Background: Tuberculosis (TB) can be prevented by screening and treatment for TB infection (LTBI), particularly among persons with risk factors for TB exposure and/or progression. We evaluated confirmed TB diagnoses in a provider network covering >7million Californians, to determine whether there were opportunities to prevent TB.
Methods: Medical records for patients within the provider network ≥1 year prior to TB diagnosis and a positive Mycobacterium tuberculosis culture during Aug 2011Dec 2012 were abstracted. We collected information on LTBI testing and treatment history, and TB risks. TB exposure risks included being: foreign born, a contact to active TB, homeless, incarcerated, a healthcare worker, or a long term care resident. TB progression risks included having diabetes, HIV, organ transplant, end stage renal disease (ESRD), smoking, cancer, and TNF-α inhibitor or steroid treatment.
Results: Records were abstracted for 158 patients; 113 (72%) had no prior LTBI history (risk factors, testing and treatment in Fig. 1), and 45 (28%) had a prior history of LTBI (risks for progression, testing and treatment in Fig. 2). Among 19 tested for TB infection, 8 (42%) were positive. Of the eleven who tested negative, eight had a history of, or an indication for, steroid or anti-TNF-α treatment; one had organ transplantation; and one had known TB exposure after the negative test. An opportunity for prevention was identified for 109 (69%) patients including those who had, 1) a TB risk but no testing; or, 2) a TB risk and a positive test or LTBI history but no treatment. Among patients with both exposure and progression risks, 27% were hospitalized during TB diagnosis and treatment. Overall, two patients with ESRD and two patients with solid organ transplants were identified.
Conclusion: Opportunities for TB prevention exist among patients accessing care in a provider network in California. The small number of ESRD and transplant patients suggests that TB prevention might be occurring in these groups. Interventions to increase LTBI screening and treatment among patients with TB risks might prevent TB, however, this analysis cannot determine how many patients need to be tested and treated to prevent a case of TB.
T. Al-Samarrai, None
J. Blum, None
J. Nomura, None
J. Flood, None
J. Schapiro, None