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Salerno MM, Burzynski J, Mangan JM, Hill A, deCastro BR, Goswami ND, Lam CK, Macaraig M, Schluger NW, Vernon AA. Adverse events among persons with TB using in-person vs. electronic directly observed therapy. Int J Tuberc Lung Dis 2023; 27:833-840. [PMID: 37880884 PMCID: PMC10794055 DOI: 10.5588/ijtld.22.0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND: We evaluated patient safety within a randomized crossover trial comparing electronic directly observed therapy (eDOT) to in-person DOT (ipDOT) in persons undergoing TB treatment in New York City, NY, USA.METHODS: Participant symptoms, symptom severity, and clinical management were documented. We assessed adverse event reports (AERs) by DOT method during the two-period crossover. Using Cox proportional-hazards mixed-effects models, we estimated the adjusted hazard ratio (aHR) of participants reporting an adverse event (AE) vs. not reporting an AE.RESULTS: Of 211 participants, 57 (27.0%) reported AEs during the two-period crossover; of these, 54.4% (31/57) were reported while using eDOT vs. 45.6% (26/57) while using ipDOT. Controlling for study group and period, the aHR for eDOT vs. ipDOT was 0.98 (95% CI 0.49-1.93). Although statistically not significant, the wide confidence intervals suggest that a significant association cannot be entirely ruled out. Gastrointestinal symptoms were most frequently reported (42.1%, 24/57). AER types and severity did not differ significantly by DOT method. Days from symptom onset to medical attention was similar across DOT methods (median: 1.0 day, IQR 0.0-2.0). No participants switched DOT methods due to AERs or monitoring concerns.CONCLUSION: Further evaluation to ascertain whether AERs differ when patients use eDOT vs. ipDOT is warranted.
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Affiliation(s)
- M M Salerno
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, NY
| | - J Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - J M Mangan
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - A Hill
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - B Rey deCastro
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - N D Goswami
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - C K Lam
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - M Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - N W Schluger
- New York Medical College, School of Medicine, Valhalla, NY
| | - A A Vernon
- Division of Viral Diseases, Centers for Disease Control, Atlanta, GA, USA
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Easton AV, Salerno MM, Trieu L, Humphrey E, Kaba F, Macaraig M, Dworkin F, Nilsen DM, Burzynski J. Cohort study of the mortality among patients in New York City with tuberculosis and COVID-19, March 2020 to June 2022. PLOS Glob Public Health 2023; 3:e0001758. [PMID: 37186110 PMCID: PMC10132536 DOI: 10.1371/journal.pgph.0001758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/07/2023] [Indexed: 05/17/2023]
Abstract
Both tuberculosis (TB) and COVID-19 can affect the respiratory system, and early findings suggest co-occurrence of these infectious diseases can result in elevated mortality. A retrospective cohort of patients who were diagnosed with TB and COVID-19 concurrently (within 120 days) between March 2020 and June 2022 in New York City (NYC) was identified. This cohort was compared with a cohort of patients diagnosed with TB-alone during the same period in terms of demographic information, clinical characteristics, and mortality. Cox proportional hazards regression was used to compare mortality between patient cohorts. One hundred and six patients with concurrent TB/COVID-19 were identified and compared with 902 patients with TB-alone. These two cohorts of patients were largely demographically and clinically similar. However, mortality was higher among patients with concurrent TB/COVID-19 in comparison to patients with TB-alone, even after controlling for age and sex (hazard ratio 2.62, 95% Confidence Interval 1.66-4.13). Nearly one in three (22/70, 31%) patients with concurrent TB/COVID-19 aged 45 and above died during the study period. These results suggest that TB patients with concurrent COVID-19 were at high risk for mortality. It is important that, as a high-risk group, patients with TB are prioritized for resources to quickly diagnose and treat COVID-19, and provided with tools and information to protect themselves from COVID-19.
