Latent tuberculosis in pregnant women: a patient perspective.

SETTING: Screening and treatment for latent tuberculosis (LTBI) in pregnant women remains controversial, although studies suggest there is a significantly increased risk of progression to active disease in the postpartum period. Studies have also shown that adherence to postpartum follow-up and treatment of LTBI is poor. To our knowledge, the reasons for this have not been investigated. We therefore identified pregnant women originating from high-burden tuberculosis (TB) countries now living in the Stockholm region, and screened and treated them for LTBI.OBJECTIVE: To explore how women diagnosed with LTBI during pregnancy understood and experienced their diagnosis and treatment.DESIGN: Sixteen semi-structured interviews with women on treatment for LTBI were analysed using content analysis with an inductive approach.RESULTS: None of the women were familiar with LTBI and assumed they had active TB, causing anxiety about who they might have infected and how it would affect the baby, as well as the fear of being stigmatised. They showed great ability to search for and understand information regarding their condition. Once treatment was initiated, they were motivated to complete it.CONCLUSION: Our findings suggest that the key factors was to provide treatment along with reliable information about LTBI to help patients overcome their concerns and misconceptions.

Methodological considerations for economic modelling of latent tuberculous infection screening in migrants.

Tuberculosis (TB) in migrants from endemic to low-incidence countries results mainly from the reactivation of latent tuberculous infection (LTBI). LTBI screening policies for migrants vary greatly between countries, and the evidence on the cost-effectiveness of the different approaches is weak and heterogeneous. The aim of this review was to assess the methodology used in published economic evaluations of LTBI screening among migrants to identify critical methodological options that must be considered when using modelling to determine value for money from different economic perspectives. Three electronic databases were searched and 10 articles were included. There was considerable variation across this small number of studies with regard to economic perspective, main outcomes, modelling technique, screening options and target populations considered, as well as in parameterisation of the epidemiological situation, test accuracy, efficacy, safety and programme performance. Only one study adopted a societal perspective; others adopted a health care or wider government perspective. Parameters representing the cascade of screening and treating LTBI varied widely, with some studies using highly aspirational scenarios. This review emphasises the need for a more harmonised approach for economic analysis, and better transparency in how policy options and economic perspectives influence methodological choices. Variability is justifiable for some parameters. However, sufficient data are available to standardise others. A societal perspective is ideal, but can be challenging due to limited data. Assumptions about programme performance should be based on empirical data or at least realistic assumptions. Results should be interpreted within specific contexts and policy options, with cautious generalisations.