Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Pulmonary Medicine, Stavanger University Hospital, Stavanger, Norway.
BMC Infect Dis. 2018 Nov 19;18(1):587. doi: 10.1186/s12879-018-3468-z.
Successful treatment of latent tuberculosis infection (LTBI) is essential to reduce tuberculosis (TB) incidence rates in low-burden countries. This study measures treatment completion and determinants of non-completion of LTBI treatment in Norway in 2016.
This prospective cohort study included all individuals notified with LTBI treatment to the Norwegian Surveillance System for Infectious Diseases (MSIS) in 2016. We obtained data from MSIS and from a standardized form that was sent to health care providers at the time of patient notification to MSIS. We determined completion rates. Pearson's chi squared test was used to study associations between pairs of categorical variables and separate crude and multivariable logistic regression models were used to identify factors associated with treatment completion and adverse drug effects.
We obtained information on treatment completion from 719 of the 726 individuals notified for LTBI treatment in 2016. Overall, 91% completed treatment. Treatment completion was highest in the foreign-born group [foreign-born, n = 562 (92%) vs Norwegian-born, n = 115 (85%), p = 0.007]. Treatment completion did not differ significantly between prescribed regimens (p = 0.124). Adverse events were the most common reason for incomplete treatment. We found no significant differences in adverse events when comparing weekly rifapentine (3RPH) with three months daily isoniazid and rifampicin (3RH). However, there were significantly fewer adverse events with 3RPH compared to other regimens (p = 0.037). Age over 35 years was significantly associated with adverse events irrespective of regimen (p = 0.024), whereas immunosuppression was not significantly associated with adverse events after adjusting for other variables (p = 0.306). Treatment under direct observation had a significant effect on treatment completion for foreign-born (multivariate Wald p-value = 0.017), but not for Norwegian-born (multivariate Wald p-value = 0.408) individuals.
We report a very high treatment completion rate, especially among individuals from countries with high TB incidence. The follow-up from tuberculosis-coordinators and the frequent use of directly observed treatment probably contributes to this. Few severe adverse events were reported, even with increased age and in individuals that are more susceptible. While these results are promising, issues of cost-effectiveness and targeting treatment to individuals at highest risk of TB are important components of public health impact.
成功治疗潜伏性结核感染（LTBI）对于降低低负担国家的结核病（TB）发病率至关重要。本研究旨在衡量 2016 年挪威 LTBI 治疗的完成情况和未完成治疗的决定因素。
本前瞻性队列研究纳入了 2016 年向挪威传染病监测系统（MSIS）报告的所有 LTBI 治疗患者。我们从 MSIS 获得数据，并从向 MSIS 报告患者时发送给医疗保健提供者的标准化表格中获取数据。我们确定了完成率。采用 Pearson's chi squared 检验研究了分类变量之间的关联，并且使用了独立的粗逻辑回归模型和多变量逻辑回归模型来确定与治疗完成和药物不良反应相关的因素。
我们从 2016 年通知的 726 名 LTBI 治疗患者中获得了 719 名患者的治疗完成信息。总体而言，91%的患者完成了治疗。在外国出生的人群中，治疗完成率最高[外国出生，n=562（92%）与挪威出生，n=115（85%），p=0.007]。不同方案之间的治疗完成率无显著差异（p=0.124）。不良事件是治疗不完整的最常见原因。我们比较每周利福喷丁（3RPH）与三个月每日异烟肼和利福平（3RH）时，发现不良事件没有显著差异。然而，与其他方案相比，3RPH 组的不良事件明显更少（p=0.037）。无论方案如何，年龄超过 35 岁与不良事件显著相关（p=0.024），而免疫抑制与其他变量调整后不良事件无关（p=0.306）。直接观察下的治疗对外国出生者（多变量 Wald p 值=0.017）的治疗完成有显著影响，但对挪威出生者（多变量 Wald p 值=0.408）无显著影响。
我们报告了非常高的治疗完成率，尤其是在结核病发病率较高的国家的人群中。这可能得益于结核协调员的随访和经常使用直接观察治疗。即使在年龄较大和更容易发生的人群中，也报告了很少的严重不良事件。尽管这些结果令人鼓舞，但成本效益问题和针对结核病风险最高的个体进行治疗是公共卫生影响的重要组成部分。