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Affiliation(s)
- Alice V. Easton
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Marco M Salerno
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Lisa Trieu
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Erica Humphrey
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Fanta Kaba
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Michelle Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Felicia Dworkin
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Diana M. Nilsen
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Joseph Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
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Mangan JM, Burzynski J, deCastro BR, Salerno MM, Lam CK, Macaraig M, Reaves M, Kiskadden-Bechtel S, Bowers S, Sathi C, Dias MP, Goswami ND, Vernon A. Challenges associated with electronic and in-person directly observed therapy during a randomized trial. Int J Tuberc Lung Dis 2023; 27:298-307. [PMID: 37035970 PMCID: PMC10807436 DOI: 10.5588/ijtld.22.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND: Electronic directly observed therapy (eDOT) has been proposed as an alternative to traditional in-person DOT (ipDOT) for monitoring TB treatment adherence. Information about the comparative performance and implementation of eDOT is limited.METHODS: The frequency of challenges during DOT, challenge type, and effect on medication observation were documented by DOT method during a crossover, noninferiority randomized controlled trial. A logistic mixed-effects model that adjusted for the study design was used to estimate the percentage of successfully observed doses when challenges occurred.RESULTS: A total of 20,097 medication doses were scheduled for observation with either eDOT (15,405/20,097; 76.7%) or ipDOT (4,692/20,097; 23.3%) for 213 study participants. In total, one or more challenges occurred during 17.3% (2,672/15,405) of eDOT sessions and 15.6% (730/4,692) of ipDOT sessions. Among 4,374 documented challenges, 27.3% (n = 1,192) were characterized as technical, 65.9% (n = 2,881) were patient-related, and 6.9% (n = 301) were program-related. Estimated from the logistic model (n = 6,782 doses, 173 participants), the adjusted percentage of doses successfully observed during problematic sessions was 21.7% (95% CI 11.2-37.8) for eDOT and 4.2% (95% CI 1.1-14.7) for ipDOT.CONCLUSION: Compared to ipDOT, challenges were encountered in a slightly higher percentage of eDOT sessions but were more often resolved to enable successful dose observation during problematic sessions.
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Affiliation(s)
- J M Mangan
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA, USA
| | - J Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - B Rey deCastro
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA, USA
| | - M M Salerno
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA, Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, NY, USA
| | - C K Lam
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA, USA, Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - M Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - M Reaves
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA, Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, NY, USA
| | - S Kiskadden-Bechtel
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA, Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, NY, USA
| | - S Bowers
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA, USA, Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - C Sathi
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA, Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, NY, USA
| | - M P Dias
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA, Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, NY, USA
| | - N D Goswami
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA, USA
| | - A Vernon
- Division of Viral Diseases, Centers for Disease Control, Atlanta, GA, USA
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Burzynski J, Mangan JM, Lam CK, Macaraig M, Salerno MM, deCastro BR, Goswami ND, Lin CY, Schluger NW, Vernon A. In-Person vs Electronic Directly Observed Therapy for Tuberculosis Treatment Adherence: A Randomized Noninferiority Trial. JAMA Netw Open 2022; 5:e2144210. [PMID: 35050357 PMCID: PMC8777548 DOI: 10.1001/jamanetworkopen.2021.44210] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Electronic directly observed therapy (DOT) is used increasingly as an alternative to in-person DOT for monitoring tuberculosis treatment. Evidence supporting its efficacy is limited. OBJECTIVE To determine whether electronic DOT can attain a level of treatment observation as favorable as in-person DOT. DESIGN, SETTING, AND PARTICIPANTS This was a 2-period crossover, noninferiority