Treatment of latent tuberculosis infection in migrants in primary careversussecondary care

Burman, M; Zenner, D; Copas, AJ; Goscé, L; Haghparast-Bidgoli, H; White, PJ; Hickson, V; Greyson, O; Trathen, D; Ashcroft, R; Martineau, AR; Abubakar, I; Griffiths, CJ; Kunst, H

Journal article

Treatment of latent tuberculosis infection in migrants in primary careversussecondary care

Abstract:: BACKGROUND: Control of latent tuberculosis infection (LTBI) is a priority in the World Health Organization strategy to eliminate TB. Many high-income, low TB incidence countries have prioritised LTBI screening and treatment in recent migrants. We tested whether a novel model of care, based entirely within primary care, was effective and safe compared to secondary care. METHODS: This was a pragmatic cluster-randomised, parallel group, superiority trial (ClinicalTrials.gov: NCT03069807) conducted in 34 general practices in London, UK, comparing LTBI treatment in recent migrants in primary care to secondary care. The primary outcome was treatment completion, defined as taking ≥90% of antibiotic doses. Secondary outcomes included treatment acceptance, adherence, adverse effects, patient satisfaction, TB incidence and a cost-effectiveness analysis. Analyses were performed on an intention-to-treat basis. RESULTS: Between September 2016 and May 2019, 362 recent migrants with LTBI were offered treatment and 276 accepted. Treatment completion was similar in primary and secondary care (82.6% versus 86.0%; adjusted OR (aOR) 0.64, 95% CI 0.31-1.29). There was no difference in drug-induced liver injury between primary and secondary care (0.7% versus 2.3%; aOR 0.29, 95% CI 0.03-2.84). Treatment acceptance was lower in primary care (65.2% (146/224) versus 94.2% (130/138); aOR 0.10, 95% CI 0.03-0.30). The estimated cost per patient completing treatment was lower in primary care, with an incremental saving of GBP 315.27 (95% CI 313.47-317.07). CONCLUSIONS: The treatment of LTBI in recent migrants within primary care does not result in higher rates of treatment completion but is safe and costs less when compared to secondary care

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Burman, M., Zenner, D., Copas, A. J., Goscé, L., Haghparast-Bidgoli, H., White, P. J., Hickson, V., Greyson, O., Trathen, D., Ashcroft, R., Martineau, A. R., Abubakar, I., Griffiths, C. J., & Kunst, H. (2024). Treatment of latent tuberculosis infection in migrants in primary careversussecondary care. European Respiratory Journal, 64(5), 2301733–2301733.

MLA Style

Burman, M, et al. “Treatment of Latent Tuberculosis Infection in Migrants in Primary CareversusSecondary Care.” European Respiratory Journal, vol. 64, no. 5, 2024, pp. 2301733–33.

Chicago Style

Burman, M, D Zenner, AJ Copas, et al. 2024. “Treatment of Latent Tuberculosis Infection in Migrants in Primary CareversusSecondary Care.” European Respiratory Journal 64 (5): 2301733–33.
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