Chest
Volume 133, Issue 4, April 2008, Pages 862-868
Journal home page for Chest

Original Research
Mycobacterial Disease
Factors Associated With Failure To Complete Isoniazid Treatment for Latent Tuberculosis Infection in Rhode Island

https://doi.org/10.1378/chest.07-2024Get rights and content

Background

The treatment of latent tuberculosis infection (LTBI) is essential for tuberculosis elimination in the United States, but the major limitation is poor adherence to therapy. To aid the design of targeted adherence interventions, we investigated the factors associated with noncompletion of isoniazid (INH) therapy for LTBI.

Methods

A retrospective analysis of patients with who failed to complete vs those who completed 9 months of INH therapy at the RISE TB Clinic (Miriam Hospital; Providence, RI) in 2003 was performed. Factors associated with treatment noncompletion were examined using univariate and multiple logistic regression analysis.

Results

Of 845 patients with LTBI, 690 patients (81.6%) initiated INH therapy, of whom 426 patients (61.7%) completed therapy, and 246 patients (35.6%) were lost to follow-up. Treatment was discontinued in 18 patients (2.6%). Patients who failed to complete therapy were younger (mean age, 30.6 vs 33.8 years, respectively; p = 0.006), and were more likely to be uninsured (42.9% vs 29.8%, respectively; p = 0.0004), to be postpartum (66.7% vs 37.3%, respectively; p = 0.043), and to report treatment side effects (54.8% vs 30.1%, respectively; p < 0.0001). Reported treatment side effects (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.2 to 6.2) and lack of medical insurance (OR, 1.7; 95% CI, 1.1 to 2.7) were each associated with treatment noncompletion in a model including both. Also, pregnant women were more likely than nonpregnant women to fail to initiate INH treatment (52.1% vs 14.7%, respectively; p < 0.0001).

Conclusions: LTBI patients who are young, pregnant or postpartum, uninsured, and/or report treatment side effects may require additional case management to improve INH treatment completion rates.

Section snippets

Study Population

Patients who initiated INH therapy for the treatment of LTBI at the RISE TB Clinic between January 2003 and December 2003 were included in the study. The RISE TB Clinic is dedicated to the management of TB and receives referrals from primary care sites across the entire state. Patients who met the criteria for a positive tuberculin skin test result according to standard guidelines,8 and had no symptoms and no chest radiographic findings suggestive of active TB were considered to have LTBI. The

Study Population

The medical records of 873 persons who were evaluated for LTBI during the study period at RISE TB Clinic were reviewed. A total of 28 persons were excluded from further analysis for the reasons shown in Figure 1. The referral sources included community health centers (42.5%), private physicians (12.9%), the Department of Health (10.2%), employer (4.9%), civil surgeon (2.9%), and other sites including schools and drug rehabilitation centers (5.8%). Of the 845 patients who were considered as

Discussion

In this study, which was conducted in a clinic dedicated to the management of TB in Rhode Island, 82% of the patients with LTBI who were eligible initiated INH therapy, and 62% of those initiating therapy completed it. Our completion rate is comparable to rates that have been reported12,14,16 for 6 months of INH therapy, and were much higher than the 19% rate reported for a similar regimen given in a 2006 study17 in Boston. We were unable to examine what components of the program led to the

References (27)

  • American Thoracic Society

    Targeted tuberculin testing and treatment of latent tuberculosis infection

    Am J Respir Crit Care Med

    (2000)
  • CR Horsburgh

    Priorities for the treatment of latent tuberculosis infection in the United States

    N Engl J Med

    (2004)
  • SH Ferebee

    Controlled chemoprophylaxis trials in tuberculosis: a general review

    Adv Tuberc Res

    (1970)
  • Cited by (61)

    View all citing articles on Scopus

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Dr. Kwara was supported by Rhode Island Foundation grant No. 20030199 and National Institutes of Health developmental grant No. K23 AI071760.

    View full text