trial with initial randomization to electronic or in-person DOT at the time outpatient tuberculosis treatment began. The trial enrolled 216 participants with physician-suspected or bacteriologically confirmed tuberculosis from July 2017 to October 2019 in 4 clinics operated by the New York City Health Department. Data analysis was conducted between March 2020 and April 2021. INTERVENTIONS Participants were asked to complete 20 medication doses using 1 DOT method, then switched methods for another 20 doses. With in-person therapy, participants chose clinic or community-based DOT; with electronic DOT, participants chose live video-conferencing or recorded videos. MAIN OUTCOMES AND MEASURES Difference between the percentage of medication doses participants were observed to completely ingest with in-person DOT and with electronic DOT. Noninferiority was demonstrated if the upper 95% confidence limit of the difference was 10% or less. We estimated the percentage of completed doses using a logistic mixed effects model, run in 4 modes: modified intention-to-treat, per-protocol, per-protocol with 85% or more of doses conforming to the randomization assignment, and empirical. Confidence intervals were estimated by bootstrapping (with 1000 replicates). RESULTS There were 173 participants in each crossover period (median age, 40 years [range, 16-86 years]; 140 [66%] men; 80 [37%] Asian and Pacific Islander, 43 [20%] Black, and 71 [33%] Hispanic individuals) evaluated with the model in the modified intention-to-treat analytic mode. The percentage of completed doses with in-person DOT was 87.2% (95% CI, 84.6%-89.9%) vs 89.8% (95% CI, 87.5%-92.1%) with electronic DOT. The percentage difference was -2.6% (95% CI, -4.8% to -0.3%), consistent with a conclusion of noninferiority. The 3 other analytic modes yielded equivalent conclusions, with percentage differences ranging from -4.9% to -1.9%. CONCLUSIONS AND RELEVANCE In this trial, the percentage of completed doses under electronic DOT was noninferior to that under in-person DOT. This trial provides evidence supporting the efficacy of this digital adherence technology, and for the inclusion of electronic DOT in the standard of care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03266003.
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Affiliation(s)
- Joseph Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Joan M. Mangan
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chee Kin Lam
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, New York
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Marco M. Salerno
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, New York
- Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, New York
| | - B. Rey deCastro
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neela D. Goswami
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Y. Lin
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neil W. Schluger
- Division of Pulmonary, Allergy & Critical Care, Columbia University, New York, New York
| | - Andrew Vernon
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Beeler Asay GR, Lam CK, Stewart B, Mangan JM, Romo L, Marks SM, Morris SB, Gummo CL, Keh CE, Hill AN, Thomas A, Macaraig M, St John K, J Ampie T, Chuck C, Burzynski J. Cost of Tuberculosis Therapy Directly Observed on Video for Health Departments and Patients in New York City; San Francisco, California; and Rhode Island (2017-2018). Am J Public Health 2020; 110:1696-1703. [PMID: 32941064 DOI: 10.2105/ajph.2020.305877] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess costs of video and traditional in-person directly observed therapy (DOT) for tuberculosis (TB) treatment to health departments and patients in New York City, Rhode Island, and San Francisco, California.Methods. We collected health department costs for video DOT (VDOT; live and recorded), and in-person DOT (field- and clinic-based). Time-motion surveys estimated provider time and cost. A separate survey collected patient costs. We used a regression model to estimate cost by DOT type.Results. Between August 2017 and June 2018, 343 DOT sessions were captured from 225 patients; 87 completed a survey. Patient costs were lowest for VDOT live ($1.01) and highest for clinic DOT ($34.53). The societal (health department + patient) costs of VDOT live and recorded ($6.65 and $12.64, respectively) were less than field and clinic DOT ($21.40 and $46.11, respectively). VDOT recorded health department cost was not statistically different from field DOT cost in Rhode Island.Conclusions. Among the 4 different modalities, both types of VDOT were associated with lower societal costs when compared with traditional forms of DOT.Public Health Implications. VDOT was associated with lower costs from the societal perspective and may reduce public health costs when TB incidence is high.
