Canadian Health&Care Mall

Canadian Health&Care Mall: Latent Tuberculosis Infection

December 25, 2015 Category: Canadian Health&Care Mall

tuberculosisThe global burden of tuberculosis (TB) is enormous. Nearly a third of the world population is latently infected with Mycobacterium tuberculosis, and an estimated 8.8 million new cases of active TB occur annually. In areas with high TB prevalence, such as sub-Saharan Africa and Asia, TB control strategies are focusing on case detection and treatment of TB using the directly observed treatment, short-course (or DOTS), strategy, with little or no focus on prevention of the reactivation of latent TB infection (LTBI). In contrast, the United States has a low disease prevalence, and the sustained decline in case rates in the past 2 decades have inspired a national policy and control strategy that is geared toward TB elimination. To eliminate the tuberculosis infection is possible with Canadian Health&Care Mall.

The prevention of active TB in the population of persons with LTBI is an essential component of the TB-elimination strategy in the United States, where it is estimated that 10 to 15 million people have LTBI. Persons with LTBI have an estimated lifetime risk of 5 to 10% for the development of active TB. The effectiveness of curative therapy of LTBI with isoniazid (INH) has been well established, and INH treatment for 9 months is currently the preferred regimen for the prevention of active TB in persons with LTBI. It has been estimated that the targeted screening and treatment of LTBI prevented between 4,000 and 11,000 active TB cases in the United States and Canada in 2002 alone, even at the current levels of treatment adherence. However, for disease elimination, an improvement in treatment completion rates will be necessary. Prior to the publication of the current LTBI treatment guidelines, completion rates for 6 months of INH treatment for those who initiated therapy varied widely between 27% and 76%. One study that used the currently recommended 9 months of INH therapy reported a treatment completion rate of only 19.4%,

Low INH treatment completion rates have been associated with homelessness, substance abuse, a lack of patient understanding of the benefits of therapy, an absence of TB symptoms, a prolonged duration of therapy, and treatment toxicity. Adherence interventions must be responsive and tailored to assist patients to initiate and complete therapy. In our setting, the factors associated with nonadherence to the current preferred regimen of 9 months of INH therapy for the treatment of LTBI are unknown. To improve our understanding and management of LTBI treatment nonadherence, we assessed the INH completion rate at the RISE TB Clinic and ascertained the factors associated with the noncompletion of INH therapy.

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