J Korean Med Sci.  2022 May;37(20):e164. 10.3346/jkms.2022.37.e164.

Latent Tuberculosis Cascade of Care Among Healthcare Workers: A Nationwide Cohort Analysis in Korea Between 2017 and 2018

• Min J
• Kim HW
• Choi JY
• Shin AY
• Kang JY
• Lee Y
• Myong JP
• Jeong H
• Bae S
• Koo HK
• Lee SS
• Park JS
• Yim HW
• Kim JS

• KMID: 2530107
• DOI: http://doi.org/10.3346/jkms.2022.37.e164

Abstract

Background
In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model.
Methods
We included 45,503 employees of medical institutions with positive interferongamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care. Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and notcompleting treatment.
Results
Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64–0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81–0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29–1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16–1.53).
Conclusion
Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.

Keyword

Latent TB; Preventive Therapy; Quality Control; Doctor; Nurse

Figure

• 

  Fig. 1 Losses and drop-outs at each stage of the latent TB cascade of care among all enrolled participants with positive result of IGRA.Eligible participants for the first step, visiting clinics for further care, are all participants with positive IGRA results. Eligible participants for the second step, initiating treatment, are participants with positive IGRA result, who did not have concurrent active TB. Eligible participants for the third step, completing treatment, are participants with positive IGRA result, who did not have concurrent active TB and who did not develop active TB during TB preventive therapy. The 95% confidence interval of proportions were calculated using the Wilson procedure without a correction for continuity.IGRA = interferon-gamma release assay, TB = tuberculosis.

• 

  Fig. 2 Intervals of days at each stage of cascade of care in LTBI. (A) Intervals from LTBI testing to initiating tuberculosis preventive therapy, (B) Intervals from initiating treatment to completing and non-completing treatment for 3HR, (C) for 4RIF, and (D) for 9INH.Data were expressed as mean and lowest and highest values. Numbers in circles indicated proportions of completing and non-completing treatment for each regimen.LTBI = latent tuberculosis infection, 9INH = 9-month isoniazid monotherapy, 4RIF = 4-month rifampin monotherapy, 3HR = 3-month rifampin and isoniazid combination therapy.

• 

  Fig. 3 Barplots presenting stratum-specific RR of not-completing treatment and effect of interaction between types of treatment center and initial treatment regimen.Multivariate analysis was adjusted by sex, age, place of residence, income level, and Charlson comorbidity index, types of treatment center, and types of initial regimen. The RR (Y axis) was calculated with reference of 3HR ate the private hospital. The error bar represents standard error of each RR.RR = relative risk, 9INH = 9-month of isoniazid monotherapy, 4RIF = 4-month of rifampin monotherapy, 3HR = 3-month of rifampin and isoniazid combination therapy.

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