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The treatment of latent tuberculosis infection in Philadelphia: an evaluation of treatment completion by drug regimen among pediatric and adult patients, 2005-2010
Thesis

The treatment of latent tuberculosis infection in Philadelphia: an evaluation of treatment completion by drug regimen among pediatric and adult patients, 2005-2010

Emily L. Hofer
Master of Public Health (M.P.H.), Drexel University
2012
DOI:
https://doi.org/10.17918/etd-4017
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Hofer_Emily_20128.16 MB
PDF Project Access upon request, Email title, URL, or DOI to archives@drexel.edu
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Hofer_Emily_2012_Suppl1395.33 kB
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Abstract

Pennsylvania--Philadelphia Latent Infections Public Health Tuberculosis
Background: Treatment of latent tuberculosis infection (LTBI) is of ever-increasing importance in developed nations attempting to eliminate tuberculosis. LTBI occurs after infection with M. tuberculosis bacterium that is contained by the immune system and suppressed to the latent stage. Cases of LTBI can convert to active Tuberculosis disease, especially soon after infection and if the body becomes immunecompromised. While treatment of LTBI can encounter many challenges including length of treatment, absence of symptoms of clinical illness, potential adverse reactions to treatment and lack of knowledge about risks of LTBI, successful treatment of LTBI can reduce the risk of developing active TB disease by 90%. From a public health perspective, treating individuals with latent TB infection can be effective to reduce the spread of infection and incidence of active TB within the community. Objectives: Main study objectives include evaluating the difference in completion rates for the main treatment regimens, and considering the influence of risk factors on completion of LTBI treatment: Evaluating the difference in treatment completion rates for LTBI patients treated with isoniazid (INH) compared to rifampin (RIF); Analyze the influence of risk factors on completion of LTBI treatment; Assess the duration of treatment and time to dropout using a Survival Analysis. Results: Overall, treatment was successfully completed for 81.5% of the sample. Among Pediatric cases the completion rate was significantly higher, with nearly 90% of pediatric patients completing treatment compared to 70% of adults. In stratified analyses, being treated with the 4-month RIF regimen (OR 1.951, 95% CI 1.272, 2.994) and being female (OR 1.882, 95% CI 1.268, 2.793) were significant predictors of treatment completion in adults. In the pediatric subset only age was found to have a significant association with successfully completing treatment, with the oldest pediatric cases, from 15 to 18 years old, having a decreased likelihood of completion (OR 0.329, 95% CI 0.128 to 0.847) compared to those 0 to 4 years of age. Conclusions: Among adults in the sample, those treated with RIF had a higher completion rate as compared to INH, indicating that for the adult population RIF may be a preferred treatment for LTBI. Among pediatric cases no association was seen between treatment type and completion. The most significant limitation was that of missing and incomplete data, such that conclusions drawn from this analysis around factors impacting treatment completion, including treatment administration type, should be drawn cautiously, if at all. Missing data limited our ability to identify significant associations between clinical and behavioral indicators and treatment completion, as have been seen in the literature. Study recommendations include a process evaluation to allow for a renewed focus on improving data collection, data entry, and database management practices at the PDPH, as well as consideration of prescribing the newly approved INH/RPT regimen for adults who would have otherwise been treated with INH alone.

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