Latent TB infection treatment acceptance and completion in the United States and Canada

C. Robert Horsburgh, Stefan Goldberg, James Bethel, Shande Chen, Paul W. Colson, Yael Hirsch-Moverman, Stephen Hughes, Robin Shrestha-Kuwahara, Timothy R. Sterling, Kirsten Wall, Paul Weinfurter, James McAuley, Judith Beison, Frank Wilson, Cheryl LeDoux, Jennifer Flood, Sumi Sun, Hugo Ortega, Randall Reves, Henry M. BlumbergJane Tapia, Jessie Wing, Sara Jacobson, Cara Endyke-Doran, Sue Etkind, Sharon Sharnprapai, Wendy Mills Sutherland, Hodan Guled, John Grabau, Wilson Miranda, Rachel Royce, Carol Dukes-Hamilton, Juani Munoz Sanchez, Connie Haley, Tamara Chavez-Lindell, Edward Graviss, Smita Chatterjee, David E. Griffith, Michael Kimerling, Ashutosh Tamhane, Monika Naus, Mark Fitzgerald, Maya Nakajima, Earl Hershfield, Barbara Roche, Nandini Selvam, Stephen Weis, Guadalupe Munguia, Jingsheng Yan, Heidi L. Venegas, Sarah Brown, Mike Jones

Research output: Contribution to journalArticle

152 Scopus citations

Abstract

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 healthcare facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P 5.003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P 5.001). 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.

Original languageEnglish
Pages (from-to)401-409
Number of pages9
JournalChest
Volume137
Issue number2
DOIs
StatePublished - 1 Feb 2010

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    Horsburgh, C. R., Goldberg, S., Bethel, J., Chen, S., Colson, P. W., Hirsch-Moverman, Y., Hughes, S., Shrestha-Kuwahara, R., Sterling, T. R., Wall, K., Weinfurter, P., McAuley, J., Beison, J., Wilson, F., LeDoux, C., Flood, J., Sun, S., Ortega, H., Reves, R., ... Jones, M. (2010). Latent TB infection treatment acceptance and completion in the United States and Canada. Chest, 137(2), 401-409. https://doi.org/10.1378/chest.09-0394