Initiation and completion rates for latent tuberculosis infection treatment: a systematic review

Abstract

BackgroundControl of latent tuberculosis infection (LTBI) is an important step towards tuberculosis elimination. Preventive treatment will prevent the development of disease in most cases diagnosed with LTBI. However, low initiation and completion rates affect the effectiveness of preventive treatment. The objective was to systematically review data on initiation rates and completion rates for LTBI treatment regimens in the general population and specific populations with LTBI.MethodsA systematic review of the literature (PubMed, Embase) published up to February 2014 was performed.ResultsForty-five studies on initiation rates and 83 studies on completion rates of LTBI treatment were found. These studies provided initiation rates (IR) and completion rates (CR) in people with LTBI among the general population (IR 26–99 %, CR 39–96 %), case contacts (IR 40–95 %, CR 48–82 %), healthcare workers (IR 47–98 %, CR 17–79 %), the homeless (IR 34–90 %, CR 23–71 %), people who inject drugs (IR 52–91 %, CR 38–89 %), HIV-infected individuals (IR 67–92 %, CR 55–95 %), inmates (IR 7–90 %, CR 4–100 %), immigrants (IR 23–97 %, CR 7–86 %), and patients with comorbidities (IR 82–93 %, CR 75–92 %). Generally, completion rates were higher for short than for long LTBI treatment regimens.ConclusionInitiation and completion rates for LTBI treatment regimens were frequently suboptimal and varied greatly within and across different populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1550-y) contains supplementary material, which is available to authorized users.

Trend and treatment outcomes of latent tuberculosis infection among migrant persons in Japan: analysis of Japan Tuberculosis Surveillance data

“…Outside of Japan, several systematic reviews on adherence for and outcomes of LTBI treatment have been conducted -for example, a review that was conducted for the WHO 2015 LTBI Guideline has concluded that treatment completion rates varied across different risk groups, ranging from 6-94%, with lower completion rates for prisoners and immigrant [12]. Another study which looked at studies from US and Canada has reported completion rates to be ranging between 22% and 90% [13], and a more recent review reported rates between 7-86%, both for foreign-born person [14]. A meta-analysis that was published in 2016 has estimated the pooled treatment completion rates for migrants to be 14.3% [15].…”

“…As for the length of treatment regimen, while the WHO 2015 Guideline has concluded that longer treatment duration was detrimental to treatment completion, a systematic review that was published a year later has concluded that study results were inconclusive, with some showing better treatment outcomes for shorter regimens using rifampicin, pyrazinamide, rifabutin and/or INH, than the standard regimen (6 or 9 months of INH) while others showing similar completion rates, and also that the studies themselves were too heterogeneous to conduct pooled analysis [14]. In our study, the proportion of lost to follow-up was bigger among those who have started treatment with INH than those with RFP monotherapy (12.3% vs. 6.4%).…”

Is Universal Screening Necessary? Incidence of Tuberculosis among Tibetan Refugees Arriving in Calgary, Alberta

“…Age and gender did not impact rates of treatment completion in this study. Evidence for directly observed therapy (DOT) in LTBI treatment is inconsistent and not currently done at Calgary TB Services [19]. …”

High rate of latent tuberculosis treatment completion in immigrants seeking asylum in Sweden

“…Current WHO guidelines for low-burden countries recommend screening for LTBI for individuals who meet criteria for treatment if diagnosed with LTBI [3]. However, rates of treatment completion are often low, and vary widely between different settings, with heterogeneous factors observed to be associated with treatment noncompletion [4][5][6].…”