559. Risk Factors for Non-completion of Latent Tuberculosis Infection Therapy at an Urban Public Health Clinic
Session: Poster Abstract Session: Latent TB Infection: Diagnosis and Treatment
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • ID week LTBI final.pdf (493.0 kB)
  • Background: In the United States, approximately 11 million individuals are infected with Mycobacterium tuberculosis(TB), with an estimated 300,000 initiating therapy for latent tuberculosis infection (LTBI) annually.  However, reported LTBI completion rates are variable, ranging from 30-90%. Ensuring completion of LTBI therapy is an essential strategy for eliminating TB in the US.  Our objective was to evaluate factors associated with non-completion of LTBI therapy among individuals initiating therapy in the Denver Metro TB Clinic (DMTBC) to inform our efforts to improve treatment completion.

    Methods: This retrospective cohort study examined factors associated with non-completion of LTBI therapy for all individuals, ≥18 years of age, who initiated a treatment plan in 2013 at DMTBC. Treatment completion was measured using pharmacy refill data and data was abstracted from the electronic medical record of DMTBC.  Patients were excluded if they had a subsequent diagnosis of active TB (n=2) or were missing data on key variables (n=76).  Analysis was performed using a multivariable log binomial regression in SAS. 

    Results: A total of 481 adults initiated LTBI therapy in 2013, with 403 meeting our inclusion criteria. The median age was 35 (range 18-72), 50% were male, 6% were ever homeless, 25% had an abnormal chest radiograph (CXR), 45% were uninsured.   355 (88%) were foreign-born, 305 (76%) reported a primary language other than English and 263 (65%) requested an interpreter.  90 patients (22%) did not complete LTBI therapy.  Individuals were more likely to discontinue therapy if they spoke English primarily (Spanish RR= 0.74, 95% CI 0.46, 1.2; other language RR= 0.55, 95% CI 0.37-0.82), were ever homeless (RR= 2.4, 95%CI 1.3, 4.4), or had a normal CXR (RR= 2.15, 95% CI 1.3, 3.6).  There was a non-significant trend towards women being less likely to complete therapy compared to males (RR=1.4, 95% CI 1.0, 2.0; p=.07).

    Conclusion: In this urban cohort, risk factors for not-completing LTBI therapy were largely not modifiable.  Future evaluations should focus on evaluating gaps between diagnosis and initiation of treatment and barriers to completion among the homeless population served by DMTBC.

    Hillary Dunlevy, MD, MPH1, Kaylynn Aiona, MPH2, Will Eaton, BS3, Robert Belknap, MD2,4 and Michelle Haas, MD2,4, (1)University of Colorado School of Medicine, Aurora, CO, (2)Denver Metro TB Clinic, Denver Public Health, Denver, CO, (3)University of Colorado School of Public Health, Aurora, CO, (4)Infectious Diseases, University of Colorado School of Medicine, Aurora, CO

    Disclosures:

    H. Dunlevy, None

    K. Aiona, None

    W. Eaton, None

    R. Belknap, None

    M. Haas, None

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