Effectiveness of reporting on latent tuberculous infection in Massachusetts, 2006-2008

Reporting of Latent TB Infection Among Non-US-Born Persons Adjusting Their Immigration Status to Permanent Residents: An Opportunity to Enhance TB Prevention

From October 15, 2019, to June 12, 2020, Public Health-Seattle & King County conducted phone outreach to individuals referred to the public health department by civil surgeons. The objective was to explore common barriers and facilitators to treatment of latent tuberculosis infection (LTBI) among this population. Civil surgeons are mandated to report cases of LTBI to the state or local health department. Outreach revealed a wide variation in patient understanding of LTBI and provider practices around discussing LTBI and recommending LTBI treatment. The results of this small-scale study can inform public health strategies to engage with civil surgeons and their patients to both improve reporting practices and increase rates of LTBI treatment completion in patients born in high TB burden countries. In addition, these findings provide insight into what challenges and opportunities may emerge when health jurisdictions mandate LTBI reporting at a state or county level.

Yield of community-based tuberculosis targeted testing and treatment in foreign-born populations in the United States: A systematic review

Objective

To synthesize outputs and outcomes of community-based tuberculosis targeted testing and treatment (TTT) programs in foreign-born populations (FBP) in the United States (US).

Methods

We systematically searched five bibliographic databases and other key resources. Two reviewers independently applied eligibility criteria to screen citations and extracted data from included studies. We excluded studies that contained <50% FBP participants or that examined steps only after diagnosis of latent TB infection (LTBI). We stratified studies as majority FBP (50–90%) and predominantly FBP (>90%). We used random-effects meta-analytic models to calculate pooled proportions and 95% confidence intervals (CI) for community-based TTT cascade steps (e.g., recruited, tested and treated), and used them to create two hypothetical cascades for 100 individuals.

Results

Fifteen studies conducted in 10 US states met inclusion criteria. Studies were heterogeneous in recruitment strategies and mostly recruited participants born in Latin America. Of 100 hypothetical participants (predominantly FBP) reached by community-based TTT, 40.4 (95% CI 28.6 to 50.1) would have valid test results, 15.7 (95% CI 9.9 to 21.8) would test positive, and 3.6 (95% CI 1.4 to 6.0) would complete LTBI treatment. Likewise, of 100 hypothetical participants (majority FBP) reached, 77.9 (95% CI 54.0 to 92.1) would have valid test results, 26.5 (95% CI 18.0 to 33.5) would test positive, and 5.4 (95% CI 2.1 to 9.0) would complete LTBI treatment. Of those with valid test results, pooled proportions of LTBI test positive for predominantly FBP and majority FBP were 38.9% (95% CI 28.6 to 49.8) and 34.3% (95% CI 29.3 to 39.5), respectively.

Conclusions

We observed high attrition throughout the care cascade in FBP participating in LTBI community-based TTT studies. Few studies included cascade steps prior to LTBI diagnosis, limiting our review findings. Moreover, Asia-born populations in the US are substantially underrepresented in the FBP community-based TTT literature.

Evaluation of latent tuberculosis infection surveillance in Peel region, Ontario, 2010-2014

BACKGROUND

In Canada, identification and treatment of individuals with latent tuberculosis infection (LTBI) is a key component in preventing the progression of LTBI to active tuberculosis (TB). In Peel region, a large municipality in Ontario where half of the population is foreign-born, LTBI surveillance data are also critical to understanding the local epidemiology of TB.

OBJECTIVE

To evaluate LTBI surveillance data collected through the integrated Public Health Information System (iPHIS) from 2010 to 2014 by assessing data quality and usefulness and to provide recommendations to improve surveillance for Peel region.

METHODS

Using the European Centre for Disease Prevention and Control framework for surveillance evaluation, data quality was assessed based on completeness and validity of key variables in the iPHIS database. Usefulness of surveillance data in informing program decisions was assessed through interviews with stakeholders from Peel Public Health.

RESULTS

Of 6,576 iPHIS records evaluated, data for gender and date of birth were greater than 99% complete, while more than half of the risk factor fields were blank or 'unknown'. A comparison of 192 paper charts to the corresponding iPHIS record identified coding errors in over 40% of iPHIS risk factor fields. Treatment completion documented in iPHIS (20%) was lower than data obtained from a follow-up telephone survey of cases (50%). Stakeholders found surveillance data to be useful (100%), however, recommendations were made for improvement of data collection and analysis.

CONCLUSION

Evaluating LTBI surveillance to improve data quality and usefulness for program planning is essential in an era of TB elimination. This evaluation resulted in standardization of data entry processes and continuation of direct follow-up with LTBI clients to confirm treatment completion. Work to understand barriers to treatment initiation and completion is currently underway.