Groups targeted for the Targeted Testing Program (TTP) were foreign-born persons recently arrived from high TB prevalence countries. These individuals were deemed unlikely to complete the Centers for Disease Control and Prevention (CDC) preferred nine-month regimen of isoniazid (9-INH) to treat Latent Tuberculosis Infection (LTBI) due to their seasonal jobs. Use of a shorter course regimen to treat LTBI was initiated to help improve completion of therapy rates in this population.
The TTP began using a four-month course of Rifampin 4-RIF to treat LTBI after reports of fatal and severe liver injuries associated with the use of a 2-month course rifampin and pyrazinamide (2-RZ). Individuals deemed to be unsuitable candidates for Rifampin-containing drug regimens (e.g. patients on oral contraception or those using medications with potential for interaction with RIF) were placed on 9-INH. All groups had similar demographics and received identical follow-up care.
Completion of therapy rates were as follows: 2-RZ 77% (106 completed therapy/138 started therapy), 4-RIF 79% (166 completed therapy/209 started therapy), 9-INH 62% (41 completed therapy/66 started therapy). Statistical comparison: 4-RIF vs. 9-INH p < 0.01; 2-RZ vs. 9-INH p < 0.05; 4-RIF vs. 2-RZ-not significant. There were no significant adverse drug effects or deaths in any group.
In this mobile population, the shorter LTBI treatment course of 4-RIF was well accepted, demonstrated no hepatic toxicity and contributed to a higher completion of therapy rate then the preferred 9-INH.
Shorter course regimens contribute to improved completion of therapy rates in foreign-born persons recently arrived from high TB prevalence countries who have LTBI.
Lewis Mooney, None.