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Trend and treatment status of latent tuberculosis infection patients in Japan - Analysis of Japan TB Surveillance data.

ABSTRACT: Management of latent tuberculosis infection (LTBI) is one of the core elements of End TB Strategy. Japan is one of the few countries in which notification of LTBI is mandatory, yet so far, the data has not been analyzed in detail. We thus conducted a cross-sectional study to examine the trend of LTBI, its treatment outcome and factors predicting treatment non-completion in Japan for the period of 2007 and 2014, using the data from the electronic Japan Tuberculosis Surveillance system. Treatment completion was defined as those whose reason for terminating the treatment was recorded as "treatment completed" and whose treatment duration was 180 days or more.During the study period, a total of 50,268 LTBI patients were notified, of which 49,525, who had started treatment, were analyzed for characteristics. 57.5% were females, and 38.5% were aged 25-44 years. As for the job category, healthcare professionals, that is medical doctors, nurses and other healthcare workers, consisted the largest group (30.4%). Overall, the number of LTBI notification has been on an increase, with a large increase observed among those aged 65 years and above. Of the 49,525 patients, the information regarding reason for termination of treatment was available for 46,128 (93.1%). Of them, 33,156 (71.9%) had completed treatment as according to the study definition. The risk factors for not completing LTBI treatment included being aged 65 years and above (adjusted odds ratio [aOR] 1.27, 95% confidence interval [95%CI] 1.10-1.47), foreign-born (aOR 1.14, 95%CI 1.02-1.28), healthcare professional (aOR 1.44, 95%CI 1.24-1.69), full-time and part-time worker (aOR 1.40, 95%CI, 1.20-1.63) and detected via contact investigation (aOR 1.26, 95%CI 1.12-1.41).Our study results revealed that the treatment completion rate was 71.9%, falling short of the national target of 85%, and also that the treatment duration was recorded as less than 180 days for approximately 20% of those who were reported as having completed treatment. Further studies may be built on ours to explore the reasons for not completing the treatment across different population groups, and identify those who benefit the most, and who has the greatest impact on ending TB, by receiving LTBI treatment.

SUBMITTER: Kawatsu L

PROVIDER: S-EPMC5665521 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Trend and treatment status of latent tuberculosis infection patients in Japan - Analysis of Japan TB Surveillance data.

Kawatsu Lisa L Uchimura Kazuhiro K Ohkado Akihiro A

PloS one 20171101 11

<h4>Objective and method</h4>Management of latent tuberculosis infection (LTBI) is one of the core elements of End TB Strategy. Japan is one of the few countries in which notification of LTBI is mandatory, yet so far, the data has not been analyzed in detail. We thus conducted a cross-sectional study to examine the trend of LTBI, its treatment outcome and factors predicting treatment non-completion in Japan for the period of 2007 and 2014, using the data from the electronic Japan Tuberculosis Su ...[more]

PMID: 29091917

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Project description:BackgroundScreening for latent tuberculosis infection (LTBI) among migrant population has become a critical issue for many low tuberculosis (TB) burden countries. Evidence regarding effectiveness of LTBI programs are limited, however, partly because of paucity of national data on treatment outcomes for LTBI. In Japan, notification of LTBI is mandatory, and its treatment outcome is reported as part of Japan's national TB surveillance system. We thus conducted a detailed analysis of LTBI among foreign-born persons, to update the epidemiological trend of newly notified LTBI between 2007 and 2018, and to examine the treatment regimen and outcome of those notified in 2016 and 2017, focusing specifically on the potential risk factors for lost to follow-up.MethodsWe extracted and analyzed the data of newly notified LTBI patients from the Japan Tuberculosis Surveillance System to examine the overall trend of notification and by age groups and modes of detection between 2007 and 2018, and the cohort data for treatment regimen and outcomes of foreign-born persons notified with LTBI in 2016 and 2017. Trends and proportions were summarized descriptively, and logistic regression analysis was conducted to identify potential risk factors for lost to follow-up. Comparisons were made with the Japan-born patients where appropriate, using chi-squared tests.ResultsBoth the number and proportion of LTBI among foreign-born persons have been constantly increasing, reaching 963 cases in 2018. Cohort analysis of the surveillance data indicated that the proportion of those on shorter regimen was higher among the foreign- than Japan-born patients (5.5% vs. 1.8%, p < 0.001). The proportion of those who have been lost to follow-up and transferred outside of Japan combined was higher among the foreign- than Japan-born patients (12.0% vs, 8.2%, p < 0.001). Risk factors for lost to follow-up were being employed on a temporal basis, and job status unknown (adjusted odds ratios 3.11 and 4.09, 95% confidence intervals 1.34-7.26 and 1.60-10.48, respectively).ConclusionsMigrant population face greater risk of interrupting LTBI treatment, and interventions to improve adherence are a critical component of programmatic management of LTBI. Further studies are needed to explore the cultural and socioeconomic situation in which foreign-born persons undergo LTBI treatment in Japan.

