Management of latent tuberculous infection in Norway in 2009: a descriptive cross-sectional study

Olsen, Anna; Andersen, Hilde Elise; Aßmus, Jörg; Djupvik, J. A.; Gran, Gerd; Skaug, Knut; Mørkve, Odd

doi:10.5588/pha.13.0011

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…The treatment completion rate of 91% is consistent with the 89% previously reported in Norway [ 13 ]. Direct comparison with previous studies is difficult due to differences in study designs, regimens, and the populations under study.…”

Section: Discussionsupporting

confidence: 89%

“…Completion rates are commonly reported as inversely related to treatment length [ 7 ]. Unsupervised six to nine months of isoniazid treatments in the US have shown around 50% completion rates [ 10 , 11 , 19 , 20 ], 3–4 months RH regimens are reported at 85–90% [ 13 , 21 – 23 ] and recent studies report similarly high completion rates with weekly (supervised) 3RPH administration [ 24 – 28 ]. Our results are consistent with a 2017 review [ 29 ] reporting no important differences in efficacy and completion rates for the 3RPH regimen when compared to other regimens.…”

Section: Discussionmentioning

confidence: 99%

“…LTBI treatment completion rates vary considerably across risk-groups and settings [ 7 ], and long duration and adverse events are well-known barriers to treatment completion [ 7 – 12 ]. A Norwegian study from 2009 found overall high LTBI treatment completion, and no adverse events requiring hospital admission [ 13 ]. Since then, Norwegian guidelines have increasingly targeted groups at high risk for TB reactivation, including older individuals with more comorbidities and recent immigrants to Norway [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

et al. 2018

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BackgroundSuccessful treatment of latent tuberculosis infection (LTBI) is essential to reduce tuberculosis (TB) incidence rates in low-burden countries. This study measures treatment completion and determinants of non-completion of LTBI treatment in Norway in 2016.MethodsThis prospective cohort study included all individuals notified with LTBI treatment to the Norwegian Surveillance System for Infectious Diseases (MSIS) in 2016. We obtained data from MSIS and from a standardized form that was sent to health care providers at the time of patient notification to MSIS. We determined completion rates. Pearson’s chi squared test was used to study associations between pairs of categorical variables and separate crude and multivariable logistic regression models were used to identify factors associated with treatment completion and adverse drug effects.ResultsWe obtained information on treatment completion from 719 of the 726 individuals notified for LTBI treatment in 2016. Overall, 91% completed treatment. Treatment completion was highest in the foreign-born group [foreign-born, n = 562 (92%) vs Norwegian-born, n = 115 (85%), p = 0.007]. Treatment completion did not differ significantly between prescribed regimens (p = 0.124). Adverse events were the most common reason for incomplete treatment. We found no significant differences in adverse events when comparing weekly rifapentine (3RPH) with three months daily isoniazid and rifampicin (3RH). However, there were significantly fewer adverse events with 3RPH compared to other regimens (p = 0.037). Age over 35 years was significantly associated with adverse events irrespective of regimen (p = 0.024), whereas immunosuppression was not significantly associated with adverse events after adjusting for other variables (p = 0.306). Treatment under direct observation had a significant effect on treatment completion for foreign-born (multivariate Wald p-value = 0.017), but not for Norwegian-born (multivariate Wald p-value = 0.408) individuals.ConclusionsWe report a very high treatment completion rate, especially among individuals from countries with high TB incidence. The follow-up from tuberculosis-coordinators and the frequent use of directly observed treatment probably contributes to this. Few severe adverse events were reported, even with increased age and in individuals that are more susceptible. While these results are promising, issues of cost-effectiveness and targeting treatment to individuals at highest risk of TB are important components of public health impact.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3468-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

et al. 2018

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“…Furthermore, although the 2015 WHO guidelines for management of LTBI in low-burden countries indicate that treatment should be considered for migrants without age restrictions [3], Swedish guidelines recommend treatment primarily to persons <35 years of age in absence of other risk factors (the Public Health Agency of Sweden). The overall completion rate in our study was relatively high, and in line with previous Scandinavian studies of LTBI completion [14,22]. Interestingly, completion rates increased significantly during the study period.…”

Section: Discussionsupporting

confidence: 91%

“…Other methods that have been shown to improve LTBI treatment completion rates are different types of culture-based interventions [23,24], that have been applied in ethnic groups believed to be at risk of treatment non-completion. However, studies conducted on immigrants to Scandinavia are contradictory in this area [14,22]. While Kan et al found that persons of Somali origin are at increased risk of non-completion, this association was not detected in our population (data not shown).…”

Section: Discussioncontrasting

confidence: 68%

High rate of latent tuberculosis treatment completion in immigrants seeking asylum in Sweden

Olssón

Winqvist

Olsson

et al. 2018

Infectious Diseases

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Immigrant screening for latent tuberculosis in Norway: a cost-effectiveness analysis

et al. 2016

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The incidence of tuberculosis (TB) disease has increased in Norway since the mid-1990s. Immigrants are screened, and some are treated, for latent TB infection (LTBI) to prevent TB disease (reactivation). In this study, we estimated the costs of both treating and screening for LTBI and TB disease, which has not been done previously in Norway. We developed a model to indicate the cost-effectiveness of four different screening algorithms for LTBI using avoided TB disease cases as the health outcome. Further, we calculated the expected value of perfect information (EVPI), and indicated areas of LTBI screening that could be changed to improve cost-effectiveness. The costs of treating LTBI and TB disease were estimated to be €1938 and €15,489 per case, respectively. The model evaluates four algorithms, and suggests three cost-effective algorithms depending on the cost-effectiveness threshold. Screening all immigrants with interferon-gamma release assays (IGRA) requires the highest threshold (€28,400), followed by the algorithms "IGRA on immigrants with risk factors" and "no LTBI screening." EVPI is approximately €5 per screened immigrant. The costs for a cohort of 20,000 immigrants followed through 10 years range from €12.2 million for the algorithm "screening and treatment for TB disease but no LTBI screening," to €14 million for "screening all immigrants for both TB disease and LTBI with IGRA." The results suggest that the cost of TB disease screening and treatment is the largest contributor to total costs, while LTBI screening and treatment costs are relatively small. Increasing the proportion of IGRA-positive immigrants who are treated decreases the costs per avoided case substantially.

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Management of latent tuberculous infection in Norway in 2009: a descriptive cross-sectional study

Cited by 4 publications

References 19 publications

Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

High rate of latent tuberculosis treatment completion in immigrants seeking asylum in Sweden

Immigrant screening for latent tuberculosis in Norway: a cost-effectiveness analysis

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