Physicians' attitudes towards self-treatment of latent tuberculosis [Short communication]

Bhanot, Nitin; Haran, Mehandi; Lodha, Ankur; Paul, Vishesh; Goswami, Raktima; Chapnick, Edward K.

doi:10.5588/ijtld.11.0232

Cited by 8 publications

(19 citation statements)

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“…This behaviour was similar to that in a previous survey [6], in which compliance was even lower, with only about 25% of physicians who were indicated for LTBI treatment completing it.…”

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confidence: 70%

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Factors influencing tuberculosis screening in healthcare workers in Portugal

2014

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Although the incidence of tuberculosis (TB) has increased in healthcare workers (HCWs) [1][2][3], several studies have shown that HCWs are not compliant with screening and/or preventive measures [4][5][6][7]. For example, a Portuguese study found that the estimated TB incidence was three-to seven-fold higher in HCWs than in the general population [8]. Latent TB infection (LTBI) diagnosis and treatment constitute the core of TB elimination, integrating the post-2015 strategies of the World Health Organization [9,10].To evaluate TB screening practices among HCWs and their reasons for nonadherence in Portugal, we developed a survey and distributed it to nurses and physicians from December 25, 2012 to January 31, 2013, closing when we received fewer than one response per day. The survey was anonymous, voluntary and digitally distributed through our network of contacts using a "snowball" distribution method where volunteers subsequently distribute the questionnaire to their contacts and so forth.Continuous data are presented as mean±SD and compared using t-tests. Categorical data are presented as n (%) and compared using the Chi-squared or Fisher's test, as appropriate. Multiple logistic regression analysis was used to identify statistically significant determinants of TB infection, exposure and screening. Crude and adjusted odds ratios and 95% confidence intervals were determined. Goodness-of-fit of the models was evaluated; comparisons with the null model used the difference of deviances, as determined by Chi-squared tests, while comparisons with the saturated model used the difference of deviances, determined using the Chi-squared or Hosmer-Lemeshow test, as appropriate. The area under the receiver operating characteristic (ROC) curve was calculated for each model. All statistical analyses were performed using the R language and software, version 2.12.1 [11]. The level of significance was fixed at 0.05.In Portugal, in 2008, there were 38 932 physicians and 56 859 nurses registered by their respective boards [12].We obtained 2414 responses, of which 399 did not meet the inclusion criteria. Thus, responses from 2015 subjects were analysed; table 1 summarises the results. Of these subjects, 1540 (76.4%) were females and 1133 (56.2%) nurses. Subjects were aged 18-73 years (mean±SD 39.02±10.60 years). 44 (2.2%) subjects had a history of TB (20 before beginning professional activity).

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“…This behaviour was similar to that in a previous survey [6], in which compliance was even lower, with only about 25% of physicians who were indicated for LTBI treatment completing it.…”

supporting

confidence: 70%

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…”

mentioning

confidence: 99%

Factors influencing tuberculosis screening in healthcare workers in Portugal

2014

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“…Physicians seem to be sceptical about taking treatment for LTBI. A US study showing that only 25% of physicians with evidence of LTBI had actually received treatment for LTBI [36]. It is possible that physicians’ reluctance to accept treatment of LTBI themselves is the reason for the decreased likelihood that they will offer this treatment to other health care workers.…”

Section: Discussionmentioning

confidence: 99%

What Patient Factors Predict Physicians’ Decision Not to Treat Latent Tuberculosis Infection in Tuberculosis Contacts?

