Latent tuberculous infection in the United States and Canada

Who completes treatment and why?

Y. Hirsch-Moverman, R. Shrestha-Kuwahara, J. Bethel, H. M. Blumberg, T. K. Venkatappa, C. R. Horsburgh, P. W. Colson, J. McAuley, J. Beison, J. Flood, K. Salcedo, R. Reves, K. Wall, H. Blumberg, J. Tapia, P. Colson, T. Venkatappa, W. Cronin, S. Collins, H. Rutz & 28 others R. Horsburgh, S. Etkind, S. Sharnprapai, S. Hughes, W. Miranda, T. Sterling, T. Stein-Hart, K. Gordon, M. Naus, K. Alasaly, Stephen Weis, G. Bayona, R. Horsburgh, S. Goldberg, H. Blumberg, P. Colson, C. Dukes-Hamilton, E. Eduardo, S. Hughes, H. Joseph, M. Nakajima, R. O'Brien, B. Roche, K. Salcedo, N. Selvam, K. Wall, P. Weinfurter, L. Yun.

Research output: Contribution to journalArticleResearchpeer-review

24 Citations (Scopus)

Abstract

OBJECTIVES: To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors.

METHODS: This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions.

RESULTS: Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6%) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take antituberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of noncompletion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness.

CONCLUSIONS: Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates.

Original languageEnglish
Pages (from-to)31-38
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume19
Issue number1
DOIs
StatePublished - 1 Jan 2015

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Canada
Infection
Therapeutics
Appointments and Schedules
Health Insurance
Interviews
Cohort Studies
Parturition
Prospective Studies

Keywords

  • Adherence
  • Latent tuberculous infection
  • Prospective cohort
  • Treatment

Cite this

Hirsch-Moverman, Y., Shrestha-Kuwahara, R., Bethel, J., Blumberg, H. M., Venkatappa, T. K., Horsburgh, C. R., ... Yun., L. (2015). Latent tuberculous infection in the United States and Canada: Who completes treatment and why? International Journal of Tuberculosis and Lung Disease, 19(1), 31-38. https://doi.org/10.5588/ijtld.14.0373
Hirsch-Moverman, Y. ; Shrestha-Kuwahara, R. ; Bethel, J. ; Blumberg, H. M. ; Venkatappa, T. K. ; Horsburgh, C. R. ; Colson, P. W. ; McAuley, J. ; Beison, J. ; Flood, J. ; Salcedo, K. ; Reves, R. ; Wall, K. ; Blumberg, H. ; Tapia, J. ; Colson, P. ; Venkatappa, T. ; Cronin, W. ; Collins, S. ; Rutz, H. ; Horsburgh, R. ; Etkind, S. ; Sharnprapai, S. ; Hughes, S. ; Miranda, W. ; Sterling, T. ; Stein-Hart, T. ; Gordon, K. ; Naus, M. ; Alasaly, K. ; Weis, Stephen ; Bayona, G. ; Horsburgh, R. ; Goldberg, S. ; Blumberg, H. ; Colson, P. ; Dukes-Hamilton, C. ; Eduardo, E. ; Hughes, S. ; Joseph, H. ; Nakajima, M. ; O'Brien, R. ; Roche, B. ; Salcedo, K. ; Selvam, N. ; Wall, K. ; Weinfurter, P. ; Yun., L. / Latent tuberculous infection in the United States and Canada : Who completes treatment and why?. In: International Journal of Tuberculosis and Lung Disease. 2015 ; Vol. 19, No. 1. pp. 31-38.
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abstract = "OBJECTIVES: To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors.METHODS: This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions.RESULTS: Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6{\%}) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take antituberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of noncompletion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness.CONCLUSIONS: Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates.",
keywords = "Adherence, Latent tuberculous infection, Prospective cohort, Treatment",
author = "Y. Hirsch-Moverman and R. Shrestha-Kuwahara and J. Bethel and Blumberg, {H. M.} and Venkatappa, {T. K.} and Horsburgh, {C. R.} and Colson, {P. W.} and J. McAuley and J. Beison and J. Flood and K. Salcedo and R. Reves and K. Wall and H. Blumberg and J. Tapia and P. Colson and T. Venkatappa and W. Cronin and S. Collins and H. Rutz and R. Horsburgh and S. Etkind and S. Sharnprapai and S. Hughes and W. Miranda and T. Sterling and T. Stein-Hart and K. Gordon and M. Naus and K. Alasaly and Stephen Weis and G. Bayona and R. Horsburgh and S. Goldberg and H. Blumberg and P. Colson and C. Dukes-Hamilton and E. Eduardo and S. Hughes and H. Joseph and M. Nakajima and R. O'Brien and B. Roche and K. Salcedo and N. Selvam and K. Wall and P. Weinfurter and L. Yun.",
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Hirsch-Moverman, Y, Shrestha-Kuwahara, R, Bethel, J, Blumberg, HM, Venkatappa, TK, Horsburgh, CR, Colson, PW, McAuley, J, Beison, J, Flood, J, Salcedo, K, Reves, R, Wall, K, Blumberg, H, Tapia, J, Colson, P, Venkatappa, T, Cronin, W, Collins, S, Rutz, H, Horsburgh, R, Etkind, S, Sharnprapai, S, Hughes, S, Miranda, W, Sterling, T, Stein-Hart, T, Gordon, K, Naus, M, Alasaly, K, Weis, S, Bayona, G, Horsburgh, R, Goldberg, S, Blumberg, H, Colson, P, Dukes-Hamilton, C, Eduardo, E, Hughes, S, Joseph, H, Nakajima, M, O'Brien, R, Roche, B, Salcedo, K, Selvam, N, Wall, K, Weinfurter, P & Yun., L 2015, 'Latent tuberculous infection in the United States and Canada: Who completes treatment and why?', International Journal of Tuberculosis and Lung Disease, vol. 19, no. 1, pp. 31-38. https://doi.org/10.5588/ijtld.14.0373

