Decision analysis for tuberculosis preventive treatment in nursing homes

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Public Health

Background:

• Older adults with positive tuberculin skin tests and fibrotic chest changes present a clinical dilemma regarding preventive treatment.
• Differing opinions exist on the utility of isoniazid (INH) preventive therapy in this specific population.

Purpose of the Study:

• To conduct a decision analysis to guide clinicians on the use of isoniazid (INH) preventive treatment in older individuals with positive tuberculin skin tests and fibrotic chest changes.
• To evaluate the impact of INH preventive treatment on survivorship and tuberculosis disease incidence in this demographic.

Main Methods:

• A decision analysis model was employed, utilizing available data to simulate outcomes.
• The analysis focused on five-year survivorship and the incidence of active tuberculosis disease.

Main Results:

• Isoniazid preventive treatment showed minimal impact on five-year survivorship.
• A significant reduction in the number of active tuberculosis disease cases was observed with INH use.
• The benefits of INH preventive treatment were found to be greater in populations with higher tuberculosis incidence.

Conclusions:

• Isoniazid preventive treatment offers an overall beneficial impact by reducing tuberculosis disease cases in older adults with positive tuberculin skin tests and fibrotic changes.
• The decision to use INH should consider the local tuberculosis incidence rates, with greater benefit observed in high-incidence settings.