Abstract
It is unknown whether patients with LTBI at high vs. low risk of developing active TB are currently adequately identified and treated in the US. In this study our objective was 1) To retrospectively apply the online calculator (tstin3d.com) to determine the probability of having LTBI and assign cumulative risk of progression. 2) Measure treatment outcomes in subjects with Low: 0-<10%, Intermediate: 10-<50% and High: 50–100% cumulative risk. We performed medical record review of tuberculin skin test and/or Interferon-γ release assay (IGRAs) positive patients with LTBI seen from 2010–2015. Of 125 subjects included, 51(41%), 46 (37%) and 28 (22%) subjects were in Low, Intermediate and High risk groups respectively. Tstin3d.com was useful in determining the probability of LTBI in tuberculin skin test positive US-born subjects. Overall treatment completion rate was 61% in 114 subjects with complete treatment information and similar completion rates were seen in the three groups (Low-60%, Intermediate-63% and High-57%). Provider assessment of important clinical risk factors was often incomplete. Logistic regression analysis showed no association of assessment of important risk factors with treatment completion. The major limitations of the calculator are the lack of an updated data on country-specific prevalence of TB disease as the global burden of TB continues to decrease as well as falsely high positive predictive values that due to “transiently” positive IGRA results in subjects from countries with low prevalence. Nonetheless, our findings suggest that tstin3d.com could be utilized in the US setting for improving providing awareness of risk stratification of patients with LTBI for short course treatment regimens based on risk.
Highlights
Our findings suggest that tstin3d.com could be utilized in the US setting for improving providing awareness of risk stratification of patients with Latent Tuberculosis Infection (LTBI) for short course treatment regimens based on risk
Our study demonstrates that tstin3d.com can be used to divide subjects with LTBI into Low, Intermediate and High cumulative risk of developing active TB based on the presence or absence of a combination of clinical risk factors in the US setting
Current standard of care practice did not result in higher treatment completion rates for patients in the High-risk group-an important goal of TB control in low burden countries
Summary
Www.tstin3d.com is a free online calculator that combines TST and/or IGRA screening results with other clinically pertinent information, to estimate the positive predictive value (PPV) of TB infection as well as individual’s annual and cumulative risk of progression to active TB. Such assessments allow the identification of patients that are at high risk of progression [6] but could be used to select shorter, supervised regimens to ensure treatment completion in that group.
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