J Korean Med Sci.  2024 Feb;39(7):e64. 10.3346/jkms.2024.39.e64.

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescri

• Kim Y
• Bae KS
• Choi UY
• Han SB
• Kim JH

• KMID: 2553317
• DOI: http://doi.org/10.3346/jkms.2024.39.e64

Abstract

Background
The treatment of pediatric patients with latent tuberculosis infection (LTBI) is a crucial TB control strategy. LTBI is not a reportable communicable disease, and data regarding LTBI treatment in pediatric patients in Korea are scarce. This study aimed to investigate the prescription patterns and treatment completion rates among pediatric patients with LTBI in Korea by analyzing National Health reimbursement claims data.
Methods
We retrospectively analyzed outpatient prescription records for pediatric patients aged 18 or younger with LTBI-related diagnostic codes from 2016 to 2020. We compared the frequency of prescriptions for the standard treatment regimen (9 months of isoniazid [9H]) and an alternative treatment regimen (3 months of isoniazid plus rifampicin [3HR]). We also assessed the treatment incompletion rates by age group, treatment regimen, treatment duration, the level of medical facility, physician’s specialty, and hospital location. We performed multivariable analysis to identify factors influencing treatment incompletion.
Results
Among the 11,362 patients who received LTBI treatment, 6,463 (56.9%) were prescribed the 9H regimen, while 4,899 (43.1%) received the 3HR regimen. Patients in the 3HR group were generally older than those in the 9H group. The proportion of 3HR regimen prescriptions significantly greater in the later period (2018–2020), in primary hospitals, under the management of non-pediatric specialists, and in metropolitan regions. The overall treatment incompletion rate was 39.7% (9H group: 46.9%, 3HR group: 30.3%). In the multivariable analysis, 9H regimen prescription was the strongest factor associated with treatment incompletion (adjusted odds ratio, 2.42; 95% confidence interval, 2.20–2.66; P < 0.001). Additionally, management in a primary hospital, a hospital’s location in a nonmetropolitan region, and management by a non-pediatric specialist were also significant risk factors for treatment incompletion.
Conclusion
Our study results suggest that promoting the use of 3HR regimen prescriptions could be an effective strategy to enhance treatment completion. Physicians in primary hospitals, hospitals located in non-metropolitan regions, and physicians without a pediatric specialty require increased attention when administering LTBI treatment to pediatric patients to ensure treatment completion.

Keyword

Latent Tuberculosis Infection; Treatment; Prescription; Completion; Regimen; Children

Reference

1. Cruz AT, Starke JR. Tuberculosis. Cherry J, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez P, editors. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA, USA: Elsevier;2019. p. 957–988.

2. Carvalho I, Goletti D, Manga S, Silva DR, Manissero D, Migliori G. Managing latent tuberculosis infection and tuberculosis in children. Pulmonology. 2018; 24(2):106–114. PMID: 29502937.

3. Nordholm AC, Lillebaek T. It is time to optimise the management of latent tuberculosis infection in children. Eur Respir J. 2021; 57(4):2004438. PMID: 33888534.

4. Son M, Park YS, Jung MH, Kang JH, Choi UY. Risk factors for latent tuberculosis infection in children in South Korea. Postgrad Med. 2018; 130(7):637–643. PMID: 30095331.

5. Cho KS. Tuberculosis control in the Republic of Korea. Epidemiol Health. 2018; 40:e2018036. PMID: 30081621.

6. Min J, Kim HW, Choi JY, Shin AY, Kang JY, Lee Y, et al. Latent tuberculosis cascade of care among healthcare workers: a nationwide cohort analysis in Korea between 2017 and 2018. J Korean Med Sci. 2022; 37(20):e164. PMID: 35607742.

7. Korea Disease Control and Prevention Agency. Annual Report on the Notified Tuberculosis in Korea, 2021. Cheongju, Korea: Korea Disease Control and Prevention Agency;2022.

8. Oh CE, Menzies D. Four months of rifampicin monotherapy for latent tuberculosis infection in children. Clin Exp Pediatr. 2022; 65(5):214–221. PMID: 34727494.

