Abstract
Objective
Treatment of latent TB infection (LTBI) in high-risk populations has been identified as a priority activity for reducing TB incidence. Treatment completion rates are usually far from the 80% target. The objective of this study was to evaluate the proportion of individuals who obtained enough medication for standard LTBI treatment.
Methods
Using the Régie de l’assurance maladie du Québec database, we extracted data on all prescriptions filled as part of the free anti-tuberculosis medication program. We calculated the proportion of patients who had obtained at least 270 doses among patients who had started treatment with isoniazid (INH), and the proportion of patients who had obtained at least 120 doses among patients who had started treatment with rifampin (RMP).
Results
Among the 2,895 patients who had started INH, 907 (31.3%) obtained at least 270 doses. Among the 373 patients who had started RMP, 242 (64.9%) obtained at least 120 doses. Women were more likely to stop INH treatment before acquiring 270 doses of the medication than men (hazard ratio [HR] = 1.08; 95% confidence interval [CI]: 1.01–1.17).
Conclusion
Only 31.3% of patients who started treatment with INH had procured at least 270 doses. Completion rates are far below target values.
Key words: Tuberculosis, isoniazid, treatment, compliance, adherence
Résumé
Objectif
Traiter l’infection tuberculeuse latente (ITL) dans les populations à haut risque représente une activité importante pour réduire le fardeau d’incidence de la tuberculose. Les taux d’achèvement du traitement demeurent en deçà de l’objectif habituel de 80 %. Le but de cette étude était d’évaluer la proportion des personnes qui se sont procuré suffisamment de médicaments pour le traitement de l’ITL.
Méthode
À partir du fichier de données de la Régie de l’assurance maladie du Québec, nous avons obtenu toutes les ordonnances remplies dans le cadre du Programme de gratuité des médicaments pour la tuberculose. Nous avons calculé, parmi des patients qui ont été traités avec isoniazide (INH), la proportion de ceux qui se sont procuré au moins 270 doses. Nous avons également calculé, parmi des patients qui ont été traités avec rifampine (RMP), la proportion de ceux qui se sont procuré au moins 120 doses.
Résultats
Parmi les 2 895 patients qui ont été traités avec l’INH, 907 (31,3 %) se sont procuré au moins 270 doses. Parmi les 373 patients qui ont commencé un traitement préventif à la RMP, 242 (64,9 %) se sont procuré au moins 120 doses. Les femmes avaient plus de chances d’abandonner le traitement avant de s’être procuré au moins 270 doses d’INH que les hommes (Ratio de taux [RT] = 1,08; Intervalle de confiance [IC] à 95 %: 1,01–1,17).
Conclusion
Seulement 31,3 % des patients qui ont été traités avec l’INH se sont procuré au moins 270 doses. Les taux d’achèvement sont bien en deçà des taux habituellement visés.
Mots Clés: tuberculose, isoniazide, traitement, observance, fidélité au traitement
Footnotes
Conflict of Interest: None to declare.
References
- 1.Public Health Agency of Canada. Tuberculosis in Canada 2010 - Pre-release. Ottawa, ON: Ministry of Public Works and Government Services; 2011. [Google Scholar]
- 2.Public Health Agency of Canada. Guidance for Tuberculosis Prevention and Control Programs in Canada. Ottawa: Ministry of Public Works and Government Services; 2011. [Google Scholar]
- 3.Public Health Agency of Canada. Canadian Tuberculosis Standards. Ottawa: Ministry of Public Works and Government Services; 2007. [Google Scholar]
- 4.Hirsch-Moverman Y, Daftary A, Franks J, Colson PW. Adherence to treatment for latent tuberculosis infection: Systematic review of studies in the US and Canada. Int J Tuberc Lung Dis. 2008;12(11):1235–54. [PubMed] [Google Scholar]
- 5.Jereb J, Etkind SC, Joglar OT, Moore M, Taylor Z. Tuberculosis contact investigations: Outcomes in selected areas of the United States, 1999. Int J Tuberc Lung Dis. 2003;7(Suppl3):S384–S390. [PubMed] [Google Scholar]
- 6.Reichler MR, Reves R, Bur S, Ford J, Thompson V, Mangura B, et al. Treatment of latent tuberculosis infection in contacts of new tuberculosis cases in the United States. South Med J. 2002;95:414–20. doi: 10.1097/00007611-200295040-00009. [DOI] [PubMed] [Google Scholar]
- 7.Anger HA, Proops D, Harris TG, Li J, Kreiswirth BN, Shashkina E, Ahuja SD. Active case finding and prevention of tuberculosis among a cohort of contacts exposed to infectious tuberculosis cases in New York City. Clin Infect Dis. 2012;54:1287–95. doi: 10.1093/cid/cis029. [DOI] [PubMed] [Google Scholar]
- 8.Cain KP, Garman KN, Laserson KF, Ferrousier-Davis OP, Miranda AG, Wells CD, Haley CA. Moving toward tuberculosis elimination: Implementation of statewide targeted tuberculin testing in Tennessee. Am J Respir Crit Care Med. 2012;186(3):273–79. doi: 10.1164/rccm.201111-2076OC. [DOI] [PubMed] [Google Scholar]
- 9.Goldberg SV, Wallace J, Jackson JC, Chaulk CP, Nolan CM. Cultural case management of latent tuberculosis infection. Int J Tuberc Lung Dis. 2004;8:76–82. [PubMed] [Google Scholar]
- 10.Menzies D, Dion MJ, Rabinovitch B, Mannix S, Brassard P, Schwartzman K. Treatment completion and costs of a randomized trial of Rifampin for 4 months versus Isoniazid for 9 months. Am J Respir Crit Care Med. 2004;170:445–49. doi: 10.1164/rccm.200404-478OC. [DOI] [PubMed] [Google Scholar]
- 11.Lardizabal A, Passannante M, Kojakali F, Hayden C, Reichman LB. Enhancement of treatment completion for latent tuberculosis infection with 4 months of Rifampin. Chest. 2006;130:1712–17. doi: 10.1378/chest.130.6.1712. [DOI] [PubMed] [Google Scholar]
- 12.Page KR, Sifakis F, Montes de Oca R, Cronin WA, Doherty MC, Federline L, et al. Improved adherence and less toxicity with Rifampin vs Isoniazid for treatment of latent tuberculosis: A retrospective study. Arch Intern Med. 2006;166:1863–70. doi: 10.1001/archinte.166.17.1863. [DOI] [PubMed] [Google Scholar]
- 13.Horsburgh CR, Jr, Goldberg S, Bethel J, Chen S, Colson PW, Hirsch-Moverman Y, et al. Latent TB infection treatment acceptance and completion in the United States and Canada. Chest. 2010;137(2):401–9. doi: 10.1378/chest.09-0394. [DOI] [PubMed] [Google Scholar]
- 14.Smith BM, Schwartzman K, Bartlett G, Menzies D. Adverse events associated with treatment of latent tuberculosis in the general population. CMAJ. 2011;183(3):E173–E179. doi: 10.1503/cmaj.091824. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Sterling TR, Villarino ME, Borisov AS, Shang N, Gordin F, Bliven-Sizemore E, et al. Three months of Rifapentine and Isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365:2155–66. doi: 10.1056/NEJMoa1104875. [DOI] [PubMed] [Google Scholar]
- 16.Centers for Disease ControlPrevention. Recommendations for use of an Isoniazid-Rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR. 2011;60(48):1650–53. [PubMed] [Google Scholar]