Fawziah Lalji

Professor

Research Classification

Pharmacoepidemiology
Infectious Diseases
Vaccination
Antibiotics and Resistance
Tuberculosis

Relevant Degree Programs

 
 

Research Methodology

administrative data
PopulationDataBC
Epidemiology
Cost effectiveness models

Open Research Positions

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Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - Nov 2019)
Reducing the tuberculosis burden in migrant populations through latent tuberculosis infection interventions : a series of cost-effectiveness analyses (2018)

BACKGROUND: In many low tuberculosis (TB) incidence countries, TB rates have stagnated. In these countries, TB disproportionately affects migrant populations due to reactivation of latent TB infection (LTBI) acquired prior to immigration. Treatment of LTBI can significantly reduce risk of TB. The objective of this thesis is to determine the performance of common LTBI diagnostic tests in migrant populations and evaluate the cost-effectiveness of LTBI screening and treatment at various stages of the migration process and in migrants with chronic diseases, such as chronic kidney disease (CKD), that increase risk of TB.METHODS: A literature search determined the sensitivity of LTBI diagnostic tests: the tuberculin skin test (TST) and interferon-gamma release assay (IGRA). A meta-analysis was completed to determine the proportion of migrants testing positive with TST and IGRA from countries of various TB incidences. Discrete event simulation models evaluated the cost-effectiveness of LTBI screening and treatment in migrants: immediately post- immigration, prior to immigration, and at time of late stage CKD diagnosis or dialysis initiation. Incremental cost- effectiveness ratios (ICERs) were calculated for quality-adjusted life years.RESULTS: Sensitivities of 88.9% and 78.2% were found for the IGRA and TST, respectively. Fewer migrants test positive with an IGRA compared with a TST. Immediately after immigration, no LTBI screening was cost-effective when applied universally to all migrants (ICERs >$138,484), but can reduce the TB burden in migrants >20%. IGRA screening pre-immigration and rifampin treatment post-arrival can reduce the TB burden by >40% and results in ICERs
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Measuring patient-reported outcomes in tuberculosis (2010)

Objectives: The primary objectives of this thesis were to: (1) measure health-related quality of life (HRQL) and health state utility values (HSUVs) among patients with active tuberculosis (TB) disease and latent tuberculosis infection (LTBI); (2) investigate the relationship betwee HRQL and adverse drug reactions (ADR)among active TB patients; (3) quantify patients' preferences for LTBI preventive treatment. Methods: Two groups of patients were administered questionnaires: (1) Short-Form 36 (SF-36), Health Utility Index (HUI) and a Visual Analog Scale (VAS) were administered to 119 LTBI and 114 active TB patients at baseline and 3 months of their treatment. (2) A discrete choice experiment (DCE) survey was developed and administered among 214 LTBI patients. Conditional logit and latent class analysis were conducted to quantify respondents' preferences toward six treatment attributes (i.e. treatment length, clinic visit frequency, and risk of developing active TB, liver damage, skin rash and fatigue). Results: The baseline SF-36, HUI-2, HUI-3, Short-Form 6D (SF-6D) and VAS scores from active TB patients were significantly lower than those from LTBI patients. Major ADRs were shown to have significant impacts on active TB patients' HRQL and patients with lower baseline SF-36 scores were more likely to develop ADRs during the treatment. The three health utility instruments (HUI-2, HUI-3, and SF-6D) displayed acceptable construct validity when applying among TB population. However, they did not generate identical HSUV scores for the same individual. The DCE study results showed that all six attributes significantly influenced respondents' treatment decision and preference estimates were reasonable and consistent with our hypotheses. Substantial preference heterogeneity was observed among respondents. Latent class analysis assigned respondents into three groups and five socio-demographic factors significantly predicted the class assignment (i.e. origin of birth, education, employment, had children or not, and use of over-the counter medications).Conclusions: Active TB disease and the treatment associated ADR have substantial impacts on patients' HRQL. HRQL measurements might have the potential to predict patients' treatment outcomes. The DCE technique provides a useful tool of understanding patients' preferences surrounding health care products. this work demonstrates the value and importance of incorporating patient-reported outcome measurements into clinical research and practice.

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Master's Student Supervision (2010 - 2018)
Does exposure to fluoroquinolone antibiotics delay diagnosis of pulmonary tuberculosis? (2010)

Tuberculosis (TB) remains a major public health concern, and a delay in its diagnosis leads to continued disease transmission, and at the population level, may result in ineffective TB control programs. This delay may be associated with the inappropriate use of antibiotics, particularly the respiratory fluoroquinolones (FQ). In our study we determined whether the use of fluoroquinolones and other antibiotics results in a delay inthe diagnosis of TB. We used population-based data from the British Columbia Linked Health Databases(BCLHD), which collects longitudinal health care information. Residents who had active pulmonary TB from January 1, 1997 to December 31, 2006 as identified through the provincial TB control database were included and linked with data in BCLHD. Negative binomial regression was used to calculate the relative risk (RR) of health care delay (the time between first patient contact with the health care system for a respiratory conditionand the initiation of anti-TB medication) and antibiotic delay (the time between first patient prescription fill for antibiotics and initiation of anti-TB medication) compared to controls, adjusting for potential confounders. A total of 2232 patients had active TB diagnosed in BC between 1997 and 2006. Of these, 1544 participants were included in the study with health care contact six months prior to the date of diagnosis. After adjusting for gender, age, foreign-born status, socioeconomicstatus, prior chest radiograph and physician specialist visit, the health care delay forpatients exposed to antibiotics was found to be significant at RR 2.10 (95% CI 1.80-2.44).Gender, age, foreign-born status and socioeconomic status were not found to be significant factors. When categorizing this delay by antibiotic type, all antibiotic categories were at a significantly increased risk for delay. In addition, this delayincreased as the antibiotics prescribed also increased for the patient. Delay related toantibiotic exposure was found to be significant for the combination of FQ and non-FQ antibiotics at RR 1.35 (95% CI 1.08-1.70), but not for the FQ or non-FQ only categories. Our results indicate a delay in TB diagnosis due to previous exposure to any antibiotic and not just fluoroquinolones.

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