Latent tuberculous infection in the United States and Canada : Who completes treatment and why? / Hirsch-Moverman, Y.; Shrestha-Kuwahara, R.; Bethel, J.; Blumberg, H. M.; Venkatappa, T. K.; Horsburgh, C. R.; Colson, P. W.; McAuley, J.; Beison, J.; Flood, J.; Salcedo, K.; Reves, R.; Wall, K.; Blumberg, H.; Tapia, J.; Colson, P.; Venkatappa, T.; Cronin, W.; Collins, S.; Rutz, H.; Horsburgh, R.; Etkind, S.; Sharnprapai, S.; Hughes, S.; Miranda, W.; Sterling, T.; Stein-Hart, T.; Gordon, K.; Naus, M.; Alasaly, K.; Weis, Stephen; Bayona, G.; Horsburgh, R.; Goldberg, S.; Blumberg, H.; Colson, P.; Dukes-Hamilton, C.; Eduardo, E.; Hughes, S.; Joseph, H.; Nakajima, M.; O'Brien, R.; Roche, B.; Salcedo, K.; Selvam, N.; Wall, K.; Weinfurter, P.; Yun., L.

In: International Journal of Tuberculosis and Lung Disease, Vol. 19, No. 1, 01.01.2015, p. 31-38.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Latent tuberculous infection in the United States and Canada

T2 - Who completes treatment and why?

AU - Hirsch-Moverman, Y.

AU - Shrestha-Kuwahara, R.

AU - Bethel, J.

AU - Blumberg, H. M.

AU - Venkatappa, T. K.

AU - Horsburgh, C. R.

AU - Colson, P. W.

AU - McAuley, J.

AU - Beison, J.

AU - Flood, J.

AU - Salcedo, K.

AU - Reves, R.

AU - Wall, K.

AU - Blumberg, H.

AU - Tapia, J.

AU - Colson, P.

AU - Venkatappa, T.

AU - Cronin, W.

AU - Collins, S.

AU - Rutz, H.

AU - Horsburgh, R.

AU - Etkind, S.

AU - Sharnprapai, S.

AU - Hughes, S.

AU - Miranda, W.

AU - Sterling, T.

AU - Stein-Hart, T.

AU - Gordon, K.

AU - Naus, M.

AU - Alasaly, K.

AU - Weis, Stephen

AU - Bayona, G.

AU - Horsburgh, R.

AU - Goldberg, S.

AU - Blumberg, H.

AU - Colson, P.

AU - Dukes-Hamilton, C.

AU - Eduardo, E.

AU - Hughes, S.

AU - Joseph, H.

AU - Nakajima, M.

AU - O'Brien, R.

AU - Roche, B.

AU - Salcedo, K.

AU - Selvam, N.

AU - Wall, K.

AU - Weinfurter, P.

AU - Yun., L.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - OBJECTIVES: To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors.METHODS: This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions.RESULTS: Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6%) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take antituberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of noncompletion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness.CONCLUSIONS: Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates.

AB - OBJECTIVES: To assess latent tuberculous infection (LTBI) treatment completion rates in a large prospective US/Canada multisite cohort and identify associated risk factors.METHODS: This prospective cohort study assessed factors associated with LTBI treatment completion through interviews with persons who initiated treatment at 12 sites. Interviews were conducted at treatment initiation and completion/cessation. Participants received usual care according to each clinic's procedure. Multivariable models were constructed based on stepwise assessment of potential predictors and interactions.RESULTS: Of 1515 participants initiating LTBI treatment, 1323 had information available on treatment completion; 617 (46.6%) completed treatment. Baseline predictors of completion included male sex, foreign birth, not thinking it would be a problem to take antituberculosis medication, and having health insurance. Participants in stable housing who received monthly appointment reminders were more likely to complete treatment than those without stable housing or without monthly reminders. End-of-treatment predictors of noncompletion included severe symptoms and the inconvenience of clinic/pharmacy schedules, barriers to care and changes of residence. Common reasons for treatment non-completion were patient concerns about tolerability/toxicity, appointment conflicts, low prioritization of TB, and forgetfulness.CONCLUSIONS: Less than half of treatment initiators completed treatment in our multisite study. Addressing tangible issues such as not having health insurance, toxicity concerns, and clinic accessibility could help to improve treatment completion rates.

KW - Adherence

KW - Latent tuberculous infection

KW - Prospective cohort

KW - Treatment

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U2 - 10.5588/ijtld.14.0373

DO - 10.5588/ijtld.14.0373

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SP - 31

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JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

SN - 1027-3719

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Hirsch-Moverman Y, Shrestha-Kuwahara R, Bethel J, Blumberg HM, Venkatappa TK, Horsburgh CR et al. Latent tuberculous infection in the United States and Canada: Who completes treatment and why? International Journal of Tuberculosis and Lung Disease. 2015 Jan 1;19(1):31-38. https://doi.org/10.5588/ijtld.14.0373