The scope and impact of treatment of latent tuberculosis infection in the United States and Canada
The scope and impact of treatment of latent tuberculosis infection in the United States and Canada
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DOI：
10.1164/rccm.200510-1563oc
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发表时间：
2006-04-15
影响因子：
24.7
通讯作者：
Horsburgh, CR
中科院分区：
文献类型：
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作者：
Sterling, TR;Bethel, J;Horsburgh, CR
理论基础：在美国和加拿大，潜在结核病感染(LTBI)的治疗范围尚不清楚。确定实施这种治疗的诊所和接受这种治疗的患者的类型，可以指导资源的利用，提高治疗的开始和完成。目的：估计开始接受LTBI治疗的人数；描述治疗LTBI的诊所的类型。方法：结核病流行病学研究联盟由19个美国和2个加拿大站点组成，在2002年对10名患者进行了一项调查。结果：2000年，19个美国站点的研究集中地区占美国人口的8.6%，占所有结核病病例的12.7%。2002年，在接受调查的244家诊所中，估计有37857名患者开始接受LTBI治疗。在这些治疗开始中，29970个(79%)发生在一般公共卫生诊所；移民/难民诊所(2409个；6.4%)和惩教/拘留设施(2325个；6.1%)是其次最常见的地点。根据这些数据、美国结核病病例比率和美国人口数据，估计美国开始接受肺结核病治疗的总人数为291,000-433,000人。当将37,145名在美国启动LTBI治疗的人推算到整个美国人口，终身未治疗结核病的风险为5%，治疗有效率为20-60%时，美国大约预防了4,000-11,000例结核病病例。结论：在美国和加拿大，LTBI治疗是在相当数量的人中启动的，主要是在公共部门。LTBI治疗可明显减轻结核病负担。
Rationale: The scope of treatment of latent tuberculosis infection (LTBI) in the United States and Canada is unknown. Identifying the types of clinics that administer such treatment and patients who receive it could guide resource utilization and improve treatment initiation and completion.Objectives: Estimate the number of persons started on LTBI treatment; describe the types of clinics that treat LTBI.Methods: The Tuberculosis Epidemiologic Studies Consortium, consisting of 19 United States and 2 Canadian sites, conducted a survey among clinics that initiated LTBI treatment for >= 10 patients in 2002.Results: Study catchment areas from the 19 United States sites represented 8.6% of the United States population and 12.7% of all tuberculosis cases in 2000. An estimated 37,857 patients started LTBI treatment during 2002 at 244 clinics surveyed. Of these treatment starts, 29,970 (79%) occurred at general public health clinics; immigrant/refugee clinics (2,409; 6.4%) and correctional/detention facilities (2,325; 6.1%) were the next most common sites. Based on these data, United States tuberculosis case rates, and United States population data, the estimated total number of LTBI treatment starts in the United States was 291,000-433,000. When the 37,145 persons who initiated LTBI treatment in the United States were extrapolated to the entire United States population, with a 5% lifetime risk of tuberculosis without treatment, and 20-60% treatment effectiveness, approximately 4,000-11,000 tuberculosis cases were prevented in the United States.Conclusions: LTBI treatment is initiated among a substantial number of persons in the United States and Canada, primarily in the public sector. Treatment of LTBI can significantly decrease the tuberculosis burden.