Chest
Volume 137, Issue 2, February 2010, Pages 401-409
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Original Research
Lung Infection
Latent TB Infection Treatment Acceptance and Completion in the United States and Canada

https://doi.org/10.1378/chest.09-0394Get rights and content

Background

Treatment of latent TB infection (LTBI) is essential for preventing TB in North America, but acceptance and completion of this treatment have not been systematically assessed.

Methods

We performed a retrospective, randomized two-stage cross-sectional survey of treatment and completion of LTBI at public and private clinics in 19 regions of the United States and Canada in 2002.

Results

At 32 clinics that both performed tuberculin skin testing and offered treatment, 123 (17.1%; 95% CI, 14.5%–20.0%) of 720 subjects tested and offered treatment declined. Employees at health-care facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75–12.9; P = .003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07–0.50; P = .001). At 68 clinics starting treatment regardless of where skin testing was performed, 1,045 (52.7%; 95% CI, 48.5%–56.8%) of 1,994 people starting treatment failed to complete the recommended course. Risk factors for failure to complete included starting the 9-month isoniazid regimen (OR, 2.08; 95% CI, 1.23–3.57), residence in a congregate setting (nursing home, shelter, or jail; OR, 2.94; 95% CI, 1.58–5.56), injection drug use (OR, 2.13; 95% CI, 1.04–4.35), age ≥ 15 years (OR, 1.49; 95% CI, 1.14–1.94), and employment at a health-care facility (1.37; 95% CI, 1.00–1.85).

Conclusions

Fewer than half of the people starting treatment of LTBI completed therapy. Shorter regimens and interventions targeting residents of congregate settings, injection drug users, and employees of health-care facilities are needed to increase completion.

Section snippets

Study Sites

The study was conducted at the 19 sites of the Tuberculosis Epidemiologic Studies Consortium (TBESC), each of which represents a partnership between an academic institution and a state or local TB control program.4 Each TBESC site was asked to examine practice sites in their catchment area that provided LTBI treatment to at least 10 persons in 2002 and could provide access to records of patients.

Study Design

The study design was a random stratified two-stage cluster sample survey with 1-year follow-up; all

Study Clinics and Study Subjects

Sixty-eight (68%) of the 100 clinics randomly selected for chart abstraction within the 19 catchment areas participated in the study. There were some differences between responding and nonresponding clinics. The response rate was substantially higher among public health clinics (82%) than among other types of clinics (26%); the latter group included private clinics, HIV clinics, and clinics serving homeless persons, immigrants, and refugees. There were also differences by size of clinic, with

Discussion

This study shows that although acceptance of LTBI treatment is relatively high (83%), the proportion completing is low (47%). When the product of these two proportions is calculated, we see that completion was achieved by only 39% of persons who were offered LTBI treatment. The major risk factor for noncompletion was being prescribed the 9-month INH regimen. As shown in Figure 1, when the proportions completing the three most commonly prescribed regimens are compared, it can be seen that there

Acknowledgments

Author contributions: Dr Horsburgh Jr: contributed to the design of the study, abstraction of study data, and analysis of the data, and wrote the first draft of the manuscript.

Dr Goldberg: contributed to the design of the study, analysis of the data, and preparation of the manuscript.

Dr Bethel: contributed to the design of the study, analysis of the data, and preparation of the manuscript. He had full access to all of the data in the study and takes responsibility for the integrity of the data

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      Citation Excerpt :

      Mendonça observed a non-completion rate of 25% among subjects aged under 15 years of age who were treated in a reference unit from 2002 to 2009.12 In large series in the USA and Canada, higher rates of non-completion of LTBIT were reported (40–52%).9,22 In Salvador, Brazil, 46.5% of children and adults contacts did not complete LTBIT.10

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    Funding/Support: This study was supported by the Centers for Disease Control and Prevention, Contract Number 200-2001-00082.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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