© 2008 American Thoracic Society
Assessing the Impact of Targeted Tuberculosis InterventionsTo the Editor:We read with interest the article by Dr. de Vries and colleagues, which discussed a successful mobile screening intervention for tuberculosis (TB) in the Netherlands, where the yield was the equivalent of 327 TB cases detected per 100,000 evaluations (1). Similar success was achieved in Tarrant County, Texas, where, over a 28-month period, a location-based intervention using a comparable mobile screening approach yielded the equivalent of 775 TB cases detected per 100,000 evaluations (2). The Tarrant County intervention included screening and treatment for latent tuberculosis infection (LTBI). Six hundred and eighty-one persons were identified with LTBI. A total of 487 (71.5%) initiated preventive treatment, and 302 (62.0%) completed treatment successfully. Of the 44 with TB, 41 (93.2%) completed adequate treatment. Patients who did not complete treatment (n = 3) were all diagnosed clinically (i.e., culture-negative) (see Table 1). These high rates of treatment completion in both persons with LTBI and TB disease may be attributable to the successful partnership of community-based organizations and public health departments in identifying, evaluating, and following high-risk populations (3).
As TB case rates decline in industrialized countries, elimination efforts will need to focus on more aggressive and targeted interventions to detect cases sooner and ensure adequate treatment supervision in high-risk populations and settings (e.g., HIV-infected persons, illicit drug users, geographic areas with high concentrations of genotype clusters) (2, 4). TB control programs must assess the impact of control activities to maximize efficiency of limited and declining resources. The use of genotyping in TB control has demonstrable added value, not only to detect clustered Mycobacterium tuberculosis isolates, representing potential ongoing transmission, but also to assess the impact of interventions aimed at reducing transmission (5). Current American Thoracic Society guidelines encourage a major expansion of targeted screening and treatment efforts, yet warn that any expansion must include the intent, and infrastructure, required to follow patients to successful treatment completion (6). Therefore, assessing the impact of targeted screening should also include measurements of treatment compliance. Identifying TB is not sufficient to reduce TB transmission; identification must be complemented with prompt initiation of therapy and aggressive follow-up of patients to ensure successful treatment completion. The use of genotyping to assess the impact of targeted interventions in high-risk populations should be encouraged. These assessments should also include measurements of treatment adherence and clinical outcomes of persons with both LTBI and TB disease.
Centers for Disease Control and Prevention
University of North Texas Health Science Center FOOTNOTES Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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