a) Health Policy, Delivery of Health Services & Health Care
AU : Left DR & Left AR
TI : Tuberculosis control policies in major metropolitan health departments in the United States V. Standard of practice in 1992.
SO : AME REV RESPIR DIS 1993, 148, 1530-1536.
DT : Per
AB :

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.