Predictors of Latent Tuberculosis Infection Treatment After Introduction of a New Regimen: A Retrospective Cohort Study at an Inner City Clinic

Abstract

Background. Despite the low and decreasing prevalence of tuberculosis (TB) in the United States, there remain certain high-risk groups with high incidence rates. The targeted screening and treatment of latent TB infection (LTBI) among these high-risk groups are needed to achieve TB elimination; however, by most accounts, LTBI treatment completion rates remain low. Methods. We retrospectively studied all patients accepting treatment for LTBI at the Fulton County Health Department TB clinic over 2 years. Medical chart abstraction was performed to collect information on sociodemographics, medical, and LTBI treatment history. Treatment completion was defined as finishing ≥88% of the prescribed regimen. Logistic regression analysis was performed to identify predictors of treatment completion. Results. Among 547 adults offered LTBI treatment, 424 (78%) accepted treatment and 298 of 424 (70%) completed treatment. The median age was 42 years, most patients were black (77%), and close to one third did not have stable housing. No significant difference in completion rates was found between the 3 regimens of 9 months isoniazid (65%), 4 months rifampin (71%), and 3 months of weekly rifapentine and isoniazid (79%). In multivariate analysis, having stable housing increased the odds of finishing treatment, whereas tobacco use and an adverse event decreased the odds. Conclusion. Utilizing comprehensive case management, we demonstrated high rates of LTBI treatment completion, including among those receiving a 3-month regimen. Completion rates were higher among persons with stable housing, and this finding highlights the need to develop strategies that will improve adherence among homeless persons.

A systematic review of adverse events of rifapentine and isoniazid compared to other treatments for latent tuberculosis infection

“…A total of 23 publications related to RCTs and 55 related to nonrandomized studies were included. A flow diagram documenting the process of study selection is provided in Figure .…”

“…This provided an opportunity for potential adverse events to be reviewed prior to administration of the medication and for the dose to be held if needed, possibly preventing progression to a more serious adverse event. Unfortunately, the frequency with which doses were held because of adverse events is not clearly reported by the included studies . Thus, the impact of this potential effect is unclear.…”

“…Unfortunately, the frequency with which doses were held because of adverse events is not clearly reported by the included studies. 5,7,18,23,43,[83][84][85][86][87][88] Thus, the impact of this potential effect is unclear.…”

Addressing Latent Tuberculosis Infection Treatment Through a Collaborative Care Model With Community Pharmacies and a Health Department

“…Completion rates for LTBI vary considerably in the literature, ranging from 35%-90%, with higher completion rates generally reported with shorter treatment regimens (10,(12)(13)(14)(15)(16)(17). Predictors for noncompletion include unstable housing, tobacco use, alcohol use, adverse drug events (ADEs), older age, patient location, poverty, and non-Hispanic ethnicity (14,(18)(19)(20)(21).…”

Latent Tuberculosis Infection Testing Practices in Long‐Term Care Facilities, Boston, Massachusetts

“…Recent data suggest a decline in TB incidence rates among LTCF and community‐dwelling older adults in California, although data on the prevalence of LTBI, LTBI screening rates, and treatment completion rates in the older population, particularly those in LTCFs, are sparse. In a study using data from 1979 to 1982, 13% of LTCF residents had LTBI .…”