Factors Associated with Unexpectedly Long Prescribed Therapy for Tuberculosis Patients Eligible for Short-Course Therapy in the United States, 2009 – 2016 Open Access

Patel, Neha (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/3484zg97k?locale=en
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Abstract

 

Background: Tuberculosis (TB) is a leading cause of death from an infectious agent and among the top 10 of all causes of death globally. TB is a treatable disease with a structured course of antibiotics, however the course can be complicated and long, often ranging from 6 – 12 months. Previous data has shown that TB patients with certain clinical characteristics may achieve comparable clinical outcomes on a shorter four month treatment regimen.

 

Objectives: Prescription of shorter regimens on a national scale in the US has not been well-studied.  This study assesses demographic and clinical risk factors associated with completion of unnecessarily long treatment among patients eligible for a shortened four month treatment course.

 

Methods: Data collected through the NTSS between 2009 and 2016 were used to look at associations between risk factors and completion of unexpectedly long treatment. Log binomial models were constructed from independent variables significantly associated with our outcome by univariate analysis plus any significant confounders.

 

Results: Between January 2009 and December 2016, there were 4,572 culture-negative pulmonary TB patients who completed their treatment regimen and met the eligibility criteria to receive a shortened four-month treatment. Asian (aRR: 0.96, 95% CI: 0.93 – 1.00) and black (aRR: 0.94, 95% CI: 0.90 – 0.98) TB patients had a higher likelihood of receiving appropriate shortened therapy compared to white patients (P < 0.05). Diabetics had an increased risk of receiving longer therapy compared to non-diabetics, even after adjusting for additional predictors (aRR: 1.04, 95% CI: 1.00 – 1.08). The risk of receiving unexpectedly long therapy was lower among patients in the Northeast, South, and West compared to the risk in patients in the Midwest (P < 0.05).

 

Conclusion: Patient characteristics such as race and ethnicity, US region of diagnosis, and diabetes were found to be significantly associated with completing unnecessarily longer therapy. Results may inform healthcare providers to promote shorter regimens in eligible populations, which may decrease adherence failure and reduce costs for TB treatments, thus decreasing burden on the public health system.

 

Table of Contents

 

 

CHAPTER I: LITERATURE REVIEW………………………………..1

 

Tuberculosis Transmission, Symptoms, and Diagnosis………...1

 

Global Burden …………………………………………………..2

 

Domestic Burden………………………………………………..2

 

Risk Factors……………………………………………………..3

 

Existing Treatments……………………………………………..4

 

Challenges in Treatment Adherence…………………………….5

 

Shortened 4 Month Treatment…………………………………..5

 

CHAPTER II: MANUSCRIPT………………………………………….8

 

Methods…………………………………………………………11

 

Results ………………………………………..…………...........14

 

Discussion……………………………………………….………16

 

References………………………………………………………21

 

Tables……………………………………………………………25

 

CHAPTER III: CONCLUSION……………………………………...…30

 

APPENDIX……………………………………………………………...31

 

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