pediatric and Adolescent Tuberculosis in the United States, 2008–2010

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