Optimizing Latent Tuberculosis Treatment Strategies Among Immigrants From High-Burden Settings

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Economics

Background:

• Foreign-born individuals represent a significant portion of tuberculosis (TB) cases in the US.
• Current guidelines recommend TB testing and treatment for all foreign-born individuals, irrespective of age or time since immigration.
• The risks of TB disease progression and treatment-related harm vary across different immigrant subgroups.

Purpose of the Study:

• To evaluate the cost-effectiveness and health outcomes of different TB infection treatment strategies.
• To stratify these strategies by age and time since immigration for individuals from high-TB-burden settings.
• To inform targeted TB preventive therapy recommendations for immigrant populations.

Main Methods:

• A decision analytical model utilizing individual-level microsimulation (Markov model) over a 30-year period.
• Simulated a cohort of 10,000 interferon-gamma release assay (IGRA)-positive, foreign-born adults from high-incidence settings.
• Compared interventions: rifampin (4 months), isoniazid (9 months), and no preventive therapy, stratified by age (35 and 65 years) and time since immigration (recent vs. remote).

Main Results:

• Rifampin was the dominant and optimal strategy for recent immigrants at both ages 35 and 65.
• For remote immigrants, rifampin remained dominant, but no treatment became optimal for older individuals (age 65).
• Incremental cost-effectiveness ratios (ICERs) for treatment versus no treatment were unfavorable for older remote immigrants.

Conclusions:

• Rifampin demonstrates cost-effectiveness for recent immigrants requiring TB preventive therapy.
• No preventive therapy is the optimal strategy for older remote immigrants, indicating lower risk.
• Stratifying TB infection treatment by age and time since immigration can optimize resource allocation and reduce unnecessary interventions.