Factors associated with refusal of preventive therapy after initial willingness to accept treatment among college students with latent tuberculosis infection in Shandong, China

Abstract

Background Preventive therapy of latent tuberculosis infection (LTBI) is an important component of tuberculosis (TB) control. Research on acceptance of TB preventive therapy (TPT) is an important topic. Current studies focus on acceptability and compliance. However, it is unclear whether LTBI patients will start TPT after accepting treatment. The study assessed the factors associated with TPT refusal after initial willingness to accept treatment. Methods Data were derived from a baseline survey of prospective study of LTBI treatment among college students in Shandong Province, China. A total of 723 students initially willing to accept TPT were included in the analysis. Stepwise logistic regression was used to explore the individual- and family-level characteristic variables that factors associated with TPT refusal after initial willingness to accept treatment. Results Of the 723 LTBI college students who initially had acceptance willingness, 436 (60.3%) finally refused TPT. At the individual level, non-medical students were more likely to refuse TPT [odds ratio (OR) = 4.87, 95% confidence interval (CI): 3.10–7.67)], as were students with moderate physical activity (OR = 1.45, 95% CI: 1.04–2.04). Students with boarding experience (OR = 0.49, 95% CI: 0.31–0.78) and a high level of knowledge about TB (OR = 0.97, 95% CI: 0.95–0.99) were less likely to refuse TPT. At the family level, those with high father’s educational level (OR = 1.50, 95% CI: 1.07–2.10) or high household income (OR = 1.80, 95% CI: 1.20–2.71) were more likely to refuse TPT after initially accepting treatment. Conclusions Factors associated with TPT refusal after initial willingness to accept treatment, such as personal (type of students, physical activity, boarding experiences, knowledge of TB) and family characteristics (father’s education level, household income) among college student with LTBI, might help identify persons for whom tailored interventions could improve the start of LTBI treatment.

Current Status of Latent Tuberculosis Infection Treatment Among Pediatric Patients in Korea: Prescription and Treatment Completion

“…In previous studies, concerns expressed by parents or patients about potential side effects have been reported as potential barriers in LTBI treatment. 25 26 As a result of these concerns, parents may have discontinued the medication, or physicians may have chosen to halt the treatment, and such situations may have empirically noted in this study.…”

Tuberculosis screening characteristics amongst freshmen in Changping District, Beijing, China

“…Among the 312 freshmen who received TPT in this study, only 26 experienced minor adverse drug reactions that were less harmful to health and could be alleviated by symptomatic treatment. It is important to note that the harmfulness of adverse drug reactions was amplified and should not be the primary reason for rejecting TPT, except in cases with clear contraindications [ 28 , 34 ]. The study also found an extremely lower rate of TPT in higher vocational colleges compared to universities, indicating that educational level might influence prophylactic medication.…”

“…Although this study didn’t present a statistical difference between those who received TPT and those who did not receive TPT on the onset of TB, however, previous study has shown TPT was associated with a 32% lower incidence of active TB than placebo [ 35 ]. Other studies had shown that strong positive for PPD is a risk factor for the onset of TB, while TPT acts as a protective factor [ 28 , 36 ]. TPT is an effective measure to prevent the occurrence of active TB.…”

“…However, the majority of people with LTBI across China have not yet received TPT. Previous studies have suggested that stigma of disease play a role in the failure of receive TPT, along with adverse drug reactions and a lack of TB knowledge [ 27 , 28 ].…”

The Characteristics of Screen for Tuberculosis among Freshmen in Changping District, Beijing, China

“…However, the majority of people with LTBI in China have not yet received TPT. Previous studies have suggested that failure to receive TPT may be attributed to the stigma of disease associated with this disease, adverse drug reactions and a lack of knowledge about TB 22,23 .…”