Latent TB infection treatment acceptance and completion in the United States and Canada

C. Robert Horsburgh; Stefan Goldberg; James Bethel; Shande Chen; Paul W. Colson; Yael Hirsch-Moverman; Stephen Hughes; Robin Shrestha-Kuwahara; Timothy R. Sterling; Kirsten Wall; Paul Weinfurter; James McAuley; Judith Beison; Frank Wilson; Cheryl LeDoux; Jennifer Flood; Sumi Sun; Hugo Ortega; Randall Reves; Henry M. Blumberg; Jane Tapia; Jessie Wing; Sara Jacobson; Cara Endyke-Doran; Sue Etkind; Sharon Sharnprapai; Wendy Mills Sutherland; Hodan Guled; John Grabau; Wilson Miranda; Rachel Royce; Carol Dukes-Hamilton; Juani Munoz Sanchez; Connie Haley; Tamara Chavez-Lindell; Edward Graviss; Smita Chatterjee; David E. Griffith; Michael Kimerling; Ashutosh Tamhane; Monika Naus; Mark Fitzgerald; Maya Nakajima; Earl Hershfield; Barbara Roche; Nandini Selvam; Stephen Weis; Guadalupe Munguia; Jingsheng Yan; Heidi L. Venegas; Sarah Brown; Mike Jones

doi:10.1378/chest.09-0394

Latent TB infection treatment acceptance and completion in the United States and Canada

C. Robert Horsburgh, Stefan Goldberg, James Bethel, Shande Chen, Paul W. Colson, Yael Hirsch-Moverman, Stephen Hughes, Robin Shrestha-Kuwahara, Timothy R. Sterling, Kirsten Wall, Paul Weinfurter, James McAuley, Judith Beison, Frank Wilson, Cheryl LeDoux, Jennifer Flood, Sumi Sun, Hugo Ortega, Randall Reves, Henry M. BlumbergJane Tapia, Jessie Wing, Sara Jacobson, Cara Endyke-Doran, Sue Etkind, Sharon Sharnprapai, Wendy Mills Sutherland, Hodan Guled, John Grabau, Wilson Miranda, Rachel Royce, Carol Dukes-Hamilton, Juani Munoz Sanchez, Connie Haley, Tamara Chavez-Lindell, Edward Graviss, Smita Chatterjee, David E. Griffith, Michael Kimerling, Ashutosh Tamhane, Monika Naus, Mark Fitzgerald, Maya Nakajima, Earl Hershfield, Barbara Roche, Nandini Selvam, Stephen Weis, Guadalupe Munguia, Jingsheng Yan, Heidi L. Venegas, Sarah Brown, Mike Jones

Research output: Contribution to journal › Article › peer-review

197 Scopus citations

Abstract

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 healthcare facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P 5.003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P 5.001). 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.

Original language	English (US)
Pages (from-to)	401-409
Number of pages	9
Journal	CHEST
Volume	137
Issue number	2
DOIs	https://doi.org/10.1378/chest.09-0394
State	Published - Feb 1 2010
Externally published	Yes

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

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10.1378/chest.09-0394

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Horsburgh, C. R., Goldberg, S., Bethel, J., Chen, S., Colson, P. W., Hirsch-Moverman, Y., Hughes, S., Shrestha-Kuwahara, R., Sterling, T. R., Wall, K., Weinfurter, P., McAuley, J., Beison, J., Wilson, F., LeDoux, C., Flood, J., Sun, S., Ortega, H., Reves, R., ... Jones, M. (2010). Latent TB infection treatment acceptance and completion in the United States and Canada. CHEST, 137(2), 401-409. https://doi.org/10.1378/chest.09-0394

Horsburgh, CR, Goldberg, S, Bethel, J, Chen, S, Colson, PW, Hirsch-Moverman, Y, Hughes, S, Shrestha-Kuwahara, R, Sterling, TR, Wall, K, Weinfurter, P, McAuley, J, Beison, J, Wilson, F, LeDoux, C, Flood, J, Sun, S, Ortega, H, Reves, R, Blumberg, HM, Tapia, J, Wing, J, Jacobson, S, Endyke-Doran, C, Etkind, S, Sharnprapai, S, Sutherland, WM, Guled, H, Grabau, J, Miranda, W, Royce, R, Dukes-Hamilton, C, Sanchez, JM, Haley, C, Chavez-Lindell, T, Graviss, E, Chatterjee, S, Griffith, DE, Kimerling, M, Tamhane, A, Naus, M, Fitzgerald, M, Nakajima, M, Hershfield, E, Roche, B, Selvam, N, Weis, S, Munguia, G, Yan, J, Venegas, HL, Brown, S & Jones, M 2010, 'Latent TB infection treatment acceptance and completion in the United States and Canada', CHEST, vol. 137, no. 2, pp. 401-409. https://doi.org/10.1378/chest.09-0394