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Affiliation(s)
- Garrett R Beeler Asay
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Chee Kin Lam
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Brock Stewart
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Joan M Mangan
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Laura Romo
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Suzanne M Marks
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Sapna Bamrah Morris
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Caroline L Gummo
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Chris E Keh
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Andrew N Hill
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Anila Thomas
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Michelle Macaraig
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Kristen St John
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Teresita J Ampie
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Christine Chuck
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - Joseph Burzynski
- Garrett R. Beeler Asay, Chee Kin Lam, Brock Stewart, Joan M. Mangan, Suzanne M. Marks, Sapna Bamrah Morris, Andrew N. Hill, and Anila Thomas are with the Division of Tuberculosis Elimination; National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Atlanta, GA. Laura Romo, Chris E. Keh, and Teresita J. Ampie are with the San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, Tuberculosis Prevention and Control, San Francisco, CA. Caroline L. Gummo and Kristen St John are with the Rhode Island Department of Health, Center for HIV, Hepatitis, STD, and Tuberculosis Epidemiology, Providence. Michelle Macaraig, Christine Chuck, and Joseph Burzynski are with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
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Burzynski J, Macaraig M, Nilsen D, Schluger NW. Transforming essential services for tuberculosis during the COVID-19 pandemic: lessons from New York City. Int J Tuberc Lung Dis 2020; 24:735-736. [PMID: 32718411 DOI: 10.5588/ijtld.20.0283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J Burzynski
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - M Macaraig
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - D Nilsen
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - N W Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA, ,
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Lam CK, Fluegge K, Macaraig M, Burzynski J. Cost savings associated with video directly observed therapy for treatment of tuberculosis. Int J Tuberc Lung Dis 2019; 23:1149-1154. [PMID: 31718750 DOI: 10.5588/ijtld.18.0625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To calculate the per-session and annual direct program costs to implement directly observed therapy (DOT) for tuberculosis treatment and to conduct a cost attribution analysis under varying proportions of DOT utilization for four DOT types.DESIGN: Program data covering the study period from September 2014 to August 2015 in New York City (NYC) were used to conduct a retrospective bottom-up micro-costing economic evaluation. For each DOT type, potential per-session and annual program savings were estimated as the cost averted by adopting a uniform distribution of DOT alternatives. Sensitivity analyses explored aggregate cost impacts of unequal distributions.RESULTS: There was a total of 38 035 unique DOT visits, of which 12 002 (32%) were clinic-based (CDOT); 15 483 (41%) were field-based (FDOT); 7185 (19%) were live-video (LVDOT); and 3365 (9%) were recorded-video (RVDOT). The per-session direct costs (in 2016 $US) for DOT services delivered during the study period were $8.46 for CDOT; $19.83 for FDOT; $6.54 for LVDOT; and $5.35 for RVDOT. Sensitivity analyses supported the main findings.CONCLUSIONS: Significant cost savings were estimated with increased utilization of VDOT. Assuming equivalent treatment adherence, duration, completion, and adverse events across DOT types, RVDOT was the modality that most minimized cost.
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Affiliation(s)
- C K Lam
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA
| | - K Fluegge
- Policy, Planning and Strategic Data Use, Office of the First Deputy Commissioner, New York City Department of Health and Mental Hygiene, Queens, NY, Institute of Health and Environmental Research, Cleveland, OH, USA
| | - M Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
| | - J Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY
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Lam CK, McGinnis Pilote K, Haque A, Burzynski J, Chuck C, Macaraig M. Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study. J Med Internet Res 2018; 20:e287. [PMID: 30459146 PMCID: PMC6280031 DOI: 10.2196/jmir.9825] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/31/2018] [Accepted: 06/28/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Since January 2013, the New York City (NYC) Health Department Tuberculosis (TB) Program has offered persons diagnosed with latent TB infection (LTBI) the 3-month, once-weekly isoniazid and rifapentine (3HP) treatment regimen. Patients on this treatment are monitored in-person under directly observed therapy (DOT). To address patient and provider barriers to in-person DOT, we piloted the use of a videoconferencing software app to remotely conduct synchronous DOT (video directly observed therapy; VDOT) for patients on 3HP. OBJECTIVE The objective of our study was to evaluate the implementation of VDOT for patients on 3HP and to assess whether treatment completion for these patients increased when they were monitored using VDOT compared with that using the standard in-person DOT. METHODS Between February and October 2015, patients diagnosed with LTBI at any of the four NYC Health Department TB clinics who met eligibility criteria for treatment with 3HP under VDOT (V3HP) were followed until 16 weeks after treatment initiation, with treatment completion defined as ingestion of 11 doses within 16 weeks. Treatment completion of patients on V3HP was compared with that of patients on 3HP under clinic-based, in-person DOT who were part of a prior study in 2013. Furthermore, outcomes of video sessions with V3HP patients were collected and analyzed. RESULTS During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001). A total of 360 video sessions were conducted for V3HP patients with a median of 8 (range: 1-11) sessions per patient and a median time of 4 (range: 1-59) minutes per session. Adherence issues (eg, >15 minutes late) during video sessions occurred 104 times. No major side effects were reported by V3HP patients. CONCLUSIONS The NYC TB program observed higher treatment completion with VDOT than that previously seen with clinic DOT among patients on 3HP. Expanding the use of VDOT may improve treatment completion and corresponding outcomes for patients with LTBI.
