Cost of nurse-managed latent tuberculous infection treatment among hard-to-reach immigrants in Israel
Cost of nurse-managed latent tuberculous infection treatment among hard-to-reach immigrants in Israel
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DOI：
10.5588/ijtld.14.0674
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发表时间：
2015-07-01
影响因子：
4
通讯作者：
Weiler-Ravell, D.
中科院分区：
文献类型：
--
作者：
Bishara, H.;Ore, L.;Weiler-Ravell, D.
背景：潜伏性结核感染（LTBI）治疗是消除结核病（TB）的重要组成部分，但坚持治疗的效果通常不令人满意。目的：研究在难以到达的埃塞俄比亚移民中，护士管理的半直接观察预防性治疗（半dopt）每周两次使用异烟肼的依从性和成本，并比较现场与区域结核病临床医生随访的治疗结果。方法：这是一项准实验回顾性队列分析，对2005-2011年期间在以色列北部Zefat街道接待中心接受LTBI筛查和治疗的埃塞俄比亚移民进行LTBI治疗。为每位患者安排了两次医生随访预约。结果：在纳入研究的663名符合条件的埃塞俄比亚移民中，628名（94.7%）完成了治疗。现场与地区结核病临床医生随访的治疗结果相似。未完成治疗与副作用显著相关（P < 0.001）。治疗总费用相对较低，但结核病临床医生随访组的总费用明显较高。结论：在难以到达的埃塞俄比亚移民中，护士管理的半dopt治疗LTBI并减少医生随访是有效和安全的。事实证明，提供现场医生随访比在地区结核病诊所进行标准随访更便宜。移民后尽早开始LTBI治疗，并免费提供治疗和便利的交通，可能也是治疗完成率高的原因。
BACKGROUND: Adherence to treatment of latent tuberculous infection (LTBI), an essential component of tuberculosis (TB) elimination, is generally unsatisfactory.OBJECTIVES: To examine the adherence and costs of nurse-managed, semi-directly observed preventive treatment (semi-DOPT) with twice-weekly isoniazid among hard-to-reach Ethiopian immigrants, and to compare the treatment outcomes of onsite vs. regional TB clinic-based physician's follow-up.METHODS: This was a quasi-experimental retrospective cohort analysis of LTBI treatment among Ethiopian immigrants in reception centres in the Zefat subdistrict of Northern Israel, screened and treated for LTBI during 2005-2011. Two physician follow-up appointments were scheduled for each patient.RESULTS: Of 663 eligible Ethiopian immigrants included in the study, 628 (94.7%) completed treatment. Treatment outcomes were similar among onsite vs. regional TB clinic-based physician follow-up. Non-completion was significantly associated with side effects (P < 0.001). The total costs of treatment were relatively low, but were significantly higher for the TB clinic-based physician follow-up group.CONCLUSION: Nurse-managed semi-DOPT for LTBI treatment with reduced physician follow-up among hard-to-reach Ethiopian immigrants was efficient and safe. Providing on-site physician follow-up proved to be cheaper than standard follow-up at the regional TB clinic. Starting LTBI treatment at an early stage after immigration, and providing treatment and convenient transportation free of charge probably also contributed to the high treatment completion rates.