Cost of nurse-managed latent tuberculous infection treatment among hard-to-reach immigrants in Israel

BACKGROUND: Adherence to treatment of latent tuberculous infection (LTBI), an essential component of tuberculosis (TB) elimination, is generally unsatisfactory. OBJECTIVES : To examine the adherence and costs of nurse-managed, semi-directly observed preventive treatment (semi-DOPT) with twice-weekly isoniazid among hard-to-reach Ethiopian immigrants, and to compare the treatment outcomes of onsite vs. regional TB clinicbased physician's follow-up. METHODS: This was a quasi-experimental retrospective cohort analysis of LTBI treatment among Ethiopian immigrants in reception centres in the Zefat subdistrict of Northern Israel, screened and treated for LTBI during 2005-2011. Two physician follow-up appointments were scheduled for each patient. RESULTS : Of 663 eligible Ethiopian immigrants included in the study, 628 (94.7%) completed treatment. Treatment outcomes were similar among onsite vs. regional TB clinic-based physician follow-up. Noncompletion was significantly associated with side effects (P ≤ 0.001). The total costs of treatment were relatively low, but were significantly higher for the TB clinic-based physician follow-up group. CONCLUSION: Nurse-managed semi-DOPT for LTBI treatment with reduced physician follow-up among hard-to-reach Ethiopian immigrants was efficient and safe. Providing on-site physician follow-up proved to be cheaper than standard follow-up at the regional TB clinic. Starting LTBI treatment at an early stage after immigration, and providing treatment and convenient transportation free of charge probably also contributed to the high treatment completion rates.