BackgroundThe U.S. Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis (three months of weekly isoniazid and rifapentine) in late 2011. While completion rates of this regimen were reported to be higher than nine months of isoniazid, little is known about the completion rates of three months of isoniazid and rifapentine compared to nine months of isoniazid or four months of rifampin in actual use scenarios.MethodsWe conducted a retrospective cohort study comparing treatment completion for latent tuberculosis (TB) infection in patients treated with nine months of isoniazid, three months of isoniazid and rifapentine or four months of rifampin in outpatient clinics and a public health TB clinic in Seattle, Washington. The primary outcome of treatment completion was defined as 270 doses of isoniazid within 12 months, 120 doses of rifampin within six months and 12 doses of isoniazid and rifapentine within four months.ResultsThree hundred ninety-three patients were included in the study. Patients were equally likely to complete three months of weekly isoniazid and rifapentine or four months of rifampin (85% completion rate of both regimens), as compared to 52% in the nine months of isoniazid group (p < 0.001). These associations remained statistically significant even after adjusting for clinic location and type of monitoring. Monitoring type (weekly versus monthly versus less often than monthly) had less impact on treatment completion than the type of treatment offered.ConclusionsPatients were equally as likely to complete the three months of isoniazid and rifapentine as four months of rifampin. Four months of rifampin is similar in efficacy compared to placebo as isoniazid and rifapentine but does not require directly observed therapy (DOT), and is less expensive compared to combination therapy with isoniazid and rifapentine, and thus can be the optimal treatment regimen to achieve the maximal efficacy in a community setting.

Introduction:The aim of this study is to describe factors associated with noncompletion of latent tuberculosis infection (LTBI) therapy.Methods: We conducted a retrospective cohort study of adults who initiated LTBI treatment with isoniazid, rifampin, or isoniazid-rifapentine at 5 clinics. Demographic, treatment, and monitoring characteristics were abstracted. We estimated descriptive statistics and compared differences between completers and noncompleters using t tests and 2 tests. Results: The rate of completion across LTBI regimens was 66% (n ‫؍‬ 393). A greater proportion of noncompleters were unmarried, used tobacco and/or alcohol, and had more medical problems than completers (all P < .05). A larger proportion of noncompleters received charity care compared with completers (P < .001). The most common reason for treatment discontinuation was loss to follow-up; the majority of these participants were treated with the longest isoniazid-only regimen.Conclusions: Patients at risk of progression to active tuberculosis with factors associated with noncompletion may benefit from interventions that enhance adherence to LTBI therapy. These interventions could include enhanced outreach, incentive programs, or home visits. (J Am Board Fam Med 2017;30: 520 -527.)

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IntroductionMeaningful feedback is essential for effective medical education, yet the feedback process has been consistently problematic for both learners and faculty. Emerging research on feedback highlights the importance of the learner, relationships, and culture for feedback to improve performance. We used the theory of self-regulated learning to develop the Prepare to Ask-Discuss-Ask-Plan Together (Prepare to ADAPT) framework to improve the feedback processes and investigated learner perceptions of this innovative feedback framework.MethodsQualitative thematic analysis of structured interviews of nine trainees participating in training on the Prepare to ADAPT feedback framework.Results The framework appeared primarily to potentially decrease learner anxiety and stress around the feedback process by providing a simple, structured discourse pattern. We identified five contributing themes: (1) increased efficiency of the feedback process; (2) formation of coaching/teamwork relationships; (3) facilitation of reflection and goal identification; (4) increased frequency of the feedback; (5) increased usefulness of the feedback.DiscussionThe Prepare to ADAPT framework may help decrease stress and anxiety of the feedback by clarifying the process, applying a structure, and developing coaching relationships. The framework was found to be easy to use and increased the number of effective feedback conversations in this exploratory study.