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    Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study.

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    Date
    2012-06-21
    Authors
    Ahearn, MA
    Bissette, Deborah J
    Blain, MLM
    Gadkowski, LB
    Goswami, ND
    Østbye, Truls
    Piedrahita, C
    Saukkonen, J
    Stout, Jason Eric
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    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 article
    Subject
    Adult
    Aged
    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
    Permalink
    https://hdl.handle.net/10161/13903
    Published Version (Please cite this version)
    10.1186/1471-2458-12-468
    Publication 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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    Scholars@Duke

    Stout

    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.
    Ostbye

    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
    Alphabetical list of authors with Scholars@Duke profiles.
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