Project description:BackgroundMultidrug resistant-tuberculosis (MDR-TB) is a major global health concern. Its treatment requires toxic medications, is longer and costlier than drug-susceptible TB, and often results in productivity losses and poor outcomes. In Japan, a TB middle-burden country, reports on treatment outcome of MDR-TB patients have only been institution-based. We thus sought to shed some light on the nationwide treatment status and outcome of MDR-TB patients in Japan.MethodsCharacteristics and treatment status and outcome of MDR-TB patients notified between 2011 and 2013 were evaluated using the data from the Japan TB Surveillance (JTBS) system. Since the treatment outcome from the surveillance data was not directly linked to any clinical records or drug susceptible test results, we also analyzed the treatment duration of MDR-TB cases in an attempt to validate our results.ResultsBetween 2011 and 2013, a total of 172 MDR-TB patients had been notified to the JTBS as MDR-TB. 68.6% (118/172) were males and 70.9% (122/172) were Japan-born - however, over the study period, the proportions of foreign-born, of those in the age group 15-64 years old and of new cases have increased. The overall treatment completion rate was 57.0%, however, when restricted to patients aged 64 years old and below, the rate improved to 71.6%. Treatment duration of 29.2% of those patients who had been recorded as "treatment completed" in fact fell short of the 540 days, the minimum duration as recommended by the Japanese guideline.ConclusionsIncreasing proportion of new cases, and of younger age groups among the MDR-TB patients indicate new transmissions. Better strategies for early detection and containment of MDR-TB are urgently needed. The overall treatment completion rate was 57.0% over the three-year study period. However, when restricting the result to those aged 64 years old and below, the rate improved to 71.6%, which was comparable to similarly industrialized countries. Due to the limitations of the JTBS data, a comprehensive survey of all MDR-TB patients may be necessary to provide more concrete evidence for decision-making.

Project description:BackgroundThe World Health Organization recommends that systematic testing and screening of latent tuberculosis infection (LTBI) among the incarcerated population "should be considered", though based on evidence of either low or very low quality. However, in Japan, a TB middle-burden country, systematic screening for LTBI in correctional facilities is currently not conducted. As part of a larger study to determine the cost-effectiveness of LTBI screening in correctional facilities in Japan, this study was conducted to determine the situation of LTBI, including treatment outcome, among the incarcerated population in Japan, and provide the essential data for cost-effectiveness analysis.MethodA cross-sectional study was conducted between 2017 and 2018 with public health centers which have one or more correctional facilities under their jurisdiction. Questionnaire surveys were sent to collect information on their policy of managing LTBI patients notified from correctional facilities, including whether or not there was a standardized procedure for initiating LTBI treatment, and also to collect sociodemographic information and treatment outcome of LTBI patients who were notified from the respective correctional facilities in 2015 and 2016.ResultsThe survey was sent to a total of 163 public health centers, out of which 133 (81.6%) responded. 8 of the 133 public health centers actively guided the correctional facilities regarding LTBI treatment initiation through a standardized procedure, while 115 either had not established such procedure or were unaware of how LTBI treatment was being initiated in the correctional facilities. A total of 91 LTBI patients were notified from the correctional facilities in 2015 and 2016, and the information of 89 were available for analysis. 82 were males, and 83 were Japan-born. Treatment outcome was known for 88 patients, of which 70 had completed treatment. Of the 18 who did not complete the treatment, 15 had been lost to follow-up upon release from the facilities. Among those who had been released whilst on treatment, the proportion of those who completed the treatment was higher in those patients who received pre-release visit by a public health nurse, than those who did not.ConclusionsLTBI treatment was often being initiated without consideration for the patients' prison term. The treatment completion rate within jail was high, indicating the possibility that incarcerated population can benefit for LTBI treatment. On the other hand, the completion rate decreased significantly among those who had been released while still on treatment. In order to optimize the benefit, initiation of LTBI must carefully be considered upon the patient's prison term, as well as coordination among the relevant organizations to ensure continuity of care after release.

Dataset Information

Trend and treatment status of latent tuberculosis infection patients in Japan - Analysis of Japan TB Surveillance data.

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Trend and treatment status of latent tuberculosis infection patients in Japan - Analysis of Japan TB Surveillance data.

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