Date of Degree

5-2018

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor(s)

Elizabeth Capezuti

Committee Members

Donna M. Nickitas

William Gallo

David Keepnews

Michelle Macaraig

Subject Categories

Community Health and Preventive Medicine | Public Health and Community Nursing

Keywords

Latent Tuberculosis Infection, Household Contacts of Cases of Active Tuberculosis in New York City, Tuberculosis Testing, Tuberculosis Evaluation, Treatment of Latent Tuberculosis Infection

Abstract

Contact investigation (CI) is one of the core elements of tuberculosis (TB) control. It is intended to achieve early identification of contacts who may have been exposed to a patient with infectious active TB and contacts who may benefit from treatment for latent tuberculosis infection (LTBI). LTBI is an infection in which the Mycobacterium tuberculosis organisms cause no signs and symptoms but the infection can be reactivated and develop into full-blown active TB disease. Failure to be identified as a contact is the primary reason for disease development in more than half of TB patients, thus a complete and timely CI is crucial for decreasing the transmission and incidence of TB. However, ensuring that contacts get tested and evaluated is challenging. A retrospective study of deidentified data extracted from the NYC TB registry was conducted to assess the demographic characteristics associated with 3008 household contacts’ decision to undergo TB testing (n=2850), evaluation (n=1037), and treatment for LTBI (n=863) from 2010 to 2014. A secondary aim was to examine if there are differences in proportion of contacts tested and evaluated based on type of provider (nurse versus and public health advisors). Multiple logistic regression analysis identified significant household contact characteristics associated with each decision point. The age of the household contacts was associated with acceptance of TB testing, such that the older the person, the less likely they were to be tested. Household contacts who are older, non-US born, and reside in Brooklyn, Queens, and Staten Island were more likely to have a TB test positive. Among household contacts with a positive TB test, Asians were more likely to undergo full evaluation while older age, males, and non-US born were less likely to be fully evaluated. Household contacts who are older, non-US born, and residing in Brooklyn, Queens, and Staten Island were less likely to accept LTBI treatment, while Asians and Hispanics were more likely to accept LTBI treatment. In terms of provider type, proportion of household contacts tested and evaluated did not differ between nurses and public health advisors.

These study findings identify factors associated with TB testing and evaluation, and LTBI treatment, which will enable public health agencies to streamline the process of contact investigation and plan for effective strategies that will increase the number of household contacts accepting TB testing and evaluation, as well as accepting and completing LTBI treatment.

Keywords: active tuberculosis, contact investigation, contacts of TB case, case management, testing, evaluation, barriers

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