Ortiz Laza N, Lopez Aranaga I, Toral Andres J, Toja Uriarte B, Santos Zorrozua B, Altube Urrengoechea L, Garros Garay J, Tabernero Huguet E
Pulmonology Service, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain.
Pulmonology Service, Galdakao-Usansolo Hospital, Galdakao, Spain.
Front Med (Lausanne). 2023 Oct 31;10:1265057. doi: 10.3389/fmed.2023.1265057. eCollection 2023.
Contact tracing and treatment of latent tuberculosis infection (LTBI) is a key element of tuberculosis (TB) control in low TB incidence countries. A TB control and prevention program has been active in the Basque Country since 2003, including the development of the nurse case manager role and a unified electronic record. Three World Health Organization-approved LTBI regimens have been used: isoniazid for 6 months (6H), rifampicin for 4 months (4R), and isoniazid and rifampicin for 3 months (3HR). Centralized follow-up by a TB nurse case manager started in January 2016, with regular telephone follow-up, telemonitoring of blood test results, and monitoring of adherence by electronic review of drugs dispensed in pharmacies.
To estimate LTBI treatment completion and toxicity of different preventive treatment regimens in a real-world setting. Secondary objective: to investigate the adherence to different approaches to preventive treatment monitoring.
A multicentre retrospective cohort study was conducted using data collected prospectively on contacts of patients with TB in five hospitals in Biscay from 2003 to 2022.
A total of 3,066 contacts with LTBI were included. The overall completion rate was 66.8%; 86.5% of patients on 3HR ( = 699) completed treatment vs. 68.3% ( = 1,260) of those on 6H ( < 0.0001). The rate of toxicity was 3.8%, without significant differences between the regimens. A total of 394 contacts were monitored by a TB nurse case manager. In these patients, the completion rate was 85% vs. 67% in those under standard care ( < 0.001). A multivariate logistic regression model identified three independent factors associated with treatment completion: being female, the 3HR regimen, and nurse telemonitoring.
3HR was well tolerated and associated with a higher rate of treatment completion. Patients with nurse telemonitoring follow-up had better completion rates.
在结核病发病率较低的国家，接触者追踪和潜伏性结核感染（LTBI）治疗是结核病控制的关键要素。自2003年以来，巴斯克地区一直在实施一项结核病控制与预防计划，包括设立护士病例管理岗位和统一电子记录。已采用三种世界卫生组织批准的LTBI治疗方案：异烟肼治疗6个月（6H）、利福平治疗4个月（4R）以及异烟肼和利福平治疗3个月（3HR）。2016年1月开始由结核病护士病例管理进行集中随访，包括定期电话随访、远程监测血液检测结果以及通过电子审查药房配药情况来监测服药依从性。
评估在实际环境中不同预防性治疗方案的LTBI治疗完成率和毒性。次要目的：调查对不同预防性治疗监测方法的依从性。
采用2003年至2022年在比斯开省五家医院前瞻性收集的结核病患者接触者数据进行多中心回顾性队列研究。
共纳入3066例LTBI接触者。总体完成率为66.8%；接受3HR方案治疗的患者（n = 699）中有86.5%完成治疗，而接受6H方案治疗的患者（n = 1260）中这一比例为68.3%（P < 0.0001）。毒性发生率为3.8%，各方案之间无显著差异。共有394例接触者由结核病护士病例管理进行监测。在这些患者中，完成率为85%，而接受标准护理的患者完成率为67%（P < 0.001）。多变量逻辑回归模型确定了与治疗完成相关的三个独立因素：女性、3HR方案以及护士远程监测。
3HR耐受性良好，且与较高的治疗完成率相关。接受护士远程监测随访的患者完成率更高。