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Affiliation(s)
- Chee Kin Lam
- Centers for Disease Control and Prevention, Atlanta, GA, United States.,Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Kara McGinnis Pilote
- Centers for Disease Control and Prevention, Atlanta, GA, United States.,Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Ashraful Haque
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Joseph Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Christine Chuck
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Michelle Macaraig
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
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Chuck C, Robinson E, Macaraig M, Alexander M, Burzynski J. Enhancing management of tuberculosis treatment with video directly observed therapy in New York City. Int J Tuberc Lung Dis 2017; 20:588-93. [PMID: 27084810 DOI: 10.5588/ijtld.15.0738] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Directly observed therapy (DOT), the standard of care for monitoring patients on treatment for tuberculosis (TB), requires substantial health department resources, and can be inconvenient and disruptive for patients. OBJECTIVE To determine whether video technology for remote observation of patients on anti-tuberculosis treatment (VDOT) is as effective as in-person DOT. DESIGN Eligible TB patients in New York City were prospectively enrolled in VDOT from September 2013 to September 2014. We compared treatment outcomes and worker output for VDOT and in-person DOT. RESULTS Among 390 patients on DOT for the treatment of TB, 61 (16%) were on VDOT and 329 (84%) on in-person DOT. Adherence to scheduled VDOT sessions was 95% (3292/3455) compared to 91% (32 204/35 442) with in-person DOT (>P < 0.01). VDOT enabled a DOT worker to observe a maximum of 25 patients per day, similar to DOT workers who observed patients in clinic (n = 25), but twice that of DOT workers who observed patients in the community (n = 12). Treatment completion with VDOT was similar to that with in-person DOT (96% vs. 97%, P = 0.63). The primary problems encountered during VDOT sessions were interruption of video and audio connectivity. CONCLUSION Implementation of VDOT resulted in successful anti-tuberculosis treatment outcomes while maximizing health department resources.
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Affiliation(s)
- C Chuck
- New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA
| | - E Robinson
- New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA
| | - M Macaraig
- New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA
| | - M Alexander
- New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA
| | - J Burzynski
- New York City Department of Health and Mental Hygiene, Queens, New York, New York, USA
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Stennis NL, Burzynski JN, Herbert C, Nilsen D, Macaraig M. Treatment for Tuberculosis Infection With 3 Months of Isoniazid and Rifapentine in New York City Health Department Clinics. Clin Infect Dis 2015; 62:53-59. [PMID: 26338781 DOI: 10.1093/cid/civ766] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Completion of treatment for tuberculosis infection (TBI) with 9 months of self-administered daily isoniazid (9H) has historically been low (<50%) among New York City (NYC) Health Department tuberculosis clinic patients. Treatment of TBI with 3 months of once-weekly isoniazid and rifapentine (3HP) administered under directly observed therapy (DOT) might increase treatment acceptance and completion. METHODS The study population included patients diagnosed with TBI at 2 NYC Health Department tuberculosis clinics from January 2013 through November 2013. Treatment acceptance and completion with 3HP were compared with historical estimates. Treatment outcomes, side effects, and reasons for refusing 3HP were described. RESULTS Among 631 patients eligible for TBI treatment, 503 (80%) were offered 3HP; 302 (60%) accepted, 92 (18%) chose other treatment, and 109 (22%) refused treatment. The most common reason for refusing 3HP was the clinic-based DOT requirement. Forty (13%) patients treated with 3HP experienced side effects--9 were restarted on 3HP, 18 switched treatment regimens, and 13 discontinued. Although treatment acceptance did not differ from historical estimates (78% vs 79%, P = .75), treatment completion increased significantly (65% vs 34%, P < .01). CONCLUSIONS Implementation of 3HP in 2 NYC Health Department tuberculosis clinics increased TBI treatment completion by 31 percentage points compared with historical estimates. More flexible DOT options may improve acceptance of 3HP. Wider use of 3HP may substantially improve TBI treatment completion in NYC and advance progress toward tuberculosis elimination.
