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Researchers identify patients not likely to complete TB treatment

Marital status, substance use and extent of medical history are among the factors that could determine which patients are most likely to finish latent tuberculosis infection treatment, according to research recently published in the Journal of the American Board of Family Medicine.

“The proportion of patients who complete [latent tuberculosis infection] treatment remains small...” McKenna C Eastment, MD, MPH, of the department of medicine at the University of Washington, and colleagues wrote. “Understanding which patients may be at risk for noncompletion can help providers identify patients, especially those at risk of progression to active tuberculosis, who may need enhanced support or case management to ensure completion.”

According to researchers, there are approximately 11 million patients in the United States with latent tuberculosis infection. The CDC recommends one of three treatment regimens: weekly isoniazid and rifapentine with directly observed therapy for 3 months; rifampin daily for 4 months or isoniazid daily for 9 months.

Eastment and colleagues performed a retrospective cohort study of 393 adults who began one of the CDC-recommended therapies at one of five clinics in the Northwestern United States. Patients were 18 years of age or older, not pregnant, and not HIV positive.

Researchers found that 34% (n = 132) of participants did not finish their regimen. These people were more likely to be single (P < .05), use alcohol and/or tobacco (P < .05), and had more medical problems (P < .05) than those who did finish the regimen. In addition, more of the noncompleters were enrolled in charity care programs compared with completers (P < .001), and most of the patients lost during follow-up were on the isoniazid-only regimen.

“However, many additional factors likely predict treatment completion, such as a patient's understanding of and motivation to take [latent tuberculosis infection] treatment, interaction between the patient and the prescribing medical provider and clinical staff, the perception and true incidence of side effects, and the response to these events by the patient and the medical provider,” Eastment and colleagues wrote.

The researchers suggested that home visits, incentive programs and enhanced outreach might increase adherence to latent tuberculosis therapies.

A recent review of the standard treatment regimens currently recommended by WHO and the CDC for latent tuberculosis infection confirmed these treatments are safe. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.