Cargando…
Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA
Latent tuberculosis infection (LTBI) treatment in persons at increased risk of disease progression is a key strategy with the strong potential to increase rate of tuberculosis (TB) decline in the United States. However, LTBI treatment in homeless persons, a population at high-risk of active TB disea...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588273/ https://www.ncbi.nlm.nih.gov/pubmed/31226132 http://dx.doi.org/10.1371/journal.pone.0218373 |
_version_ | 1783429223416856576 |
---|---|
author | Onwubiko, Udodirim Wall, Kristin Sales, Rose-Marie Holland, David P. |
author_facet | Onwubiko, Udodirim Wall, Kristin Sales, Rose-Marie Holland, David P. |
author_sort | Onwubiko, Udodirim |
collection | PubMed |
description | Latent tuberculosis infection (LTBI) treatment in persons at increased risk of disease progression is a key strategy with the strong potential to increase rate of tuberculosis (TB) decline in the United States. However, LTBI treatment in homeless persons, a population at high-risk of active TB disease, is usually associated with poor adherence. We describe the impact of using directly observed treatment (DOT) versus self-administered treatments (SAT) as an adherence-improving intervention to administer four months of daily rifampin regimen for LTBI treatment among homeless adults in Atlanta. Retrospective analysis of clinical care data on 274 homeless persons who initiated daily rifampin treatment for LTBI treatment at a county health department between January 2014 and December 2016 was performed. To reduce bias from non-random assignment of treatment, an inverse probability of treatment weighted (IPTW) logistic regression model was used to assess the effect of treatment type on treatment completion. Subgroup analyses were performed to assess heterogeneity of treatment effect on LTBI completion. Of 274 LTBI treatment initiators, 177 (65%) completed treatment [DOT 118/181 (65%), SAT 59/93 (63%)]. In the fully adjusted and weighted analysis, the odds of completing LTBI treatment on DOT was 40% higher than the odds of completing treatment by SAT [adjusted odds ratio (95% CI), aOR: 1.40 (1.07, 1.82), p = 0.014]. The unstable nature of homeless persons’ lifestyle makes LTBI treatment difficult for many reasons. Our study lends support to the use of DOT to improve LTBI treatment completion among subgroups of homeless persons on treatment with daily rifampin. |
format | Online Article Text |
id | pubmed-6588273 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-65882732019-06-28 Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA Onwubiko, Udodirim Wall, Kristin Sales, Rose-Marie Holland, David P. PLoS One Research Article Latent tuberculosis infection (LTBI) treatment in persons at increased risk of disease progression is a key strategy with the strong potential to increase rate of tuberculosis (TB) decline in the United States. However, LTBI treatment in homeless persons, a population at high-risk of active TB disease, is usually associated with poor adherence. We describe the impact of using directly observed treatment (DOT) versus self-administered treatments (SAT) as an adherence-improving intervention to administer four months of daily rifampin regimen for LTBI treatment among homeless adults in Atlanta. Retrospective analysis of clinical care data on 274 homeless persons who initiated daily rifampin treatment for LTBI treatment at a county health department between January 2014 and December 2016 was performed. To reduce bias from non-random assignment of treatment, an inverse probability of treatment weighted (IPTW) logistic regression model was used to assess the effect of treatment type on treatment completion. Subgroup analyses were performed to assess heterogeneity of treatment effect on LTBI completion. Of 274 LTBI treatment initiators, 177 (65%) completed treatment [DOT 118/181 (65%), SAT 59/93 (63%)]. In the fully adjusted and weighted analysis, the odds of completing LTBI treatment on DOT was 40% higher than the odds of completing treatment by SAT [adjusted odds ratio (95% CI), aOR: 1.40 (1.07, 1.82), p = 0.014]. The unstable nature of homeless persons’ lifestyle makes LTBI treatment difficult for many reasons. Our study lends support to the use of DOT to improve LTBI treatment completion among subgroups of homeless persons on treatment with daily rifampin. Public Library of Science 2019-06-21 /pmc/articles/PMC6588273/ /pubmed/31226132 http://dx.doi.org/10.1371/journal.pone.0218373 Text en © 2019 Onwubiko et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Onwubiko, Udodirim Wall, Kristin Sales, Rose-Marie Holland, David P. Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA |
title | Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA |
title_full | Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA |
title_fullStr | Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA |
title_full_unstemmed | Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA |
title_short | Using Directly Observed Therapy (DOT) for latent tuberculosis treatment – A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA |
title_sort | using directly observed therapy (dot) for latent tuberculosis treatment – a hit or a miss? a propensity score analysis of treatment completion among 274 homeless adults in fulton county, ga |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588273/ https://www.ncbi.nlm.nih.gov/pubmed/31226132 http://dx.doi.org/10.1371/journal.pone.0218373 |
work_keys_str_mv | AT onwubikoudodirim usingdirectlyobservedtherapydotforlatenttuberculosistreatmentahitoramissapropensityscoreanalysisoftreatmentcompletionamong274homelessadultsinfultoncountyga AT wallkristin usingdirectlyobservedtherapydotforlatenttuberculosistreatmentahitoramissapropensityscoreanalysisoftreatmentcompletionamong274homelessadultsinfultoncountyga AT salesrosemarie usingdirectlyobservedtherapydotforlatenttuberculosistreatmentahitoramissapropensityscoreanalysisoftreatmentcompletionamong274homelessadultsinfultoncountyga AT hollanddavidp usingdirectlyobservedtherapydotforlatenttuberculosistreatmentahitoramissapropensityscoreanalysisoftreatmentcompletionamong274homelessadultsinfultoncountyga |