Risk factors for treatment default in close contacts with latent tuberculous infection

Abstract

Objective To characterize risk factors for non-completion of treatment for latent tuberculosis infection (LTBI). Secondarily, to assess the impact of LTBI treatment regimen on subsequent risk of tuberculosis. Methods Close contacts of adults (≥15 years) with pulmonary tuberculosis were prospectively enrolled in a multi-center study in the U.S. and Canada from January 2002–December 2006. Close contacts to TB patients were screened and cross-matched with tuberculosis registries to identify those who developed active tuberculosis. Results Of the 3,238 contacts screened, 1,714 (53%) were diagnosed with LTBI. Preventive therapy was recommended in 1,371 (80%); 1,147 contacts (84%) initiated therapy, of whom 723 (63%) completed treatment. In multivariate analysis, study site, initial interview sites other than a home or healthcare setting, and treatment with isoniazid were significantly associated with LTBI treatment non-completion. Fourteen tuberculosis cases were identified in contacts, all of whom initiated isoniazid. There were two cases among persons who received six or more months of isoniazid (66 cases/100,000 person-years), and nine cases among persons who received 0–5 months (median 2 months) of isoniazid (792 cases/100,000 person-years; p<0.001); data on duration of isoniazid for three cases were not available. Conclusion Only 53% (723 of 1,371) of close contacts for whom preventive therapy was recommended actually completed treatment. Close contacts of TB patients were significantly less likely to complete LTBI treatment if they took isoniazid. Less than six months of isoniazid therapy was associated with increased risk of active TB.

Assessment of 16‐year retrospective cohort study of factors associated with non‐compliance with a tuberculosis contact tracing programme at a Spanish hospital

“…In our study, the factors associated with non‐compliance with recommendations were being of foreign origin, alcoholism, being recommended to repeat the TST at 3 months, being recommended LTBIT, an index case aged under 35 years, and a smear‐positive index case. These factors have previously been identified by other authors as being associated with non‐compliance. Non‐compliance among foreigners may often be due to their working conditions, because they are often employed in precarious jobs where taking time off to attend the recommended appointments could result in loss of earnings or employment .…”

“…However, despite the importance of contact tracing, remarkably few studies in the literature have reported on the results of contact monitoring from initial screening until the end of treatment . Some studies have analysed monitoring from the first appointment until the third month, whereas others have focused solely on monitoring treatment of contacts with LTBI …”

Barriers to treatment adherence for individuals with latent tuberculosis infection: A systematic search and narrative synthesis of the literature

“…Refugees and other persons born outside the country, pregnant women, and health care workers were less likely to initiate treatment. Initiation rates were higher where specific strategies to improve adherence were used, discussed below …”

Necrotizing Neck Mass in a Young Female

“…There are different risk factors for the non-compliance. Race was found to be the most common risk factor; Hispanics, people born outside the US and Canadians had lower rates of medication compliance, whereas blacks had the highest compliance [6].…”