Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study.
Abstract
BACKGROUND: Treatment of latent tuberculosis infection (LTBI) is a key component in
U.S. tuberculosis control, assisted by recent improvements in LTBI diagnostics and
therapeutic regimens. Effectiveness of LTBI therapy, however, is limited by patients'
willingness to both initiate and complete treatment. We aimed to evaluate the demographic,
medical, behavioral, attitude-based, and geographic factors associated with LTBI treatment
initiation and completion of persons presenting with LTBI to a public health tuberculosis
clinic. METHODS: Data for this prospective cohort study were collected from structured
patient interviews, self-administered questionnaires, clinic intake forms, and U.S.
census data. All adults (>17 years) who met CDC guidelines for LTBI treatment between
January 11, 2008 and May 6, 2009 at Wake County Health and Human Services Tuberculosis
Clinic in Raleigh, North Carolina were included in the study. In addition to traditional
social and behavioral factors, a three-level medical risk variable (low, moderate,
high), based on risk factors for both progression to and transmission of active tuberculosis,
was included for analysis. Clinic distance and neighborhood poverty level, based on
percent residents living below poverty level in a person's zip code, were also analyzed.
Variables with a significance level <0.10 by univariate analysis were included in
log binomial models with backward elimination. Models were used to estimate risk ratios
for two primary outcomes: (1) LTBI therapy initiation (picking up one month's medication)
and (2) therapy completion (picking up nine months INH therapy or four months rifampin
monthly). RESULTS: 496 persons completed medical interviews and questionnaires addressing
social factors and attitudes toward LTBI treatment. 26% persons initiated LTBI therapy
and 53% of those initiating completed therapy. Treatment initiation predictors included:
a non-employment reason for screening (RR 1.6, 95% CI 1.0-2.5), close contact to an
infectious TB case (RR 2.5, 95% CI 1.8-3.6), regular primary care(RR 1.4, 95% CI 1.0-2.0),
and history of incarceration (RR 1.7, 95% CI 1.0-2.8). Persons in the "high" risk
category for progression/transmission of TB disease had higher likelihood of treatment
initiation (p < 0.01), but not completion, than those with lower risk. CONCLUSIONS:
Investment in social support and access to regular primary care may lead to increased
LTBI therapy adherence in high-risk populations.
Type
Journal articleSubject
AdultAged
Aged, 80 and over
Female
Humans
Latent Tuberculosis
Male
Middle Aged
Patient Acceptance of Health Care
Prospective Studies
Qualitative Research
Risk Factors
Socioeconomic Factors
Surveys and Questionnaires
United States
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https://hdl.handle.net/10161/13903Published Version (Please cite this version)
10.1186/1471-2458-12-468Publication Info
Ahearn, MA; Bissette, Deborah J; Blain, MLM; Gadkowski, LB; Goswami, ND; Østbye, Truls;
... Stout, Jason Eric (2012). Predictors of latent tuberculosis treatment initiation and completion at a U.S. public
health clinic: a prospective cohort study. BMC Public Health, 12. pp. 468. 10.1186/1471-2458-12-468. Retrieved from https://hdl.handle.net/10161/13903.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Jason Eric Stout
Professor of Medicine
My research focuses on the epidemiology, natural history, and treatment of tuberculosis
and nontuberculous mycobacterial infections. I am also interested in the impact of
HIV infection on mycobacterial infection and disease, and in examining health disparities
as they relate to infectious diseases, particularly in immigrant populations.
Truls Ostbye
Professor of Family Medicine and Community Health
Chronic disease epidemiology; obesity; health services research; population health;
public health; social medicine; health information systems; health surveys; programme
evaluation; clinical trials; aging; nutrition; dementia; Global Health
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