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Affiliation(s)
- Natalie L Stennis
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, Long Island City, New York
| | - Joseph N Burzynski
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, Long Island City, New York
| | - Cheryl Herbert
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, Long Island City, New York
| | - Diana Nilsen
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, Long Island City, New York
| | - Michelle Macaraig
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, Long Island City, New York
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Affiliation(s)
- Michelle Macaraig
- From the New York City Department of Health and Mental Hygiene, New York
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Macaraig M, Agerton T, Driver CR, Munsiff SS, Abdelwahab J, Park J, Kreiswirth B, Driscoll J, Zhao B. Strain-specific differences in two large Mycobacterium tuberculosis genotype clusters in isolates collected from homeless patients in New York City from 2001 to 2004. J Clin Microbiol 2006; 44:2890-6. [PMID: 16891508 PMCID: PMC1594631 DOI: 10.1128/jcm.00160-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We studied two large Mycobacterium tuberculosis genotype clusters associated with recent outbreaks in homeless persons to determine factors associated with these tuberculosis (TB) strains. Isolates from all culture-positive TB cases diagnosed from 1 January 2001 to 31 December 2004 were genotyped. Patients whose isolates had identical restriction fragment length polymorphism patterns and spoligotypes were considered clustered. Health department records were reviewed and reinterviews attempted for clustered cases. Patients with the Cs30 and BEs75 strains were compared to other genotypically clustered cases and to each other. The two largest genotype clusters among homeless persons were the Cs30 strain (n = 105) and the BEs75 strain (n = 47). Fifty-one (49%) patients with the Cs30 strain and 28 (60%) with the BEs75 strain were homeless. Compared to patients with the BEs75 strain, patients with the Cs30 strain were less likely to be respiratory acid-fast bacillus smear positive (51% versus 72%). Furthermore, patients with the BEs75 strain were more likely to be HIV infected (74% versus 42%), which suggests that most patients with this strain advanced to disease after recent infection. Cases in clusters of strains that have been circulating in the community over a long time period, such as the Cs30 strain, require additional investigation to determine whether clustering is a result of recent transmission or reactivation of remote infection.
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Affiliation(s)
- Michelle Macaraig
- New York City Department of Health and Mental Hygiene, 225 Broadway, 22nd Floor, New York, NY 10007, USA.
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Driver CR, Kreiswirth B, Macaraig M, Clark C, Munsiff SS, Driscoll J, Zhao B. Molecular epidemiology of tuberculosis after declining incidence, New York City, 2001-2003. Epidemiol Infect 2006; 135:634-43. [PMID: 17064454 PMCID: PMC2870613 DOI: 10.1017/s0950268806007278] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculosis incidence in New York City (NYC) declined between 1992 and 2000 from 51.1 to 16.6 cases per 100,000 population. In January 2001, universal real-time genotyping of TB cases was implemented in NYC. Isolates from culture-confirmed tuberculosis cases from 2001 to 2003 were genotyped using IS6110 and spoligotype to describe the extent and factors associated with genotype clustering after declining TB incidence. Of 2408 (91.8%) genotyped case isolates, 873 (36.2%) had a pattern indistinguishable from that of another study period case, forming 212 clusters; 248 (28.4%) of the clustered cases had strains believed to have been widely transmitted during the epidemic years in the early 1990s in NYC. An estimated 27.4% (873 minus 212) of the 2408 cases were due to recent infection that progressed to active disease during the study period. Younger age, birth in the United States, homelessness, substance abuse and presence of TB symptoms were independently associated with greater odds of clustering.
