Cost-effectiveness of expanded latent TB infection testing and treatment: Lynn City, Massachusetts, USA.

BACKGROUND: Between October 2016 and March 2019, Lynn Community Health Center in Massachusetts implemented a targeted latent TB infection testing and treatment (TTT) program, increasing testing from a baseline of 1,200 patients tested to an average of 3,531 patients tested, or 9% of the population per year.METHODS: We compared pre-implementation TTT, represented by the first two quarters of implementation data, to TTT, represented by 12 quarters of data. Time, diagnostic, and laboratory resources were estimated using micro-costing. Other cost and testing data were obtained from the electronic health record, pharmaceutical claims, and published reimbursement rates. A Markov cohort model estimated future health outcomes and cost-effectiveness from a societal perspective in 2020 US dollars. Monte Carlo simulation generated 95% uncertainty intervals.RESULTS: The TTT program exhibited extended dominance over baseline pre-intervention testing and had an incremental cost-effectiveness ratio (ICER) of US$52,603 (US$22,008â-"US$95,360). When compared to baseline pre-TTT testing, the TTT program averted an estimated additional 7.12 TB cases, 3.49 hospitalizations, and 0.16 deaths per lifetime cohort each year.CONCLUSIONS: TTT was more cost-effective than baseline pre-implementation testing. Lynn Community Health Centerâ-™s experience can help inform other clinics considering expanding latent TB infection testing.

Scaling Up Latent Tuberculosis Infection Testing and Treatment for Non-US Born Patients in a Federally Qualified Community Health Center.

In the United States (US), tuberculosis elimination strategies include scaling up latent tuberculosis infection (LTBI) diagnosis and treatment for persons at risk of progression to tuberculosis disease. The Massachusetts Department of Public Health partnered with Lynn Community Health Center to provide care to patients with LTBI who were born outside the US. The electronic health record was modified to facilitate collection of data elements for public health assessment of the LTBI care cascade. Among health center patients born outside the US, testing for tuberculosis infection increased by over 190%. From October 1, 2016 to March 21, 2019, 8827 patients were screened and 1368 (15.5%) were diagnosed with LTBI. Using the electronic health record, we documented treatment completion for 645/1368 (47.1%) patients. The greatest drop-offs occurred between testing for TB infection and clinical evaluation after a positive test (24.3%) and between the recommendation for LTBI treatment and completion of a treatment course (22.8%). Tuberculosis care delivery was embedded in the primary care medical home, bringing patient-centered care to those at high risk for loss to follow up. The partnership between public health and the community health center promoted quality improvement.

A genotypic and spatial epidemiologic analysis of Massachusetts' Mycobacterium tuberculosis cases from 2012 to 2015.

BACKGROUND: Massachusetts had a rate of 2.8 cases of tuberculosis (TB) per 100,000 individuals in 2015. Although TB in Massachusetts is on the decline, the case rate remains far above the 2020 National TB Target of 1.4 per 100,000. To reduce the TB case rate in Massachusetts, it is necessary to understand the local epidemiology and transmission risks. METHODS: We used an existing TB case database of Massachusetts TB cases in the time frame from 2012 to 2015, which links de-identified patient demographic information with TB genotypes obtained from the United States Centers for Disease Control and Prevention's (CDC) TB Genotyping Information Management System database. Two or more cases with identical genotypes, which were close in space (within 50 km), as determined in a geographic information system (GIS), and time (3 years), were considered TB clusters. RESULTS: We analyzed 543 genotyped cases. We identified a total of 85 cases that met the TB cluster criteria, and a total of 33 clusters. US-born individuals (p = 0.003), homeless individuals (p = 0.001) and those reporting illicit substance use (p = 0.001) and alcohol use (p = 0.001) were more likely to appear in a TB cluster. CONCLUSION: Through a combined genotypic and spatial epidemiological approach, we identified populations and individuals more likely to be in a TB cluster. Testing populations identified as at risk for being in a TB cluster, and providing appropriate treatment, may decrease the overall TB case rate and support efforts to achieve national 2020 TB targets.

Noise creates polarization artefacts.

The accuracy of calculations of both the degree and angle of polarization depend strongly on the noise in the measurements used. The noise in the measurements recorded by both camera based systems and spectrometers can lead to significant artefacts and incorrect conclusions about high degrees of polarization when in fact none exist. Three approaches are taken in this work: firstly, the absolute error introduced as a function of the signal to noise ratio for polarization measurements is quantified in detail. An important finding here is the reason for why several studies incorrectly suggest that black (low reflectivity) objects are highly polarized. The high degree of polarization is only an artefact of the noise in the calculation. Secondly, several simple steps to avoid such errors are suggested. Thirdly, if these points can not be followed, two methods are presented for mitigating the effects of noise: a maximum likelihood estimation method and a new denoising algorithm to best calculate the degree of polarization of natural polarization information.

Effectiveness of reporting on latent tuberculous infection in Massachusetts, 2006-2008.

Massachusetts is one of five states that mandate the reporting of latent tuberculous infection (LTBI). We assessed 2006-2008 Massachusetts surveillance data for LTBI to describe the system and examine the characteristics of persons with LTBI. Over 3 years, 15 301 LTBI cases were reported (4742-5398/year). Among those with known country of birth (n = 11 655), 9983 (85.7%) were foreign-born. Substantial under-ascertainment and/or under-reporting appear likely; mandatory reporting does not appear sufficient for LTBI detection. Enhanced targeted testing, active LTBI surveillance, or laboratory-based surveillance may be needed to eliminate tuberculosis disease in the United States.

Le Massachusetts est l'un des cinq états qui exige la déclaration de l'infection tuberculeuse latente (LTBI). Nous avons évalué les données de surveillance de la LTBI au Massachusetts de 2006 à 2008 afin de décrire le système et d'étudier les caractéristiques des patients. En trois ans, 15 301 cas ont été rapportés (4742 à 5398 par an). Parmi les 11 655 patients dont le pays d'origine était connu, 9983 (85,7%) étaient nés à l'étranger. Il est probable que ce système de déclaration et de surveillance est déficient, car la déclaration obligatoire ne parait pas suffire à la détection de la LTBI. L'élimination de la tuberculose aux Etats-Unis pourrait nécessiter de mettre l'accent sur le dépistage ciblé, la surveillance active de la LTBI ou une surveillance basée sur les examens de laboratoire.

Massachusetts es uno de los cinco estados en los cuales la notificación de la infección tuberculosa latente (LTBI) es obligatoria. En el presente estudio se evaluaron los datos de la vigilancia de esta afección entre el 2006 y el 2008, con el objeto de describir el sistema de vigilancia y examinar las características de las personas con diagnóstico de LTBI en Massachusetts. Durante el período de 3 años del estudio se notificaron 15 301 casos (de 474 a 5398 por año). De los casos en los cuales se conocía el país de origen (n = 11 655), 9983 personas habían nacido en el extranjero (85,7%). Es muy probable que exista una considerable deficiencia en la verificación y la notificación; la declaración obligatoria no parece una medida suficiente para detectar la LTBI. Se precisa una intensificación de las pruebas diagnósticas dirigidas, una vigilancia activa o una vigilancia de laboratorio de esta afección, con el propósito de eliminar la enfermedad tuberculosa en los Estados Unidos de América.

Pre- and post-operative treatment of constant and intermittent exotropia.

Intermittent exotropia is classified according to the AC/A ratio. Convergence amplitude measured on a light includes accommodative convergence. Amplitude measured while maintaining clear, single, binocular vision on 20/30 print utilizes only true fusional convergence.