@article{a82cca67b84b477c80961e87a5b9fa92,

title = "Latent TB infection treatment acceptance and completion in the United States and Canada",

abstract = "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 healthcare facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P 5.003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P 5.001). 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.",

author = "Horsburgh, {C. Robert} and Stefan Goldberg and James Bethel and Shande Chen and Colson, {Paul W.} and Yael Hirsch-Moverman and Stephen Hughes and Robin Shrestha-Kuwahara and Sterling, {Timothy R.} and Kirsten Wall and Paul Weinfurter and James McAuley and Judith Beison and Frank Wilson and Cheryl LeDoux and Jennifer Flood and Sumi Sun and Hugo Ortega and Randall Reves and Blumberg, {Henry M.} and Jane Tapia and Jessie Wing and Sara Jacobson and Cara Endyke-Doran and Sue Etkind and Sharon Sharnprapai and Sutherland, {Wendy Mills} and Hodan Guled and John Grabau and Wilson Miranda and Rachel Royce and Carol Dukes-Hamilton and Sanchez, {Juani Munoz} and Connie Haley and Tamara Chavez-Lindell and Edward Graviss and Smita Chatterjee and Griffith, {David E.} and Michael Kimerling and Ashutosh Tamhane and Monika Naus and Mark Fitzgerald and Maya Nakajima and Earl Hershfield and Barbara Roche and Nandini Selvam and Stephen Weis and Guadalupe Munguia and Jingsheng Yan and Venegas, {Heidi L.} and Sarah Brown and Mike Jones",

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

year = "2010",

month = feb,

day = "1",

doi = "10.1378/chest.09-0394",

language = "English (US)",

volume = "137",

pages = "401--409",

journal = "CHEST",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

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TY - JOUR

T1 - Latent TB infection treatment acceptance and completion in the United States and Canada

AU - Horsburgh, C. Robert

AU - Goldberg, Stefan

AU - Bethel, James

AU - Chen, Shande

AU - Colson, Paul W.

AU - Hirsch-Moverman, Yael

AU - Hughes, Stephen

AU - Shrestha-Kuwahara, Robin

AU - Sterling, Timothy R.

AU - Wall, Kirsten

AU - Weinfurter, Paul

AU - McAuley, James

AU - Beison, Judith

AU - Wilson, Frank

AU - LeDoux, Cheryl

AU - Flood, Jennifer

AU - Sun, Sumi

AU - Ortega, Hugo

AU - Reves, Randall

AU - Blumberg, Henry M.

AU - Tapia, Jane

AU - Wing, Jessie

AU - Jacobson, Sara

AU - Endyke-Doran, Cara

AU - Etkind, Sue

AU - Sharnprapai, Sharon

AU - Sutherland, Wendy Mills

AU - Guled, Hodan

AU - Grabau, John

AU - Miranda, Wilson

AU - Royce, Rachel

AU - Dukes-Hamilton, Carol

AU - Sanchez, Juani Munoz

AU - Haley, Connie

AU - Chavez-Lindell, Tamara

AU - Graviss, Edward

AU - Chatterjee, Smita

AU - Griffith, David E.

AU - Kimerling, Michael

AU - Tamhane, Ashutosh

AU - Naus, Monika

AU - Fitzgerald, Mark

AU - Nakajima, Maya

AU - Hershfield, Earl

AU - Roche, Barbara

AU - Selvam, Nandini

AU - Weis, Stephen

AU - Munguia, Guadalupe

AU - Yan, Jingsheng

AU - Venegas, Heidi L.

AU - Brown, Sarah

AU - Jones, Mike

N1 - Funding Information: Funding/Support: This study was supported by the Centers for Disease Control and Prevention, Contract Number 200-2001-00082.

PY - 2010/2/1

Y1 - 2010/2/1

N2 - 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 healthcare facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P 5.003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P 5.001). 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.

AB - 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 healthcare facilities were more likely to decline (odds ratio [OR], 4.74; 95% CI, 1.75-12.9; P 5.003), whereas those in contact with a patient with TB were less likely to decline (OR, 0.19; 95% CI, 0.07-0.50; P 5.001). 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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Latent TB infection treatment acceptance and completion in the United States and Canada

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