Risk factors for failure to complete a course of latent tuberculosis infection treatment in Salvador, Brazil
Abstract:BACKGROUND: Although treatment of latent tuberculosis infection (LTBI) is an essential component of tuberculosis (TB) control in countries such as the United States, it is not widely practiced in most TB-endemic countries.
OBJECTIVE: To examine the practice of and adherence to LTBI treatment in a high-risk population in Brazil.
DESIGN: We followed household contacts (HHCs) of patients hospitalized with pulmonary TB in Salvador, Brazil, for 6 months after they initiated LTBI treatment with isoniazid (INH). HHCs were asked to return to the hospital once a month for 6 months for follow-up visits and INH refills.
RESULTS: Of 101 HHCs who initiated LTBI treatment, 54 (53.5%) completed the 6-month regimen. The risk of treatment non-completion was significantly higher in HHCs who reported side effects to INH (RR 2.69, 95%CI 1.3–5.8, P = 0.01), and in those who had to take two buses for a one-way trip to the hospital (RR 1.8, 95%CI 1.01–3.3, P = 0.04). Of the 101 HHCs, 29 (28.7%) did not return for any follow-up visits; these HHCs were significantly more likely to have a 2-bus commute to the hospital compared to HHCs who completed treatment (OR 20.69, 95%CI 2.1–208.4, P = 0.01).
CONCLUSION: Nearly 50% of HHCs at high risk for developing TB completed a 6-month course of LTBI treatment. Completion of LTBI treatment was most affected by medication intolerance and commuting difficulties for follow-up visits.
Document Type: Regular Paper
Affiliations: 1: Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil 2: School of Public Health, University of California, Berkeley, California, USA 3: Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil 4: Laboratório Integrado de Microbiologia e Imunorregulação, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil 5: Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; and Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil 6: Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; and Laboratório Avançado de Saúde Pública, Centro de Pesquisas Gonçalo Moniz, Salvador, Bahia, Brazil
Publication date: June 1, 2009
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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