Infectious Disease

Less than half of people with latent TB in the US initiate therapy

April 10, 2022

2 min read

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Disclosures:
Shah reports receiving support for attending meetings and/or travel from the CDC paid to their institution. Please see the study for all other authors’ relevant financial disclosures.

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Researchers uncovered gaps in the care cascade for latent tuberculosis in the United States, including that less than half of people diagnosed with latent TB in 2016 and 2017 initiated treatment.

“Tuberculosis remains a leading cause of death and morbidity from an infectious disease globally,” Maunank R. Shah, MD, PhD, associate professor of medicine in the division of infectious diseases at Johns Hopkins University School of Medicine, told Healio.

IDN0422Holzman

Holzman SB, et al. Clin Infect Dis. 2022;doi:10.1093/cid/ciac248.

“In the US, TB elimination will require preventing progression to TB disease through the diagnosis and treatment of latent TB infection, but there are several steps along the latent TB care cascade that must be successfully completed, from initial testing to medical evaluation through completion of treatment,” Shah said.

Potential gaps along the care cascade have “not been previously characterized adequately,” Shah said.

Shah and colleagues studied data on individuals receiving latent TB care between 2016 and 2017 from 15 TB clinics in the US to quantify the care cascade.

Among 23,885 people tested in the clinics, they found that 70% received a tuberculin skin test, 29% a Quantiferon test, and 8% a T-SPOT.TB test. Among US-born patients, 34% had indications for testing, with the most common reasons being homeless shelter screening (35%), drug rehabilitation screening (28%), contact investigations (15%), and medical risk such as HIV or being considered immunosuppressed (6%), Shah and colleagues reported. Those without indication were typically tested for employment screening (62%) and student clearance (27%) purposes, they said.

Among participants who were tested, 12% had at least one positive test result, 3% of US-born individuals and 23% of those not born in the US Of the 2,515 diagnosed with latent TB infection, 42% initiated therapy — 43% of non -US-born participants and 39% of US-born participants. Among them, 76% completed treatment.

“Clinicians and health departments should prioritize targeted testing of individuals with epidemiologic risks for TB infection or host risks for progression to TB disease and avoid screening populations with low latent TB prevalence, consistent with recently updated national guidelines,” Shah said. “While significant progress has been made in shortening the duration of latent TB treatment, the largest gap and barrier to successful therapy is at the level of treatment initiation.”

Shah said further research is needed to better understand patient knowledge and acceptance of latent TB diagnosis and treatment, and factors impacting retention in care.

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