Eastment McKenna C, McClintock Adelaide H, McKinney Christy M, Narita Masahiro, Molnar Alexandra
From the Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle (ME); the Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (AHM, AM); the Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle (CMM); the Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle (MN); and the Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, Washington (MN).
J Am Board Fam Med. 2017 Jul-Aug;30(4):520-527. doi: 10.3122/jabfm.2017.04.170070.
The aim of this study is to describe factors associated with noncompletion of latent tuberculosis infection (LTBI) therapy.
We conducted a retrospective cohort study of adults who initiated LTBI treatment with isoniazid, rifampin, or isoniazid-rifapentine at 5 clinics. Demographic, treatment, and monitoring characteristics were abstracted. We estimated descriptive statistics and compared differences between completers and noncompleters using tests and χ tests.
The rate of completion across LTBI regimens was 66% (n = 393). A greater proportion of noncompleters were unmarried, used tobacco and/or alcohol, and had more medical problems than completers (all < .05). A larger proportion of noncompleters received charity care compared with completers ( < .001). The most common reason for treatment discontinuation was loss to follow-up; the majority of these participants were treated with the longest isoniazid-only regimen.
Patients at risk of progression to active tuberculosis with factors associated with noncompletion may benefit from interventions that enhance adherence to LTBI therapy. These interventions could include enhanced outreach, incentive programs, or home visits.
本研究旨在描述与潜伏性结核感染(LTBI)治疗未完成相关的因素。
我们对在5家诊所开始使用异烟肼、利福平或异烟肼-利福喷汀进行LTBI治疗的成年人进行了一项回顾性队列研究。提取了人口统计学、治疗和监测特征。我们估计了描述性统计数据,并使用检验和χ检验比较了完成治疗者和未完成治疗者之间的差异。
LTBI治疗方案的完成率为66%(n = 393)。与完成治疗者相比,未完成治疗者中未婚、使用烟草和/或酒精以及有更多医疗问题的比例更高(所有P <.05)。与完成治疗者相比,未完成治疗者中接受慈善护理的比例更大(P <.001)。治疗中断的最常见原因是失访;这些参与者中的大多数接受的是仅使用异烟肼的最长疗程治疗。
有进展为活动性结核病风险且存在与治疗未完成相关因素的患者可能会从增强LTBI治疗依从性的干预措施中获益。这些干预措施可包括加强外展服务、激励计划或家访。