Latent TB Infection Treatment Acceptance and Completion in the United States and Canada-猫眼课题宝

DOI：

10.1378/chest.09-0394

发表时间：

2010-02-01

期刊：

CHEST

影响因子：

9.6

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Horsburgh, C. Robert, Jr.;Goldberg, Stefan;Weinfurter, Paul

背景资料：潜伏性结核感染（LTBI）的治疗对于预防北美的结核病是必不可少的，但是这种治疗的接受和完成还没有被系统地评估过。方法：我们在2002年对美国和加拿大19个地区的公立和私立诊所的LTBI治疗和完成情况进行了回顾性、随机两阶段横断面调查。在进行结核菌素皮肤测试并提供治疗的32家诊所中，720名接受测试并提供治疗的受试者中有123人（17.1%; 95%CI，14.5%-20.0%）拒绝。卫生保健机构的员工更有可能下降（比值比[OR]，4.74; 95%CI，1.75-12.9; P = .003），而与结核病患者接触的员工下降的可能性较小（OR，0.19; 95%CI，0.07-0.50; P = .001）。在68家开始治疗的诊所中，无论在何处进行皮肤测试，1，994名开始治疗的人中有1，045名（52.7%; 95% CI，48.5%-56.8%）未能完成推荐的疗程。未能完成的风险因素包括开始9个月的异烟肼方案（OR，2.08; 95% CI，1.23-3.57），居住在聚集环境中（疗养院、收容所或监狱; OR，2.94; 95% CI，1.58-5.56），注射吸毒（OR，2.13; 95%CI，1.04-4.35），年龄>= 15岁（OR，1.49; 95%CI，1.14-1.94），在医疗机构工作（1.37; 95%CI，1.00-1.85）。需要针对聚集场所居民、注射吸毒者和卫生保健机构雇员的短期方案和干预措施，以提高完成率。CHEST 2010，137（2）：401-409

Background: Treatment of latent TB infection (LTBI) is essential for preventing TB in North America, but acceptance and completion of this treatment have not been systematically assessed.Methods: We performed a retrospective, randomized two-stage cross-sectional survey of treatment and completion of LTBI at public and private clinics in 19 regions of the United States and Canada in 2002.Results: At 32 clinics that both performed tuberculin skin testing and offered treatment, 123 (17.1%; 95% CI, 14.5%-20.0%) of 720 subjects tested and offered treatment declined. Employees at health-care facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P = .003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P = .001). At 68 clinics starting treatment regardless of where skin testing was performed, 1,045 (52.7%; 95% CI, 48.5%-56.8%) of 1,994 people starting treatment failed to complete the recommended course. Risk factors for failure to complete included starting the 9-month isoniazid regimen (OR, 2.08; 95% CI, 1.23-3.57), residence in a congregate setting (nursing home, shelter, or jail; OR, 2.94; 95% CI, 1.58-5.56), injection drug use (OR, 2.13; 95% CI, 1.04-4.35), age >= 15 years (OR, 1.49; 95% CI, 1.14-1.94), and employment at a health-care facility (1.37; 95% CI, 1.00-1.85).Conclusions: Fewer than half of the people starting treatment of LTBI completed therapy. Shorter regimens and interventions targeting residents of congregate settings, injection drug users, and employees of health-care facilities are needed to increase completion. CHEST 2010,137(2):401-409

Latent TB Infection Treatment Acceptance and Completion in the United States and Canada

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