TY - JOUR
T1 - Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States
T2 - Evidence from commercial insurance data
AU - Stockbridge, Erica L.
AU - Loethen, Abiah D.
AU - Annan, Esther
AU - Miller, Thaddeus L.
N1 - Funding Information:
ADL is employed at Magellan Health, Inc, a commercial managed care organization. Additionally, Magellan has a contractual arrangement with the University of North Texas Health Science Center, and ELS works with Magellan through this contractual relationship. Magellan provided salary support and access to the data, but Magellan did not have any additional role in the study design, analysis, decision to publish, or preparation of the manuscript. No other authors have financial disclosures to report. The authors gratefully acknowledge the US Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination and its Tuberculosis Epidemiologic Studies Consortium (Atlanta, GA, USA) for its continued guidance and valuable intellectual contributions. Additionally, the research reported in this publication was developed in collaboration with Magellan Health, Inc. (Scottsdale, AZ, USA). We thank Magellan for their invaluable contributions to this work. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the United States Centers for Disease Control and Prevention (CDC) or Magellan Health, Inc. Mention of company names or products does not imply endorsement by the CDC or Magellan.
Publisher Copyright:
© 2020 Stockbridge et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2020/12
Y1 - 2020/12
N2 - Background Risk-targeted testing and treatment of latent tuberculosis infection (LTBI) is a critical component of the United States’ (US) tuberculosis (TB) elimination strategy, but relatively low treatment completion rates remain a challenge. Both treatment persistence and completion may be facilitated by diagnosing LTBI using interferon gamma release assays (IGRA) rather than tuberculin skin tests (TST). Methods We used a national sample of administrative claims data to explore associations diagnostic test choice (TST, IGRA, TST with subsequent IGRA) and treatment persistence and completion in persons initiating a daily dose isoniazid LTBI treatment regimen in the US private healthcare sector between July 2011 and March 2014. Associations were analyzed with a generalized ordered logit model (completion) and a negative binomial regression model (persistence). Results Of 662 persons initiating treatment, 327 (49.4%) completed at least the 6-month regimen and 173 (26.1%) completed the 9-month regimen; 129 (19.5%) persisted in treatment one month or less. Six-month completion was least likely in persons receiving a TST (42.2%) relative to persons receiving an IGRA (55.0%) or TST then IGRA (67.2%; p = 0.001). Those receiving an IGRA or a TST followed by an IGRA had higher odds of completion compared to those receiving a TST (aOR = 1.59 and 2.50; p = 0.017 and 0.001, respectively). Receiving an IGRA or a TST and subsequent IGRA was associated with increased treatment persistence relative to TST (aIRR = 1.14 and 1.25; p = 0.027 and 0.009, respectively). Conclusions IGRA use is significantly associated with both higher levels of LTBI treatment completion and treatment persistence. These differences are apparent both when IGRAs alone were administered and when IGRAs were administered subsequent to a TST. Our results suggest that IGRAs contribute to more effective LTBI treatment and consequently individual and population protections against TB.
AB - Background Risk-targeted testing and treatment of latent tuberculosis infection (LTBI) is a critical component of the United States’ (US) tuberculosis (TB) elimination strategy, but relatively low treatment completion rates remain a challenge. Both treatment persistence and completion may be facilitated by diagnosing LTBI using interferon gamma release assays (IGRA) rather than tuberculin skin tests (TST). Methods We used a national sample of administrative claims data to explore associations diagnostic test choice (TST, IGRA, TST with subsequent IGRA) and treatment persistence and completion in persons initiating a daily dose isoniazid LTBI treatment regimen in the US private healthcare sector between July 2011 and March 2014. Associations were analyzed with a generalized ordered logit model (completion) and a negative binomial regression model (persistence). Results Of 662 persons initiating treatment, 327 (49.4%) completed at least the 6-month regimen and 173 (26.1%) completed the 9-month regimen; 129 (19.5%) persisted in treatment one month or less. Six-month completion was least likely in persons receiving a TST (42.2%) relative to persons receiving an IGRA (55.0%) or TST then IGRA (67.2%; p = 0.001). Those receiving an IGRA or a TST followed by an IGRA had higher odds of completion compared to those receiving a TST (aOR = 1.59 and 2.50; p = 0.017 and 0.001, respectively). Receiving an IGRA or a TST and subsequent IGRA was associated with increased treatment persistence relative to TST (aIRR = 1.14 and 1.25; p = 0.027 and 0.009, respectively). Conclusions IGRA use is significantly associated with both higher levels of LTBI treatment completion and treatment persistence. These differences are apparent both when IGRAs alone were administered and when IGRAs were administered subsequent to a TST. Our results suggest that IGRAs contribute to more effective LTBI treatment and consequently individual and population protections against TB.
UR - http://www.scopus.com/inward/record.url?scp=85097125259&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0243102
DO - 10.1371/journal.pone.0243102
M3 - Article
C2 - 33270737
AN - SCOPUS:85097125259
SN - 1932-6203
VL - 15
JO - PLoS ONE
JF - PLoS ONE
IS - 12 December
M1 - e0243102
ER -