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Successes and challenges of latent TB screening and treatment in a high-prevalence US region

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BACKGROUND: South Texas has higher TB disease incidence than much of the United States. We evaluated a multi-site South Texas interferon-gamma release assay (IGRA)-based testing and latent TB infection (LTBI) treatment program targeting high-risk populations.

METHODS: Number of IGRA tests, test results, LTBI confirmation, and treatment outcomes were collected over 2.5 years. Sixteen semi-structured patient interviews and 10 site-based focus groups were conducted with providers, nurses, and administrators. Grounded theory identified themes associated with successful outcomes.

RESULTS: Of 9,050 IGRA tests, 687 (8%) were positive; 340 (49%) confirmed as LTBI; 191 initiated LTBI treatment; and 130 (68% of initiators) completed treatment. Patient barriers to treatment completion included lack of knowledge, misconceptions, and treatment toxicities. Clinic staff concurred that toxicity was a barrier to treatment and requiring new processes with limited resources were implementation barriers.

CONCLUSIONS: Over 9,000 patients were screened with a high prevalence of IGRA positivity, but confirming LTBI, initiating, and completing treatment were challenging. Qualitative evaluation supports low literacy patient education on LTBI and toxicities and expanded support for process implementation and provider training. These findings highlight challenges at all levels of the LTBI care cascade and provide patient, staff, and provider perspectives on implementation of these programs.

Keywords: IGRA testing; latent tuberculosis infection; program evaluation; qualitative evaluation

Document Type: Research Article

Affiliations: 1: Primary Care Internal Medicine Residency Program, Brigham and Women´s Hospital, Boston, MA 2: Public Health Region 8, Texas Department of State Health Services, San Antonio, TX 3: Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA 4: School of Nursing, University of Texas Health San Antonio, San Antonio, TX 5: University Health, San Antonio, TX 6: Health Resource in Action, Boston, MA 7: San Antonio Metropolitan Health District, San Antonio, TX 8: Heartland National TB Center, San Antonio, TX 9: Division of Infectious Diseases, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA

Publication date: August 1, 2022

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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