9. Joint Committee for the Revision of Korean Guidelines for Tuberculosis. Korean Guideline for Tuberculosis. 4th ed. Cheongju, Korea: Korea Disease Control and Prevention Agency;2020.

10. Nolt D, Starke JR. Tuberculosis infection in children and adolescents: testing and treatment. Pediatrics. 2021; 148(6):e2021054663. PMID: 34851422.

11. Plourde PJ, Basham CA, Derksen S, Schultz J, McCulloch S, Larcombe L, et al. Latent tuberculosis treatment completion rates from prescription drug administrative data. Can J Public Health. 2019; 110(6):705–713. PMID: 31297736.

12. Horsburgh CR Jr, Goldberg S, Bethel J, Chen S, Colson PW, Hirsch-Moverman Y, et al. Latent TB infection treatment acceptance and completion in the United States and Canada. Chest. 2010; 137(2):401–409. PMID: 19793865.

13. Schein YL, Madebo T, Andersen HE, Arnesen TM, Dyrhol-Riise AM, Tveiten H, et al. Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study. BMC Infect Dis. 2018; 18(1):587. PMID: 30453946.

14. Cruz AT, Starke JR. Completion rate and safety of tuberculosis infection treatment with shorter regimens. Pediatrics. 2018; 141(2):e20172838. PMID: 29363561.

15. Gaensbauer J, Aiona K, Haas M, Reves R, Young J, Belknap R. Better completion of pediatric latent tuberculosis treatment using 4 months of rifampin in a US-based tuberculosis clinic. Pediatr Infect Dis J. 2018; 37(3):224–228. PMID: 28777204.

16. Spyridis NP, Spyridis PG, Gelesme A, Sypsa V, Valianatou M, Metsou F, et al. The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study. Clin Infect Dis. 2007; 45(6):715–722. PMID: 17712755.

17. Macaraig MM, Jalees M, Lam C, Burzynski J. Improved treatment completion with shorter treatment regimens for latent tuberculous infection. Int J Tuberc Lung Dis. 2018; 22(11):1344–1349. PMID: 30355415.

18. Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, et al. Guidelines for treatment of latent tuberculosis infection: recommendations from the national tuberculosis controllers association and CDC, 2020. MMWR Recomm Rep. 2020; 69(1):1–11.

19. Go U, Park M, Kim UN, Lee S, Han S, Lee J, et al. Tuberculosis prevention and care in Korea: evolution of policy and practice. J Clin Tuberc Other Mycobact Dis. 2018; 11:28–36. PMID: 31720389.

20. Korea Disease Control and Prevention Agency. Treatment outcomes of tuberculosis patients through Private–Public Mix collaboration (PPM) in private sector, 2009. Public Health Wkly Rep. 2010; 3:409–412.

21. Park JS, Kim EY. Analysis on Trend of Medical Service Industry, 2017. Cheongju, Korea: Korea Health Industry Development Institute;2017.

22. Lee S. Spatial and socioeconomic inequalities in accessibility to healthcare services in South Korea. Healthcare (Basel). 2022; 10(10):2049. PMID: 36292496.

23. Tchakounte Youngui B, Tchounga BK, Graham SM, Bonnet M. Tuberculosis infection in children and adolescents. Pathogens. 2022; 11(12):1512. PMID: 36558846.

24. Yun KW, Kim YK, Kim HR, Lee MK, Lim IS. Usefulness of interferon-γ release assay for the diagnosis of latent tuberculosis infection in young children. Korean J Pediatr. 2016; 59(6):256–261. PMID: 27462354.

25. Hill L, Blumberg E, Sipan C, Schmitz K, West J, Kelley N, et al. Multi-level barriers to LTBI treatment: a research note. J Immigr Minor Health. 2010; 12(4):544–550. PMID: 19085104.

26. Yuan Y, Jin J, Bi X, Geng H, Li S, Zhou C. Factors associated with refusal of preventive therapy after initial willingness to accept treatment among college students with latent tuberculosis infection in Shandong, China. BMC Infect Dis. 2023; 23(1):38. PMID: 36670356.