Browsing by Subject "Latent Tuberculosis / prevention & control"
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Item A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States(Wolters Kluwer Health, Inc., 2021-02-19) Annan, Esther; Stockbridge, Erica L.; Katz, Dolly; Mun, Eun-Young; Miller, Thaddeus L.ABSTRACT: More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.Item Latent Tuberculosis Infection Testing and Treatment in the Private Sector: Evidence from Commercial Health Insurance Claims(2017-05) Stockbridge, Erica L.; Miller, Thaddeus L.; Carlson, Erin K.; Ho, ChristineTargeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis (TB) elimination strategy. Little research on LTBI testing and treatment has been conducted outside of public healthcare settings, so there is a dearth of information about the provision of LTBI-related services in the private sector environment. This gap was highlighted by recent health insurance-related regulatory changes that are expected to increase LTBI testing and treatment by private providers. Our research aimed to provide insight on the LTBI-related services provided to commercially insured individuals in the private sector setting. We analyzed a national sample of commercial insurance medical and pharmacy claims data from the Optum National Research Database for 4 million people ages 0 to 64; these data represented insurance-paid healthcare services received between January 2011 and December 2013 at minimum. We estimated private sector LTBI testing rates and examined patient characteristics associated with private sector LTBI testing. We also developed a claims-based method to identify LTBI treatment in the private sector and subsequently used this method to estimate treatment completion rates and identify clinical and system factors associated with treatment completion. We found that LTBI testing was not uncommon in the private sector and it is generally targeted to patients at the highest risk of TB/LTBI. Further, our claims-based method to identify and evaluate LTBI treatment successfully identified such treatment occurring in the private sector. Private sector LTBI treatment completion rates were in the range of those found in public health settings. Additionally, we identified factors unique to the private healthcare system that are associated with LTBI treatment completion. Our results suggest that the commercial sector may be a valuable adjunct to more traditional venues for TB prevention. Moreover, medical and pharmacy claims data and the claims-based methods we developed offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate TB prevention.