Barriers to Acceptance of latent Mycobacterium tuberculosis Infection (LTBI) Treatment among Physicians at an Urban Tertiary Care Medical Center in Philadelphia
Identification and treatment of latent tuberculosis infection (TLTBI) is the cornerstone of the U.S TB control strategy. LTBI treatment rates between 8 and 80% have been reported in physicians. We aimed to determine TLTBI rates, barriers to accepting TLTBI, and prescribing TLTBI among internal medicine physicians at a tertiary care hospital in Philadelphia.
An online questionnaire including demographic information, tuberculin skin test (TST)/Interferon gamma release assay (IGRA) status, and LTBI treatment status was distributed to internal medicine residents, subspecialty fellows and faculty. Responses to hypothetical scenarios involving decisions to treat LTBI were collected. Data was analyzed using Stata 13. Fisher's exact test and Spearman's correlation were used for comparative statistics.
Of 75 participants, 64%, 26% and 9% were residents, faculty and fellows respectively. 56 % had trained in regions with high rates of TB; 60% had received BCG vaccination. None of the respondents had been diagnosed with active TB.
36% of respondents had been diagnosed with LTBI 33% of whom started TLTBI. 2 failed to complete treatment owing to drug toxicity.
50% of respondents declined TLTBI owing to fear of drug toxicity and interaction with alcohol. Other reasons for declining treatment are shown in Graph 1.
Acceptance of TLTBI was associated with increased likelihood of recommending TLTBI in 2 of 8 hypothetical clinical scenarios (Graph 2, 3).
It is concerning that 36% of physicians sampled were diagnosed with LTBI and only a third of them accepted treatment. The main reasons for declining TLTBI were fear of drug toxicity, interaction with alcohol and the false perception that remote BCG vaccination influenced TST/IGRA results. Awareness of newer therapy such as the 12 dose Isoniazid/ Rifapentine regimen could result in higher acceptance rates of TLTBI. Although there was no clear correlation between physicians' willingness to accept, and recommend TLTBI, a larger study could prove this association. These results raise serious questions about physicians' attitudes towards TLTBI. It is important for physicians to be aware of current guidelines and strong indications for TLTBI to ensure national TB control.
M. Behme, None
R. Fischer, None