Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening
Abstract Background Refugees are at increased risk of developing tuberculosis (TB) soon after resettlement. Targeting high-risk populations for latent tuberculosis infection (LTBI) screening and treatment is an important measure towards eliminating TB in low incidence countries, however, there are l...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-09-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-021-06637-z |
| _version_ | 1819140008069562368 |
|---|---|
| author | R. K. Lim R. Talavlikar O. Chiazor J. Bietz H. Gardiner D. Fisher |
| author_facet | R. K. Lim R. Talavlikar O. Chiazor J. Bietz H. Gardiner D. Fisher |
| author_sort | R. K. Lim |
| collection | DOAJ |
| description | Abstract Background Refugees are at increased risk of developing tuberculosis (TB) soon after resettlement. Targeting high-risk populations for latent tuberculosis infection (LTBI) screening and treatment is an important measure towards eliminating TB in low incidence countries, however, there are low rates of screening and treatment completion in the LTBI cascade of care. The authors hypothesized that an interferon-gamma release assay (IGRA) screening strategy would lead to a higher proportion of refugees completing LTBI screening and treatment, compared to sequential screening with tuberculin skin test (TST) and confirmatory IGRA. Methods This retrospective cohort study included eligible refugees screened with a sequential strategy versus a solo-IGRA strategy at different time periods from a centralized refugee clinic. The primary outcome was the proportion completing LTBI screening in each cohort. Results A total of 471 subjects were included (240 in sequential screening, 231 in solo-IGRA screening). 54% of refugees completed LTBI screening with sequential testing, compared to 85% of those screened with a solo-IGRA. Time to completing screening was also shorter in the solo-QFT group (difference 16.5 days, p < 0.01, 95% confidence interval 9.3, 23.7). There was a higher incidence of LTBI diagnosis in the solo-IGRA group (41 versus 20, p = 0.002). Screening completion was predicted by solo-IGRA screening (aOR 3.74, 95% confidence interval 2.30, 6.09; p < 0.001) and if refugees were privately-sponsored (aOR 2.81, 95% confidence interval 1.53, 5.15; p = 0.001). Treatment completion rates did not differ between groups. Conclusion This study has identified fewer dropouts in the LTBI cascade of care if a solo-IGRA strategy is used for screening. An IGRA should be strongly considered as the screening method for refugees arriving in low-incidence settings if resources are available. |
| first_indexed | 2024-12-22T11:31:43Z |
| format | Article |
| id | doaj.art-bb6db0bf51934cefaf04d949f1067ffe |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-22T11:31:43Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-bb6db0bf51934cefaf04d949f1067ffe2022-12-21T18:27:36ZengBMCBMC Infectious Diseases1471-23342021-09-012111810.1186/s12879-021-06637-zFewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screeningR. K. Lim0R. Talavlikar1O. Chiazor2J. Bietz3H. Gardiner4D. Fisher5Cumming School of Medicine, University of CalgaryMosaic Refugee Health Clinic, Mosaic Primary Care NetworkMosaic Refugee Health Clinic, Mosaic Primary Care NetworkMosaic Refugee Health Clinic, Mosaic Primary Care NetworkCalgary Tuberculosis Services, Alberta Health ServicesCumming School of Medicine, University of CalgaryAbstract Background Refugees are at increased risk of developing tuberculosis (TB) soon after resettlement. Targeting high-risk populations for latent tuberculosis infection (LTBI) screening and treatment is an important measure towards eliminating TB in low incidence countries, however, there are low rates of screening and treatment completion in the LTBI cascade of care. The authors hypothesized that an interferon-gamma release assay (IGRA) screening strategy would lead to a higher proportion of refugees completing LTBI screening and treatment, compared to sequential screening with tuberculin skin test (TST) and confirmatory IGRA. Methods This retrospective cohort study included eligible refugees screened with a sequential strategy versus a solo-IGRA strategy at different time periods from a centralized refugee clinic. The primary outcome was the proportion completing LTBI screening in each cohort. Results A total of 471 subjects were included (240 in sequential screening, 231 in solo-IGRA screening). 54% of refugees completed LTBI screening with sequential testing, compared to 85% of those screened with a solo-IGRA. Time to completing screening was also shorter in the solo-QFT group (difference 16.5 days, p < 0.01, 95% confidence interval 9.3, 23.7). There was a higher incidence of LTBI diagnosis in the solo-IGRA group (41 versus 20, p = 0.002). Screening completion was predicted by solo-IGRA screening (aOR 3.74, 95% confidence interval 2.30, 6.09; p < 0.001) and if refugees were privately-sponsored (aOR 2.81, 95% confidence interval 1.53, 5.15; p = 0.001). Treatment completion rates did not differ between groups. Conclusion This study has identified fewer dropouts in the LTBI cascade of care if a solo-IGRA strategy is used for screening. An IGRA should be strongly considered as the screening method for refugees arriving in low-incidence settings if resources are available.https://doi.org/10.1186/s12879-021-06637-zTuberculosisLatent tuberculosisScreeningRefugee |
| spellingShingle | R. K. Lim R. Talavlikar O. Chiazor J. Bietz H. Gardiner D. Fisher Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening BMC Infectious Diseases Tuberculosis Latent tuberculosis Screening Refugee |
| title | Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening |
| title_full | Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening |
| title_fullStr | Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening |
| title_full_unstemmed | Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening |
| title_short | Fewer losses in the cascade of care for latent tuberculosis with solo interferon-gamma release assay screening compared to sequential screening |
| title_sort | fewer losses in the cascade of care for latent tuberculosis with solo interferon gamma release assay screening compared to sequential screening |
| topic | Tuberculosis Latent tuberculosis Screening Refugee |
| url | https://doi.org/10.1186/s12879-021-06637-z |
| work_keys_str_mv | AT rklim fewerlossesinthecascadeofcareforlatenttuberculosiswithsolointerferongammareleaseassayscreeningcomparedtosequentialscreening AT rtalavlikar fewerlossesinthecascadeofcareforlatenttuberculosiswithsolointerferongammareleaseassayscreeningcomparedtosequentialscreening AT ochiazor fewerlossesinthecascadeofcareforlatenttuberculosiswithsolointerferongammareleaseassayscreeningcomparedtosequentialscreening AT jbietz fewerlossesinthecascadeofcareforlatenttuberculosiswithsolointerferongammareleaseassayscreeningcomparedtosequentialscreening AT hgardiner fewerlossesinthecascadeofcareforlatenttuberculosiswithsolointerferongammareleaseassayscreeningcomparedtosequentialscreening AT dfisher fewerlossesinthecascadeofcareforlatenttuberculosiswithsolointerferongammareleaseassayscreeningcomparedtosequentialscreening |