Can Primary Care Drive Tuberculosis Elimination? Increasing Latent Tuberculosis Infection Testing and Treatment Initiation at a Community Health Center with a Large Non-U.S.-born Population.
Can Primary Care Drive Tuberculosis Elimination? Increasing Latent Tuberculosis Infection Testing and Treatment Initiation at a Community Health Center with a Large Non-U.S.-born Population.
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DOI：
10.1007/s10903-022-01438-1
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发表时间：
2023-08
影响因子：
1.9
通讯作者：
Katrak, Shereen S
中科院分区：
文献类型：
--
作者：
Tang, Amy S;Mochizuki, Tessa;Dong, Zinnia;Flood, Jennifer;Katrak, Shereen S
社区卫生中心(CHC)在结核病隐性感染(LTBI)检测和治疗中发挥着关键作用。我们在2010年至2019年的一系列质量改进(QI)干预期间，对一家拥有大量非美国出生(USB)人口的CHC的儿科和成人患者进行了LTBI测试和治疗的回顾性分析。在124,695名接受初级保健访问的患者中，40%的患者接受了结核病(TB)感染检测，在接受检测的患者中，20%的患者检测呈阳性，其中包括39%的50-79岁成年人。与18-49岁的成年人相比，6-17岁的儿童接受长期脑损伤检测和治疗的几率增加[优势比和95%可信区间分别为3.23(3.10，3.36)和1.41(1.12，1.79)]，而年龄为 ≥ 65岁的儿童接受检测和治疗的几率较低。在分析期间，与旨在减少长期脑损伤护理障碍的资金不足的QI干预措施不谋而合，接受长期脑损伤检测的患者比例显著增加，成人患者(6%至47%，p <； 0.001)和儿童患者(23%至80%，p <； 0.001)。在分析期间，接受LTBI治疗处方的患者比例也有显著增加，以及提供者使用包括基于利福霉素的治疗在内的循证策略。我们的研究表明，初级保健干预可以减少LTBI治疗的障碍，并推动结核病的消除。网上版载有补充材料，可在10.1007/s10903-022-01438-1查阅。
Community health centers (CHC) play a key role in latent tuberculosis infection (LTBI) testing and treatment. We performed a retrospective analysis of LTBI testing and treatment among pediatric and adult patients at a CHC with a large non-U.S.-born (USB) population during a series of quality improvement (QI) interventions from 2010 to 2019. Among 124,695 patients with primary care visits, 40% of patients were tested for tuberculosis (TB) infection and among those tested, 20% tested positive, including 39% of adults aged 50–79 years. Compared to adults aged 18–49 years, children aged 6–17 had increased odds of LTBI testing and treatment initiation [odds ratio and 95% confidence interval 3.23 (3.10, 3.36) and 1.41 (1.12, 1.79), respectively], while age ≥ 65 was associated with lower odds of both testing and treatment initiation. Over the analysis period, coinciding with unfunded QI interventions intended to reduce barriers to LTBI care, there was a significant increase in the proportion of patients receiving LTBI testing for both adults (6% to 47%, p < 0.001) and children (23% to 80%, p < 0.001). During the analysis period, there was also a significant increase in the proportion of patients receiving prescriptions for LTBI treatment, as well as provider use of evidence-based strategies including rifamycin-based treatment. Our study suggests that primary care interventions can reduce barriers to LTBI treatment and drive TB elimination. The online version contains supplementary material available at 10.1007/s10903-022-01438-1.