title: Cost of nurse-managed latent tuberculous infection treatment among hard-to-reach immigrants in Israel.
abstract: BACKGROUND
  Adherence to treatment of latent tuberculous infection (LTBI), an essential component of tuberculosis (TB) elimination, is generally unsatisfactory.
  
  
  OBJECTIVE
  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 clinic-based 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. Non-completion 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pulmonary Division and Tuberculosis Centre, Nazareth Hospital, Nazareth, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Ramat Gan, Israel; School of Public Health, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Bishara
authors.affiliation: School of Public Health, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel; Department of Health Systems Management, Yezreel Valley College, Yezreel Valley, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Ore
authors.affiliation: Public Health Department, Northern District, Ministry of Health, Nazareth, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Vinitsky
authors.affiliation: Pulmonary Division and Tuberculosis Centre, Nazareth Hospital, Nazareth, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Bshara
authors.affiliation: Pulmonary Division and Tuberculosis Centre, Nazareth Hospital, Nazareth, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Armaly
authors.affiliation: Pulmonary Division and Tuberculosis Centre, Nazareth Hospital, Nazareth, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Weiler-Ravell
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects* / Q000627:therapeutic use; D007557:Israel; D055985:Latent Tuberculosis / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid