Screening for latent tuberculous infection in people living with HIV infection in Auckland, New Zealand

Gow, N; Briggs, Simon; Nisbet, Mitzi

doi:10.5588/jtld.17.0103

Cited by 5 publications

(15 citation statements)

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“…This is a longitudinal study conducted in a HIV clinic with fairly satisfactory compliance to established LTBI screening and treatment guidance, in the setting of an intermediate TB burden city. The compliance figures of LTBI screening in Hong Kong (84%) appeared to be higher than that of other developed countries (<70%) 11–13,15 . Nonetheless, the prevalence of LTBI in this study (32%) was similar to nearby Asian places (Iran, Korea, Thailand, Taiwan) 21,22 , and the proportion of TB cases with LTBI testing history (56%) was close to that of a Canadian study (61%) 14 .…”

Section: Discussionmentioning

confidence: 67%

“…Alternatively, the more expensive one-off Interferon-γ release assay (IGRA) could be performed, which however give a non-comparable result 10 . The compliance of HIV services in implementing LTBI screening and treatment was often unsatisfactory, as noted in high-income countries with a low TB/HIV burden 11–15 . In UK, the full compliance rate of healthcare providers was just 35% 11 , while the ever LTBI testing rates among HIV patients in US, Canada and New Zealand were below 70% 12–15 .…”

Section: Introductionmentioning

confidence: 99%

“…The compliance of HIV services in implementing LTBI screening and treatment was often unsatisfactory, as noted in high-income countries with a low TB/HIV burden 11–15 . In UK, the full compliance rate of healthcare providers was just 35% 11 , while the ever LTBI testing rates among HIV patients in US, Canada and New Zealand were below 70% 12–15 . With highly active antiretroviral therapy (HAART), immune recovery is becoming an achievable outcome 16,17 .…”

Section: Introductionmentioning

confidence: 99%

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A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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Latent TB infection (LTBI) in HIV patients, its treatment, and immunological recovery following highly active antiretroviral therapy (HAART) could interact and impact TB disease progression. We aim to examine the factors associated with LTBI and TB disease development among HIV patients. Longitudinal clinical and laboratory data were accessed from the largest HIV specialist clinic in Hong Kong, where HAART and yearly LTBI screening are routinely provided for HIV patients. Between 2002 and mid-2017, among 2079 HIV patients with 14119 person-years (PY) of follow-up, 32% of LTBI screened patients (n = 1740) were tested positive. The overall TB incidence was 1.26/100 PY from HIV diagnosis to HAART initiation, falling to 0.37/100 PY. A lower risk of TB disease progression was associated with local residence, Chinese ethnicity, negative baseline LTBI result, being on HAART, LTBI treatment, higher baseline CD4 and CD4/CD8 ratio. A positive test at baseline, but not subsequent testing results, was significantly associated with TB disease development. Baseline LTBI screening is an important strategy for identifying HIV patients at risk of TB disease progression. Routine repeat LTBI screening on an annual basis might not give additional benefits to patients on HAART with good immunological responses. Such practice should require re-evaluation.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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“…[10] This is the first study to examine these issues in any real detail, although a range of LTBI chemoprophylaxis acceptance rates of between 17-85% in PLWH have been reported from elsewhere in the UK and other low TB incidence countries. [19][20][21] In our cohort, LTBI testing and chemoprophylaxis uptake was very high. Over 99% of questionnaire respondents accepted IGRA testing, and over 94% of those who were consequently diagnosed with LTBI and for whom chemoprophylaxis was recommended, successfully completed treatment.…”

