Burman, M;
Zenner, D;
Copas, AJ;
Goscé, L;
Haghparast-Bidgoli, H;
White, PJ;
Hickson, V;
... Kunst, H; + view all
(2024)
Treatment of latent tuberculosis infection in migrants in primary care versus secondary care.
The European respiratory journal
, 64
(5)
, Article 2301733. 10.1183/13993003.01733-2023.
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Abstract
BACKGROUND: Control of latent tuberculosis infection (LTBI) is a priority in the World Health Organization strategy to eliminate TB. Many high-income, low TB incidence countries have prioritised LTBI screening and treatment in recent migrants. We tested whether a novel model of care, based entirely within primary care, was effective and safe compared to secondary care. METHODS: This was a pragmatic cluster-randomised, parallel group, superiority trial (ClinicalTrials.gov: NCT03069807) conducted in 34 general practices in London, UK, comparing LTBI treatment in recent migrants in primary care to secondary care. The primary outcome was treatment completion, defined as taking ≥90% of antibiotic doses. Secondary outcomes included treatment acceptance, adherence, adverse effects, patient satisfaction, TB incidence and a cost-effectiveness analysis. Analyses were performed on an intention-to-treat basis. RESULTS: Between September 2016 and May 2019, 362 recent migrants with LTBI were offered treatment and 276 accepted. Treatment completion was similar in primary and secondary care (82.6% versus 86.0%; adjusted OR (aOR) 0.64, 95% CI 0.31-1.29). There was no difference in drug-induced liver injury between primary and secondary care (0.7% versus 2.3%; aOR 0.29, 95% CI 0.03-2.84). Treatment acceptance was lower in primary care (65.2% (146/224) versus 94.2% (130/138); aOR 0.10, 95% CI 0.03-0.30). The estimated cost per patient completing treatment was lower in primary care, with an incremental saving of GBP 315.27 (95% CI 313.47-317.07). CONCLUSIONS: The treatment of LTBI in recent migrants within primary care does not result in higher rates of treatment completion but is safe and costs less when compared to secondary care.
| Type: | Article |
|---|---|
| Title: | Treatment of latent tuberculosis infection in migrants in primary care versus secondary care |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1183/13993003.01733-2023 |
| Publisher version: | http://dx.doi.org/10.1183/13993003.01733-2023 |
| Language: | English |
| Additional information: | Copyright ©The authors 2024. This version is distributed under the terms of the Creative Commons Attribution Licence 4.0. |
| Keywords: | Humans, Latent Tuberculosis, Primary Health Care, Female, Male, Adult, Secondary Care, Transients and Migrants, Cost-Benefit Analysis, Antitubercular Agents, London, Middle Aged, Young Adult, Medication Adherence, Adolescent |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10200731 |
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