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TREATMENT COMPLETION RATES FOR LTBI, ARKANSAS, 2006-2010: WHAT DO WE DO WITH NEGATIVE FINDINGS ? Mukasa LN, MBChB PhD., Bates JH, MD., Phillips J. MD.,

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Presentation on theme: "TREATMENT COMPLETION RATES FOR LTBI, ARKANSAS, 2006-2010: WHAT DO WE DO WITH NEGATIVE FINDINGS ? Mukasa LN, MBChB PhD., Bates JH, MD., Phillips J. MD.,"— Presentation transcript:

1 TREATMENT COMPLETION RATES FOR LTBI, ARKANSAS, 2006-2010: WHAT DO WE DO WITH NEGATIVE FINDINGS ? Mukasa LN, MBChB PhD., Bates JH, MD., Phillips J. MD., Abernathy RS, MD., Karpoff E. BSN RNP., Diatta N., Patil N, MD MHSA. Arkansas Department of Health

2 Background/Statement of Problem  Treatment completion for LTBI was original focus area for program evaluation in Arkansas, 2006  LTBI is reportable in Arkansas  Over the years, treatment LTBI remained priority  Thirty seven percent of the cases, 2004-2007 were missed opportunities  We sought to increase LTBI Tx completion to 65% by 2010

3 Background…  Average 2500 LTBI cases diagnosed per year  Reporting LTBI initially incomplete using paper forms  In 2005, we predicted that the TB case rate would be 2.0 per 100, 000 population in 2010 if interventions at time were maintained  We sought to accelerate TB elimination by aggressively treating LTBI

4 A Missed TB Opportunity was defined as a TB case:  Known to have a prior LTBI diagnosis  Known to be HIV positive before TB diagnosis  From established targeted intervention groups  Nursing Homes  Prisons  Health Care Workers  Foreign-born students  Age less than 5 years  Reported After Death

5 Prediction of Arkansas TB Case Rates 2006-2010 YearTB Case Rate PredictedObserved 20064736 20073237 20082829 20092428 20102027 *Rate Per million population

6 Aims/Objectives 1)Evaluate Completion LTBI Treatment 2004-2010 2)Illustrate concept second generation surveillance  Case rate vs. Treatment LTBI  Clustering vs. Treatment of LTBI 3) Discuss next steps

7 Methods  Stakeholders included clinicians, colleges, poultry workers, correction institutions and nursing homes  LTBI cases came from targeted testing and contact investigation  Cases LTBI were captured using a standard form  Analysis was approached in 3 ways:  Treatment completion rates for LTBI  Construction of a missed opportunity measure  Genotype cluster analysis

8 Data Flow Web-Enabled TB Registry TB Contacts LTBI Cases E-forms Evaluation Treatment LTBI Contact Investigations Targeted Testing

9 Arkansas 75 Counties Within 5 Regions: A Centralized Public Health Infrastructure Little Rock Predictive Model of LTBI Treatment to include Regions is Pending

10 Results  Treatment completion rates for LTBI ranged from 50 to 55% during the 5-year study period  35-40% of all TB cases were missed opportunities  13.5% of all cases were known prior LTBI  64% of case-isolates were in genotype clusters

11 TB Cases Reported from Prior LTBI, Arkansas, 2004-2010 YearTotal CasesPrior LTBI NumberPercent 20107879.0 2009821113.4 2008832125.3 2004-20074545512.1 Overall6979413.5

12 TB Trends by Treatment Completion for LTBI, Arkansas, 2004-2010 YearTB CasesTB Case Rate**Foreign-born (%)Completion TLTBI (%) 2010782.730.848.0* 2009822.828.055.7 2008832.922.954.6 20071063.729.253.2 20061023.631.450.5 20051144.129.052.8 20041324.836.449.3 20031274.718.9 20021365.014.7 20011626.117.9 20001997.814.6 TLTBI =Treatment LTBI* Provisional Data** Cases per 100,000 population

13 Genotype Clustering, Arkansas, 2005-2010, (n=401) 64% 36% Spoligotype-MIRU method

14 Electronic Contact Form

15 2-Page Electronic LTBI Form

16 The TB Trends in Arkansas and the US are in similar direction Are we constructing another U-shaped Curve of Concern ?

17 Conclusions/Recommendations  The goal of increasing LTBI treatment completion rates from 50% to 65% was not achieved. Complete data analysis is pending  We could not link the modest decline in TB incidence, 2006-2010 to treatment LTBI  The level of clustering by genotype suggests substantial ongoing TB transmission  Deployment of two electronic forms for TB contacts and LTBI will greatly improve surveillance and real-time analysis of LTBI in Arkansas  The introduction of the long awaited “game changers”, namely IGRA and 3-month regimen for LTBI is ongoing in Arkansas.  The new tools in deployment, we believe, will reverse the negative findings in our our study

18 Next Steps  Computerize all LTBI records 2006-2010  Construct predictive models Treatment Completion  Logistic Regression Treatment completion (Y/N)=region + gender+ age + US-born status, etc…  Cox’s Proportional Hazards Model Curves Months on Isoniazid by group e.g region, US-born status, etc..  Study and adopt interventions from other programs


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