Section: Discussionmentioning

confidence: 79%

“…We have previously demonstrated that there is currently limited LTBI screening occurring amongst PLWH in the UK [ 10 ]. This is the first study to examine these issues in any real detail, although a range of LTBI chemoprophylaxis acceptance rates of between 17 and 85% in PLWH have been reported from elsewhere in the UK and other low TB incidence countries [ 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Latent tuberculosis screening and treatment in HIV: highly acceptable in a prospective cohort study

et al. 2021

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BackgroundPeople living with HIV (PLWH) are at increased risk of reactivation of latent TB infection (LTBI). Although UK and international guidelines identify this group as a priority for LTBI screening and treatment, data on attitudes of PLWH to this policy recommendation are lacking.MethodsA five-point, Likert-style questionnaire was administered to PLWH to assess views and intentions towards accepting LTBI screening and treatment. Subsequent Immune Gamma Release Assay (IGRA) testing was offered, and chemoprophylaxis if required. Influencing demographic and psychological associations with planned, and actual, testing and treatment uptake, were assessed using multivariable logistic regression.Results444/716 (62%) patients responded. 417/437 (95.4%) expressed intention to accept LTBI testing. The only significant association was the perceived importance of testing to the individual (aOR 8.98, 95% CI 2.55–31.67). 390/393 (99·2%) accepted appropriate IGRA screening; 41/390 (10·5%) were positive. 397/431 (92.1%) expressed intention to accept chemoprophylaxis, associated with perceived importance of treatment (aOR 3.52, 95% CI 1.46–8.51), a desire to have treatment for LTBI (aOR 1.77, 95% CI 0.99–3.15), and confidence in taking treatment (aOR 3.77, 95% CI 1.84–7.72). Of those offered chemoprophylaxis, 36/37 (97·3%) accepted and 34/36 (94·4%) completed treatment. There were no correlates with actual screening acceptance.ConclusionsLTBI is common amongst PLWH, highlighting the importance of robust screening and treatment programmes. This study shows that screening and treatment for LTBI is highly acceptable to PLWH and provides strong, objective, evidence for policy-makers developing guidelines in this cohort.

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The impact, effectiveness and outcomes of targeted screening thresholds for programmatic latent tuberculosis infection testing in HIV

White

Baggaley

Patel

et al. 2022

Aids

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Background:Screening and treatment for latent tuberculosis infection (LTBI) are key for TB control. In the UK, the National Institute for Health and Care Excellence (NICE) and the British HIV Association (BHIVA) give conflicting guidance on which groups of people with HIV (PWH) should be screened, and previous national analysis demonstrated heterogeneity in how guidance is applied. There is an urgent need for a firmer clinical effectiveness evidence base on which to build screening policy.Methods:We conducted a systematic, programmatic LTBI-screening intervention for all PWH receiving care in Leicester, UK. We compared yields (percentage IGRA positive) and number of tests required when applying the NICE and BHIVA testing strategies, as well as strategies targeting screening by TB incidence in patients’ countries of birth.Results:Of 1053 PWH tested, 118 were IGRA-positive (11.2%). Positivity was associated with higher TB incidence in country-of-birth [adjusted odds ratio, 50–149 cases compared with <50 cases/100 000: 11.6; 95% confidence interval (CI) 4.79–28.10)]. There was high testing uptake (1053/1069, 98.5%). Appropriate chemoprophylaxis was commenced in 100 of 117 (85.5%) patients diagnosed with LTBI, of whom 96 of 100 (96.0%) completed treatment. Delivering targeted testing to PWH from countries with TB incidence greater than 150 per 100 000 population or any sub-Saharan African country, would have correctly identified 89.8% of all LTBI cases while cutting tests required by 46.1% compared with NICE guidance, performing as well as BHIVA 2018 guidance.Conclusion:Targeting screening to higher risk PWH increases yield and reduces the number requiring testing. Our proposed ‘PWH-LTBI streamlined guidance’ offers a simplified approach, with the potential to improve national LTBI-screening implementation.

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Screening for latent tuberculous infection in people living with HIV infection in Auckland, New Zealand

Abstract: LTBI screening was incomplete in our clinic, but improved between 2011 and 2014. A significant number of patients with LTBI did not originate from a high TB incidence country.

Cited by 5 publications

References 0 publications

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Latent tuberculosis screening and treatment in HIV: highly acceptable in a prospective cohort study

The impact, effectiveness and outcomes of targeted screening thresholds for programmatic latent tuberculosis infection testing in HIV

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