Kawatsu Lisa, Uchimura Kazuhiro, Ohkado Akihiro
Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti- tuberculosis Association (RIT/JATA), Tokyo, Japan.
PLoS One. 2017 Nov 1;12(11):e0186588. doi: 10.1371/journal.pone.0186588. eCollection 2017.
Management of latent tuberculosis infection (LTBI) is one of the core elements of End TB Strategy. Japan is one of the few countries in which notification of LTBI is mandatory, yet so far, the data has not been analyzed in detail. We thus conducted a cross-sectional study to examine the trend of LTBI, its treatment outcome and factors predicting treatment non-completion in Japan for the period of 2007 and 2014, using the data from the electronic Japan Tuberculosis Surveillance system. Treatment completion was defined as those whose reason for terminating the treatment was recorded as "treatment completed" and whose treatment duration was 180 days or more.
During the study period, a total of 50,268 LTBI patients were notified, of which 49,525, who had started treatment, were analyzed for characteristics. 57.5% were females, and 38.5% were aged 25-44 years. As for the job category, healthcare professionals, that is medical doctors, nurses and other healthcare workers, consisted the largest group (30.4%). Overall, the number of LTBI notification has been on an increase, with a large increase observed among those aged 65 years and above. Of the 49,525 patients, the information regarding reason for termination of treatment was available for 46,128 (93.1%). Of them, 33,156 (71.9%) had completed treatment as according to the study definition. The risk factors for not completing LTBI treatment included being aged 65 years and above (adjusted odds ratio [aOR] 1.27, 95% confidence interval [95%CI] 1.10-1.47), foreign-born (aOR 1.14, 95%CI 1.02-1.28), healthcare professional (aOR 1.44, 95%CI 1.24-1.69), full-time and part-time worker (aOR 1.40, 95%CI, 1.20-1.63) and detected via contact investigation (aOR 1.26, 95%CI 1.12-1.41).
Our study results revealed that the treatment completion rate was 71.9%, falling short of the national target of 85%, and also that the treatment duration was recorded as less than 180 days for approximately 20% of those who were reported as having completed treatment. Further studies may be built on ours to explore the reasons for not completing the treatment across different population groups, and identify those who benefit the most, and who has the greatest impact on ending TB, by receiving LTBI treatment.
潜伏性结核感染（LTBI）管理是终结结核病战略的核心要素之一。日本是少数几个强制报告LTBI的国家之一，但迄今为止，尚未对相关数据进行详细分析。因此，我们利用日本结核病电子监测系统的数据，开展了一项横断面研究，以考察2007年至2014年期间日本LTBI的流行趋势、治疗结果以及预测治疗未完成的因素。治疗完成定义为治疗终止原因记录为“治疗完成”且治疗持续时间为180天或更长时间的患者。
在研究期间，共报告了50268例LTBI患者，其中49525例开始治疗的患者被分析其特征。57.5%为女性，38.5%年龄在25 - 44岁之间。就职业类别而言，医疗保健专业人员，即医生、护士和其他医护人员，占比最大（30.4%）。总体而言，LTBI报告数量一直在增加，65岁及以上人群中增幅较大。在49525例患者中，46128例（93.1%）有治疗终止原因的信息。其中，33156例（71.9%）根据研究定义完成了治疗。未完成LTBI治疗的风险因素包括年龄在65岁及以上（调整优势比[aOR] 1.27，95%置信区间[95%CI] 1.10 - 1.47）、外国出生（aOR 1.14，95%CI 1.02 - 1.28）、医疗保健专业人员（aOR 1.44，95%CI 1.24 - 1.69）、全职和兼职工作者（aOR 1.40，95%CI 1.20 - 1.63）以及通过接触者调查发现（aOR 1.26，95%CI 1.12 - 1.41）。
我们的研究结果显示，治疗完成率为71.9%，未达到国家85%的目标，并且在报告完成治疗的患者中，约20%的患者治疗持续时间记录少于180天。可在我们研究的基础上进一步开展研究，以探索不同人群未完成治疗的原因，并确定哪些人通过接受LTBI治疗受益最大以及对终结结核病影响最大。
