TY - JOUR
T1 - Tuberculosis prevention in Mexican immigrants
T2 - Limitations of short-course therapy
AU - Kandula, Namratha R.
AU - Dworkin, Mark S.
AU - Carroll, Margaret R.
AU - Lauderdale, Diane S.
N1 - Funding Information:
We are grateful to Karen Grush, Jane Lux, and Ana Rodriguez at the DeKalb County Health Department, and Margaret Swartz and Vicki Biddle at the Illinois Department of Public Health for their gracious assistance and collaboration. We would also like to thank Marshall Chin and John Lantos at the University of Chicago for their helpful advice on the manuscript. This research was supported by a grant from the Robert Wood Johnson Foundation.
PY - 2004/2
Y1 - 2004/2
N2 - Background: Two months of rifampin and pyrazinamide (RIF/PZA) for tuberculosis prevention has been advocated as a way to improve adherence in mobile populations, such as recent immigrants. However, RIF/PZA requires intensive patient and laboratory monitoring for hepatotoxicity. Objectives: To describe the feasibility and outcomes of using RIF/PZA for TB prevention during a tuberculosis outbreak in a Mexican immigrant community, where 23 adults and 11 children were treated with RIF/PZA between August 2001 and October 2001. Methods: Retrospective chart review and interviews with health department employees were conducted to assess completion rates, hepatotoxicity, cost, and feasibility of monitoring. Results: Ten (91%) children and 13 (57%) adults completed RIF/PZA. One child (9%) and four adults (17%) developed drug-induced hepatitis. Cultural barriers affected care. The adults resisted the biweekly blood draw, believing it would "drain them of energy." RIF/PZA, plus monitoring, was twice as costly as 4 months of rifampin. Conclusions: RIF/PZA was associated with significant hepatotoxicity, poor completion, and cultural barriers to monitoring, and was more costly than standard therapy. Tuberculosis prevention must address potential clinical, cultural, and economic barriers to completion and monitoring of short-course therapy in immigrants.
AB - Background: Two months of rifampin and pyrazinamide (RIF/PZA) for tuberculosis prevention has been advocated as a way to improve adherence in mobile populations, such as recent immigrants. However, RIF/PZA requires intensive patient and laboratory monitoring for hepatotoxicity. Objectives: To describe the feasibility and outcomes of using RIF/PZA for TB prevention during a tuberculosis outbreak in a Mexican immigrant community, where 23 adults and 11 children were treated with RIF/PZA between August 2001 and October 2001. Methods: Retrospective chart review and interviews with health department employees were conducted to assess completion rates, hepatotoxicity, cost, and feasibility of monitoring. Results: Ten (91%) children and 13 (57%) adults completed RIF/PZA. One child (9%) and four adults (17%) developed drug-induced hepatitis. Cultural barriers affected care. The adults resisted the biweekly blood draw, believing it would "drain them of energy." RIF/PZA, plus monitoring, was twice as costly as 4 months of rifampin. Conclusions: RIF/PZA was associated with significant hepatotoxicity, poor completion, and cultural barriers to monitoring, and was more costly than standard therapy. Tuberculosis prevention must address potential clinical, cultural, and economic barriers to completion and monitoring of short-course therapy in immigrants.
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U2 - 10.1016/j.amepre.2003.10.011
DO - 10.1016/j.amepre.2003.10.011
M3 - Article
C2 - 14751331
AN - SCOPUS:1642497544
VL - 26
SP - 163
EP - 166
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
SN - 0749-3797
IS - 2
ER -
