Attitudes about tuberculosis prevention in the elimination phase: a survey among physicians in Germany

PLoS One. 2014 Nov 13;9(11):e112681. doi: 10.1371/journal.pone.0112681. eCollection 2014.

Abstract

Background: Targeted and stringent measures of tuberculosis prevention are necessary to achieve the goal of tuberculosis elimination in countries of low tuberculosis incidence.

Methods: We ascertained the knowledge about tuberculosis risk factors and stringency of tuberculosis prevention measures by a standardized questionnaire among physicians in Germany involved in the care of individuals from classical risk groups for tuberculosis.

Results: 510 physicians responded to the online survey. Among 16 risk factors immunosuppressive therapy, HIV-infection and treatment with TNF-antagonist were thought to be the most important risk factors for the development of tuberculosis in Germany. Exposure to a patient with tuberculosis ranked on the 10th position. In the event of a positive tuberculin-skin-test or interferon-γ release assay only 50%, 40%, 36% and 25% of physicians found that preventive chemotherapy was indicated for individuals undergoing tumor necrosis factor-antagonist therapy, close contacts of tuberculosis patients, HIV-infected individuals and migrants, respectively.

Conclusions: A remarkably low proportion of individuals with latent infection with Mycobacterium tuberculosis belonging to classical risk groups for tuberculosis are considered candidates for preventive chemotherapy in Germany. Better knowledge about the risk for tuberculosis in different groups and more stringent and targeted preventive interventions will probably be necessary to achieve tuberculosis elimination in Germany.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antitubercular Agents / therapeutic use*
  • Attitude*
  • Coinfection
  • Data Collection / statistics & numerical data
  • Disease Eradication / organization & administration*
  • Female
  • Germany
  • HIV Infections / drug therapy
  • HIV Infections / virology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / isolation & purification
  • Physicians / psychology*
  • Risk Factors
  • Transients and Migrants
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / microbiology
  • Tuberculosis, Pulmonary / prevention & control*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • Anti-HIV Agents
  • Antitubercular Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha

Grants and funding

The study was funded by the German Center for Infection Research (DZIF). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.