Latent Tuberculosis Cascade of Care Among Healthcare Workers: A Nationwide Cohort Analysis in Korea Between 2017 and 2018

Abstract

Background In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model. Methods We included 45,503 employees of medical institutions with positive interferon-gamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care. Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and not-completing treatment. Results Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64–0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81–0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29–1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16–1.53). Conclusion Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.

Intention to receive Latent Tuberculosis Infection (LTBI) treatment and its associated factors among healthcare workers in a Malaysian teaching university hospital

“…Gender emerged as a significant factor in determining intent to receive LTBI treatment, given that female HCWs displayed 2.03 times more willingness to do so than male HCWs in this study. In a similar vein, male HCWs in South Korea exhibited 1.2 times higher chance of refusing LTBI treatment despite a positive diagnosis [ 49 ]. On the contrary, male HCWs in the US showed 1.9 times more likelihood to accept LTBI treatment than female HCWs [ 21 ].…”

The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018

“…We constructed a prospective observational cohort of individuals screened in congregate settings within the nationwide screening project for LTBI ( 18 ). Individuals were tested by IGRA between March 2017 and December 2018.…”

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

“…The Korean government consistently supports TB control initiatives, which encompass investigating close contacts of TB cases, mandatory LTBI screening for healthcare workers, and LTBI treatment for high-risk groups. 5 6 7 Following TB control guidelines, pediatric patients diagnosed with LTBI are recommended to undergo treatment. Currently, the standard regimen is 9 months of isoniazid (9H), with 3 months of isoniazid plus rifampicin (3HR) treatment as a recommended alternative.…”