干扰素γ释放试验检测与美国潜伏性结核感染治疗的持续和完成相关：来自商业保险数据的证据。
Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data.
机构信息
Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, United States of America.
Department of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America.
出版信息
PLoS One. 2020 Dec 3;15(12):e0243102. doi: 10.1371/journal.pone.0243102. eCollection 2020.
BACKGROUND
Risk-targeted testing and treatment of latent tuberculosis infection (LTBI) is a critical component of the United States' (US) tuberculosis (TB) elimination strategy, but relatively low treatment completion rates remain a challenge. Both treatment persistence and completion may be facilitated by diagnosing LTBI using interferon gamma release assays (IGRA) rather than tuberculin skin tests (TST).
METHODS
We used a national sample of administrative claims data to explore associations diagnostic test choice (TST, IGRA, TST with subsequent IGRA) and treatment persistence and completion in persons initiating a daily dose isoniazid LTBI treatment regimen in the US private healthcare sector between July 2011 and March 2014. Associations were analyzed with a generalized ordered logit model (completion) and a negative binomial regression model (persistence).
RESULTS
Of 662 persons initiating treatment, 327 (49.4%) completed at least the 6-month regimen and 173 (26.1%) completed the 9-month regimen; 129 (19.5%) persisted in treatment one month or less. Six-month completion was least likely in persons receiving a TST (42.2%) relative to persons receiving an IGRA (55.0%) or TST then IGRA (67.2%; p = 0.001). Those receiving an IGRA or a TST followed by an IGRA had higher odds of completion compared to those receiving a TST (aOR = 1.59 and 2.50; p = 0.017 and 0.001, respectively). Receiving an IGRA or a TST and subsequent IGRA was associated with increased treatment persistence relative to TST (aIRR = 1.14 and 1.25; p = 0.027 and 0.009, respectively).
CONCLUSIONS
IGRA use is significantly associated with both higher levels of LTBI treatment completion and treatment persistence. These differences are apparent both when IGRAs alone were administered and when IGRAs were administered subsequent to a TST. Our results suggest that IGRAs contribute to more effective LTBI treatment and consequently individual and population protections against TB.
背景
针对潜伏性结核感染（LTBI）的风险靶向检测和治疗是美国（US）结核病（TB）消除策略的关键组成部分，但相对较低的治疗完成率仍是一个挑战。使用干扰素γ释放试验（IGRA）而不是结核菌素皮肤试验（TST）来诊断 LTBI 可能有助于提高治疗的持续性和完成率。
方法
我们使用国家行政索赔数据样本，探索了诊断测试选择（TST、IGRA、TST 后加用 IGRA）与 2011 年 7 月至 2014 年 3 月期间在美国私营医疗保健部门开始接受每日剂量异烟肼 LTBI 治疗方案的个体的治疗持续性和完成率之间的关联。使用广义有序逻辑模型（完成）和负二项回归模型（持续）进行关联分析。
结果
在 662 名开始治疗的患者中，有 327 名（49.4%）至少完成了 6 个月的疗程，有 173 名（26.1%）完成了 9 个月的疗程；有 129 名（19.5%）在治疗一个月或更短时间内持续治疗。与接受 IGRA（55.0%）或 TST 后加用 IGRA（67.2%）的患者相比，接受 TST 的患者（42.2%）完成 6 个月治疗的可能性最低（p=0.001）。与接受 TST 的患者相比，接受 IGRA 或 TST 后加用 IGRA 的患者完成治疗的可能性更高（优势比[OR]=1.59 和 2.50；p=0.017 和 0.001）。与接受 TST 相比，接受 IGRA 或 TST 后加用 IGRA 与治疗持续时间延长相关（调整后危险比[aIRR]=1.14 和 1.25；p=0.027 和 0.009）。
结论
IGRA 的使用与 LTBI 治疗完成率和治疗持续性的提高显著相关。当单独使用 IGRAs 或在 TST 后使用 IGRAs 时，都会出现这些差异。我们的结果表明，IGRAs 有助于更有效的 LTBI 治疗，从而为个人和人群提供对结核病的保护。
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