||Left DR & Left AR
||Tuberculosis control policies in major metropolitan
health departments in the United States V. Standard of practice in
||AME REV RESPIR DIS 1993, 148, 1530-1536.
Since 1978, in the United States, 28 metropolitan
health departments initially reporting greater than 250 cases of
TB per year were surveyed to determine the standard of practice
in the control of pulmonary TB and factors affecting treatment policy.
In this survey, results were compared with data obtained in 1978,
1980, 1984 & 1988. As in the previous years, all departments
completed the survey. The predominant treatment regimen was 6 months
of chemotherapy (64 + or - 1.33% of patients) involving isoniazid
(I), rifampin (R) and pyrazinamide (Z). Estimated duration of treatment,
which had decreased from 20.2 + or - 2.1 months in 1980 to 7.58
+ or -1.02 months in 1988, increased to 9.34 + or -2.32 months in
1992 (p< 0.01). This was attributed to an increased incidence
of HIV infection during the previous 4 years. In 1984, HIV infection
was estimated to coincide with TB in 2.54 percent of all patients,
7.72 percent in 1988 and 17.42 percent in 1992. Several other major
departures from prior perceived practices were reported. In 1980,
32.1 percent of all patients were hospitalized initially for TB
treatment, and this number decreased progressively to 17.8 percent
in 1988; in 1992, 34.2 + or -1.32 percent of patients with TB were
hospitalized for initial treatment. In 1988, no program reported
regular use of alternative therapy to isoniazid for chemoprophylaxis;
in 1992, 21 programs used alternative regimens (predominantly R-containing).
In 1992, nine programs reported increased funds for treatment of
TB (27.2+/- 1.97 percent inflation), whereas 16 reported a mean
decrease of 14 percent after inflation. The conclusions were that
TB treatment in the major metropolitan health departments consisted
predominantly of SCC utilizing I, R and Z and that overall mortality
was not greater because of initially drug-resistant organisms. However,
HIV-associated disease now was a major etiologic factor in TB, and
the number of hospitalizations had doubled in 4 years. The lack
of increase in funds for treatment was expected to exacerbate the
problems in TB control, in the future.
|KEYWORDS: HEALTH POLICY; USA.