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Affiliation(s)
- C R Driver
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, New York, NY 10007, USA.
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Driver CR, Macaraig M, McElroy PD, Clark C, Munsiff SS, Kreiswirth B, Driscoll J, Zhao B. Which patients' factors predict the rate of growth of Mycobacterium tuberculosis clusters in an urban community? Am J Epidemiol 2006; 164:21-31. [PMID: 16641308 DOI: 10.1093/aje/kwj153] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Factors influencing tuberculosis cluster growth are poorly understood. The authors examined clusters of two or more culture-confirmed Mycobacterium tuberculosis cases between January 1, 2001, and December 31, 2003, that had insertion sequence 6110 (IS6110) restriction fragment length polymorphism and spoligotype patterns identical to those of another study case. Genotypes first seen in New York, New York, before or during 1993 were considered historical; recent strains were those first seen after 1993. The authors examined the effect of the combined characteristics of infectiousness of the first two cases in a cluster on the rate of cluster growth. Genotyping was performed for 2,408 (91.8%) of the 2,623 tuberculosis cases diagnosed; 873 cases were in 212 clusters. Thirty-one clusters had historical strains, 153 were recent, and 28 were of unknown period. Patients' infectiousness was not associated with the rate of cluster growth among historical strain clusters. Among recent strain clusters, infectiousness of both of the initial cases was associated with a higher rate of cluster growth compared with clusters in which neither initial case was infectious, upon adjustment for male sex (rate ratio = 2.62, 95% confidence interval: 1.19, 5.78). The rate of genotype cluster growth should be monitored regardless of how long the strain has been present in the community. However, infectiousness in the first two cases may be useful to prioritize genotype cluster investigations.
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Affiliation(s)
- Cynthia R Driver
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York, NY 10007, USA.
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Manangan LP, Moore M, Macaraig M, MacNeil J, Shevick G, Northrup J, Pratt R, Adams LV, Boutotte J, Sharnprapai S, Qualls N. Health department costs of managing persons with suspected and noncounted tuberculosis in New York City, Three Texas counties, and Massachusetts. J Public Health Manag Pract 2006; 12:248-53. [PMID: 16614560 DOI: 10.1097/00124784-200605000-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe persons with suspected (did not meet the national tuberculosis [TB] surveillance case definition) and noncounted TB (met the TB case definition but transferred and were counted by another jurisdiction) and estimate costs incurred by public health departments for managing them. METHODS We reviewed TB registry, medical records, budgets, bills, salaries, organizational charts, and travel/activity logs from the year 2000 at health departments in New York City (NYC), three Texas (TX) counties (El Paso, Hidalgo, and Webb), and Massachusetts (MA). We also interviewed or observed personnel to estimate the time spent on activities for these patients. RESULTS In 2000, NYC and MA had more persons with suspected (n = 2,996) and noncounted (n = 163) TB than with counted (n = 1,595) TB. TX counties had more persons with counted TB (n = 179) than with suspected (n = 55) and noncounted (n = 15) TB. Demographic and clinical characteristics varied widely. For persons with suspected TB, NYC spent an estimated $1.7 million, with an average cost of $636 for each person; TX counties spent $60,928 ($1,108 per patient); and MA spent $1.1 million ($3,330 per patient). For persons with noncounted TB, NYC spent $303,148 ($2,180 per patient), TX counties spent $40,002 ($2,667 per patient), and MA spent $84,603 ($3,525 per patient). CONCLUSIONS Health departments incurred substantial costs in managing persons with suspected and noncounted TB. These costs should be considered when allocating TB program resources.
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Affiliation(s)
- Lilia P Manangan
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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