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

Publication ,  Journal Article
Goswami, ND; Gadkowski, LB; Piedrahita, C; Bissette, D; Ahearn, MA; Blain, MLM; Østbye, T; Saukkonen, J; Stout, JE
Published in: BMC Public Health
June 21, 2012

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.

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Published In

BMC Public Health

DOI

EISSN

1471-2458

Publication Date

June 21, 2012

Volume

12

Start / End Page

468

Location

England

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Socioeconomic Factors
  • Risk Factors
  • Qualitative Research
  • Public Health
  • Prospective Studies
  • Patient Acceptance of Health Care
  • Middle Aged
  • Male
 

Citation

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Goswami, N. D., Gadkowski, L. B., Piedrahita, C., Bissette, D., Ahearn, M. A., Blain, M. L. M., … Stout, J. E. (2012). Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study. BMC Public Health, 12, 468. https://doi.org/10.1186/1471-2458-12-468
Goswami, Neela D., Lara Beth Gadkowski, Carla Piedrahita, Deborah Bissette, Marshall Alex Ahearn, Michela L. M. Blain, Truls Østbye, Jussi Saukkonen, and Jason E. Stout. “Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study.BMC Public Health 12 (June 21, 2012): 468. https://doi.org/10.1186/1471-2458-12-468.
Goswami ND, Gadkowski LB, Piedrahita C, Bissette D, Ahearn MA, Blain MLM, et al. Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study. BMC Public Health. 2012 Jun 21;12:468.
Goswami, Neela D., et al. “Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study.BMC Public Health, vol. 12, June 2012, p. 468. Pubmed, doi:10.1186/1471-2458-12-468.
Goswami ND, Gadkowski LB, Piedrahita C, Bissette D, Ahearn MA, Blain MLM, Østbye T, Saukkonen J, Stout JE. Predictors of latent tuberculosis treatment initiation and completion at a U.S. public health clinic: a prospective cohort study. BMC Public Health. 2012 Jun 21;12:468.
Journal cover image

Published In

BMC Public Health

DOI

EISSN

1471-2458

Publication Date

June 21, 2012

Volume

12

Start / End Page

468

Location

England

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Socioeconomic Factors
  • Risk Factors
  • Qualitative Research
  • Public Health
  • Prospective Studies
  • Patient Acceptance of Health Care
  • Middle Aged
  • Male