Prior Screening for Latent Tuberculosis Among Patients Diagnosed With Tuberculosis Disease: Missed Opportunities?

Fischer, Heidi; Qian, Lei; Li, Zhuoxin; Garba, Saadiq; Bruxvoort, Katia J; Skarbinski, Jacek; Ku, Jennifer H; Lewin, Bruno J; Mahale, Parag S; Shaw, Sally F; Spence, Brigitte C; Tartof, Sara Y

Fischer, Heidi; Qian, Lei; Li, Zhuoxin; Garba, Saadiq; Bruxvoort, Katia J; Skarbinski, Jacek; Ku, Jennifer H; Lewin, Bruno J; Mahale, Parag S; Shaw, Sally F; Spence, Brigitte C; Tartof, Sara Y.

Afiliación

Fischer H; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Qian L; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Li Z; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Garba S; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
Bruxvoort KJ; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Skarbinski J; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ku JH; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Lewin BJ; Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California, USA.
Mahale PS; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Shaw SF; Department of Family Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
Spence BC; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
Tartof SY; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.

Open Forum Infect Dis ; 10(11): ofad545, 2023 Nov.

Article en En | MEDLINE | ID: mdl-38023560

RESUMEN

Background: California has the largest number of tuberculosis (TB) disease cases in the United States. This study in a large California health system assessed missed opportunities for latent tuberculosis (LTBI) screening among patients with TB disease. Methods: Kaiser Permanente Southern California patients who were ≥18 years old with membership for ≥24 months during the study period from 1 January 2008 to 31 December 2019 were included. Prior LTBI test (tuberculin skin test or interferon-Î³ release assay) or diagnosis code prior to TB disease diagnosis was assessed among patients with observed TB disease (confirmed by polymerase chain reaction and/or culture). In the absence of current treatment practices, more patients screened for LTBI may have developed TB disease. We estimated hypothetical TB disease cases prevented by multiplying LTBI progression rates by the number of LTBI-positive patients prescribed treatment. Results: A total of 1289 patients with observed TB disease were identified; 148 patients were LTBI positive and 84 were LTBI negative. Patients not prescreened for LTBI made up 82.0% of observed TB disease cases (1057/1289). Adding the hypothetical maximum estimate for prevented cases decreased the percentage of patients who were not prescreened for LTBI to 61.7% [1057/(1289 + 424)]. Conclusions: One-fifth of patients were screened for LTBI prior to their active TB diagnosis. Assuming the upper bound of cases prevented through current screening, almost 62% of TB disease patients were never screened for LTBI. Future work to elucidate gaps in LTBI screening practices and to identify opportunities to improve screening guidelines is needed.

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Open Forum Infect Dis Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos

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