Infectious Disease
Assess the factors contributing to Tuberculosis missed opportunities in Arkansas, 2009-2021 Danielle Boothe* Danielle Boothe Namvar Zohoori Clare Brown Ruofei Du Joseph Bates Leonard Mukasa Sean Young
Background: The Arkansas Department of Health (ADH) conducts routine high-risk-based Tuberculosis (TB) screening on various subpopulations known to be at risk for TB and Latent Tuberculosis Infection (LTBI). There needs to be more knowledge on patient-level factors associated with TB cases that were missed based on the screening strategies. This study aims to determine characteristics associated with missed TB opportunities.
Methods: The study design is a retrospective cohort using surveillance and genotyping data. A TB missed opportunity is a case of active TB reported in Arkansas that should never have occurred, given the prevailing intervention strategies in the state. There are ten missed opportunities criteria; the top three include persons born before 1951, previously reported cases of LTBI, and homeless individuals. The predictor variables are sputum smear, chest cavitary evidence, sex, race/ethnicity, genotypic clustering, public health region, and diagnosis year. Generalized estimating equations analysis assessed factors associated with TB missed opportunities.
Results: A total of 1015 persons with TB disease were reported to the ADH TB Program between 2009 and 2021. Of those, 547 (53.9%) were categorized as TB missed opportunities, with the majority, 260 (47.5%) being persons born before TB treatment in 1951. After adjusting for all predictor variables, being white non-Hispanic substantially increased the odds of being classified in the missed opportunity group (adjusted OR = 5.18; CI: 3.18, 8.45). Black non-Hispanic had an increased odds of 2.71 (CI:1.60, 4.59). Having evidence of chest cavitary and being in a genotypic cluster decreased the odds of being classified in the missed opportunity group by 35% and 32%, respectively.
Conclusion: Given Arkansas’s current strategy, fifty-four percent of cases could have been prevented. Knowing the factors associated with TB missed opportunities can assist the program in prioritizing sub-populations known at risk for TB and LTBI. Furthermore, efforts are underway to construct an LTBI registry.