Treatment of latent tuberculosis infection in migrants in primary care versus secondary care
Burman, M., Zenner, D., Copas, A. J. , Goscé, L., Haghparast-Bidgoli, H., White, P. J., Hickson, V., Greyson, O., Trathen, D., Ashcroft, R. 
ORCID: 0000-0001-6065-4717, Martineau, A. R., Abubakar, I., Griffiths, C. J. & Kunst, H. (2024).
Treatment of latent tuberculosis infection in migrants in primary care versus secondary care.
European Respiratory Journal, 64(5),
article number 2301733.
doi: 10.1183/13993003.01733-2023
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%versus86.0%; 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%versus2.3%; aOR 0.29, 95% CI 0.03–2.84). Treatment acceptance was lower in primary care (65.2% (146/224)versus94.2% (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.
| Publication Type: | Article |
|---|---|
| Additional Information: | Copyright ©The authors 2024. This version is distributed under the terms of the Creative Commons Attribution Licence 4.0. |
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Departments: | The City Law School |
| SWORD Depositor: |
Available under License Creative Commons Attribution.
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