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Original Research: LUNG INFECTION |

Latent TB Infection Treatment Acceptance and Completion in the United States and Canada

C. Robert Horsburgh, Jr, MD; Stefan Goldberg, MD; James Bethel, PhD; Shande Chen, PhD; Paul W. Colson, PhD; Yael Hirsch-Moverman, MPH; Stephen Hughes, PhD; Robin Shrestha-Kuwahara, MPH; Timothy R. Sterling, MD; Kirsten Wall, MHS; Paul Weinfurter, BA; the Tuberculosis Epidemiologic Studies Consortium
Author and Funding Information

From the Department of Epidemiology (Dr Horsburgh), Boston University School of Public Health, Boston, MA; Centers for Disease Control and Prevention (Dr Goldberg, Ms Shrestha-Kuwahara, Mr Weinfurter), Atlanta, GA; Westat (Dr Bethel), Rockville MD; Department of Biostatistics (Dr Chen), University of North Texas Health Science Center, Fort Worth, TX; Columbia University (Dr Colson, Ms Hirsch-Moverman), New York, NY; New York State Department of Health (Dr Hughes), Albany, NY; Division of Infectious Diseases (Dr Sterling), Vanderbilt University School of Medicine, Nashville, TN; and the Denver Health and Hospital Authority (Ms Wall), Denver CO.

Correspondence to: C. Robert Horsburgh Jr, MD, Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, T3E, Boston, MA 02118; e-mail: rhorsbu@bu.edu


Funding/Support: This study was supported by the Centers for Disease Control and Prevention, Contract Number 200-2001-00082.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):401-409. doi:10.1378/chest.09-0394
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Background:  Treatment of latent TB infection (LTBI) is essential for preventing TB in North America, but acceptance and completion of this treatment have not been systematically assessed.

Methods:  We performed a retrospective, randomized two-stage cross-sectional survey of treatment and completion of LTBI at public and private clinics in 19 regions of the United States and Canada in 2002.

Results:  At 32 clinics that both performed tuberculin skin testing and offered treatment, 123 (17.1%; 95% CI, 14.5%-20.0%) of 720 subjects tested and offered treatment declined. Employees at health-care facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P = .003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P = .001). At 68 clinics starting treatment regardless of where skin testing was performed, 1,045 (52.7%; 95% CI, 48.5%-56.8%) of 1,994 people starting treatment failed to complete the recommended course. Risk factors for failure to complete included starting the 9-month isoniazid regimen (OR, 2.08; 95% CI, 1.23-3.57), residence in a congregate setting (nursing home, shelter, or jail; OR, 2.94; 95% CI, 1.58-5.56), injection drug use (OR, 2.13; 95% CI, 1.04-4.35), age ≥ 15 years (OR, 1.49; 95% CI, 1.14-1.94), and employment at a health-care facility (1.37; 95% CI, 1.00-1.85).

Conclusions:  Fewer than half of the people starting treatment of LTBI completed therapy. Shorter regimens and interventions targeting residents of congregate settings, injection drug users, and employees of health-care facilities are needed to increase completion.

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