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

dc.contributor.author Ahearn, MA
dc.contributor.author Bissette, Deborah J
dc.contributor.author Blain, MLM
dc.contributor.author Gadkowski, LB
dc.contributor.author Goswami, ND
dc.contributor.author Østbye, Truls
dc.contributor.author Piedrahita, C
dc.contributor.author Saukkonen, J
dc.contributor.author Stout, Jason Eric
dc.coverage.spatial England
dc.date.accessioned 2017-04-01T13:22:33Z
dc.date.available 2017-04-01T13:22:33Z
dc.date.issued 2012-06-21
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/22720842
dc.identifier 1471-2458-12-468
dc.identifier.uri https://hdl.handle.net/10161/13903
dc.description.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.
dc.language eng
dc.relation.ispartof BMC Public Health
dc.relation.isversionof 10.1186/1471-2458-12-468
dc.subject Adult
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Female
dc.subject Humans
dc.subject Latent Tuberculosis
dc.subject Male
dc.subject Middle Aged
dc.subject Patient Acceptance of Health Care
dc.subject Prospective Studies
dc.subject Qualitative Research
dc.subject Risk Factors
dc.subject Socioeconomic Factors
dc.subject Surveys and Questionnaires
dc.subject United States
dc.title Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/22720842
pubs.begin-page 468
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Community and Family Medicine
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group School of Medicine
pubs.organisational-group School of Nursing
pubs.organisational-group School of Nursing - Secondary Group
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published online
pubs.volume 12
dc.identifier.eissn 1471-2458


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