2013

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ObjectiveThe study aimed to determine factors that are associated with physicians’ decision to offer treatment for latent tuberculosis infection (LTBI) in contacts of patients with tuberculosis.MethodsWe performed a nested case-control study in a cohort of contacts of patients with pulmonary tuberculosis who had a tuberculin skin test (TST) ≥ 10 mm. Cases were those who were offered treatment for LTBI. Controls were randomly selected from those who were not offered treatment for LTBI by the reviewing physician. Odds ratios were estimated by multivariate logistic regression.ResultsThere were 195 cases and 279 controls. The following factors were significantly (positively or negatively) associated with being offered LTBI treatment in the multivariate analysis: female gender (OR 2.9; 95% CI 1.6–5.5), TST conversion (OR 3.9; 2.0–7.9), TST > 20 mm (OR 4.1; 1.8–9.1, for TST of 21–30 mm and OR 7.9; 2.6–23.8, for TST >30 mm), sputum smear positive index case (OR 12.7; 4.5–36.1), being overseas-born and immigration more than 2 years ago (OR 0.1; 0.06–0.3), being a health care worker (OR 0.2; 0.1–0.6), being a non-household contact of the TB index case (OR 0.3; 0.2–0.6) and age >35 years (OR 0.2; 0.1–0.5 for age 35 to 54.9 years and OR 0.04; 0.01–0.2 for age ≥55 years). Previous BCG vaccine and chest x-ray findings were not significantly associated with physicians’ decision to offer treatment for LTBI.ConclusionsMost factors that influenced physicians’ decisions on treatment for LTBI were based on evidence of an association with risk of developing TB or risk of having an adverse reaction to treatment for LTBI. However, the decreased likelihood of offering treatment for LTBI to people born overseas, men and health care workers, was apparently not based on any evidence of risk. Efforts should be made to ensure that these groups are given access to treatment for LTBI.

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“…This social support focused on risk factors for non-adherence to preventive therapy such as being female and/or belonging to a marginalised group, 43 , 81-83 age, 83,84 illegal drug use, 46 homelessness, 47 alcohol misuse, 85 and TB-affected families' and individual's own knowledge, attitudes and perceptions. 80,86 Although our group had originally applied for funding to perform a 2×2 factorial study evaluating economic support versus social support and socioeconomic support versus standard of care, the sample size required was prohibitive and that application was not funded. The final funded study design of this CRESIPT pilot study did not allow analysis of the differential impact of the social support component and the economic support component of cash transfers on access to preventive therapy and TB cure rates.…”

Section: Discussionmentioning

confidence: 99%

Beyond pills and tests: addressing the social determinants of tuberculosis

Wingfield¹,

Tovar²,

Huff³

et al. 2016

Clinical Medicine

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Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strategies is limited. The research described in this article, based on the 2016 Royal College of Physicians Linacre Lecture, aimed to address this knowledge gap. The research was divided into two phases: the first phase was an analysis of a cohort study identifying TB-related costs of TB-affected households and creating a clinically relevant threshold above which those costs became catastrophic; the second was the design, implementation and evaluation of a household randomised controlled evaluation of socio-economic support to improve access to preventive therapy, increase TB cure, and mitigate the effects of catastrophic costs. The first phase showed TB remains a disease of people living in poverty - 'free' TB care was unaffordable for impoverished TB-affected households and incurring catastrophic costs was associated with as many adverse TB treatment outcomes (including death, failure of treatment, lost to follow-up and TB recurrence) as multidrug resistant (MDR) TB. The second phase showed that, in TB-affected households receiving socio-economic support, household contacts were more likely to start and adhere to TB preventive therapy, TB patients were more likely to be cured and households were less likely to incur catastrophic costs. In impoverished Peruvian shantytowns, poverty remains inextricably linked with TB and incurring catastrophic costs predicted adverse TB treatment outcome. A novel socio-economic support intervention increased TB preventive therapy uptake, improved TB treatment success and reduced catastrophic costs. The impact of the intervention on TB control is currently being evaluated by the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) study.

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Physicians' attitudes towards self-treatment of latent tuberculosis [Short communication]

Cited by 8 publications

References 0 publications

Factors influencing tuberculosis screening in healthcare workers in Portugal

Factors influencing tuberculosis screening in healthcare workers in Portugal

What Patient Factors Predict Physicians’ Decision Not to Treat Latent Tuberculosis Infection in Tuberculosis Contacts?

Beyond pills and tests: addressing the social determinants of tuberculosis

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