Do Resident Physicians Agree with LTBI Treatment Guidelines?
Methods: We surveyed internal medicine residents from an single academic medical center regarding their personal history of LTBI, as well as their attitudes towards LTBI diagnosis and treatment in their patients. We queried country of birth, year of birth, and country of medical school training. The BCG World Atlas (www.bcgatlas.org) was used to ascertain the personal history of BCG vaccination for all respondents, based on country and year of birth.
Results: 37 of 60 residents (62%) responded to the survey. Among 23 respondents born outside the U.S., 18 (78%) were assigned a history of BCG vaccination. There were 6 respondents with a personal history of LTBI, and 2 of 6 (33%) reported completing treatment. One respondent had a personal history of pulmonary TB. Among 30 respondents without a history of LTBI, 22 (73%) would accept LTBI treatment based on a positive TST, while 26 (87%) would accept treatment based on a positive IGRA (p=0.2). Overall, 17 of 37 respondents (46%) would recommend LTBI treatment for a BCG-vaccinated individual with a first-ever positive TST, increasing to 86% (32/37) for a first-ever positive IGRA in a BCG-vaccinated individual (p<0.01). In contrast, there was no difference in attitudes towards treating a converted TST (32/37, 86%) or IGRA (33/37, 89%) in BCG-vaccinated individuals. Contrary to our hypothesis, we did not find a significant relationship between a resident physician’s personal history of BCG vaccination and LTBI treatment attitudes.
Conclusion: A resident’s personal history of BCG vaccination was not associated with acceptance of LTBI treatment in their patients. Further work is needed to define both the cultural and educational factors that motivate attitudes towards LTBI treatment among resident physicians.
A. Headly, None
D. R. Linkin, None
C. Vinnard, None