Modeling the Impact of Recommendations for Primary Care-Based Screening for Latent Tuberculosis Infection in California
Modeling the Impact of Recommendations for Primary Care-Based Screening for Latent Tuberculosis Infection in California
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DOI：
10.1177/0033354920927845
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发表时间：
2020-07-01
影响因子：
3.3
通讯作者：
Shete, Priya B.
中科院分区：
文献类型：
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作者：
Parriott, Andrea;Kahn, James G.;Shete, Priya B.
目的对潜伏性结核感染者（LTBI）进行有针对性的检测和治疗是美国消除结核病（TB）战略的重要组成部分。2016年1月，加州公共卫生部发布了结核病风险评估工具和用户指南（加州工具）以及LTBI测试指南，2016年9月，美国预防服务工作组（USPSTF）发布了在初级保健环境中进行LTBI测试的建议。我们估计的流行病学效果，坚持这两个建议在加州。方法我们使用了基于个人的马尔可夫微观模拟模型，估计结核病的病例数，预计到2026年与基线LTBI战略相比，USPSTF或加州工具指南的实施。我们根据年龄和原籍国、目标人群中的概率以及基于现有数据进行初级保健的概率估计了LTBI的风险。我们假设100%的坚持测试指导，但不完善的坚持treatment.Results USPSTF和加州工具的指导实施将导致几乎相同数量的测试管理和结核病预防的情况。如果完全遵守这两项建议，到2026年将避免约7000例结核病病例（与基线相比减少40%）。几乎所有的这种下降将推动减少的情况下，在非美国出生的persons.Conclusions通过关注非美国出生的人口，坚持LTBI测试策略建议的USPSTF和加州的工具，可以大大减少结核病的负担在加州在未来十年。
Objective Targeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California.Methods We used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment.Results Implementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non-US-born persons.Conclusions By focusing on the non-US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.