Adherence and Toxicity during the Treatment of Latent Tuberculous Infection in a Referral Center in Spain

Abstract

The screening and treatment of latent tuberculosis infection (LTBI) in countries with a low incidence of TB is a key strategy for the elimination of tuberculosis (TB). However, treatment can result in adverse events (AEs) and have poor adherence. This study aimed to describe treatment outcomes and AEs for LTBI patients at two departments in Vall d’Hebron University Hospital in Barcelona, Spain. A retrospective study was conducted on all persons treated for LTBI between January 2018 and December 2020. Variables collected included demographics, the reason for LTBI screening and treatment initiation, AEs related to treatment, and treatment outcome. Out of 261 persons who initiated LTBI treatment, 145 (55.6%) were men, with a median age of 42.1 years. The indications for LTBI screening were household contact of a TB case in 96 (36.8%) persons, immunosuppressive treatment in 84 (32.2%), and recently arrived migrants from a country with high TB incidence in 81 (31.0%). Sixty-three (24.1%) persons presented at least one AE during treatment, and seven (2.7%) required definitive discontinuation of treatment. In the multivariate analysis, AE development was more frequent in those who started LTBI treatment due to immunosuppression. Overall, 226 (86.6%) completed treatment successfully. We concluded that LTBI screening and treatment groups had different risks for adverse events and treatment outcomes. Persons receiving immunosuppressive treatment were at higher risk of developing AEs, and recently arrived immigrants from countries with a high incidence of TB had greater LTFU. A person-centered adherence and AE management plan is recommended.

Factors Associated with Non-Adherence to Tuberculosis Preventive Treatment among Adult Contacts of Pulmonary Tuberculosis Cases with Latent Tuberculosis Infection in Catalonia, Spain, in 2019−2021

“…The percentages of TB preventive treatment non-adherence among adult contacts of pulmonary TB cases found in Catalonia, Spain, in this study were similar or higher than those found in studies carried out in Spain [ 15 , 16 , 17 , 18 ]. In a study carried out in the province of Lleida in 2016, a non-adherence rate of 29.7% was found in a cohort of 199 contacts (with an average age of 45.1 years) [ 16 ].…”

“…In a study carried out in the province of Alicante in 2011, a non-adherence percentage of 19.6% was found in a cohort of 338 contacts (average age of 34.1 years) [ 17 ]. In a study carried out in the city of Barcelona by the Vall d’Hebron Hospital in 2018–2020, a non-adherence percentage of 13.4% (95% CI: 9.1–17.7%) was found among 261 (24.1%) contacts [ 18 ]. Nevertheless, it is difficult to compare non-adherence rates observed in different studies due to their different methodologies and settings.…”

“…The study carried out in Alicante included contacts attended by Public Health Services and by the Preventive Medicine Service of Sant Joan Hospital, Alicante, and only tuberculin tests were used to detect latent TB infections [ 17 ]. In the study carried out by the Vall d’Hebron Hospital, contacts were treated by the hospital [ 18 ].…”