528. Use of Shortened Regimen for the Treatment of Latent Tuberculosis Infection in Patients of the Veterans Affairs Healthcare System—2012–2015.
Session: Poster Abstract Session: Latent Tuberculosis Diagnosis and Management
Thursday, October 27, 2016
Room: Poster Hall
Background: 

As the incidence rate of tuberculosis (TB) declines in the United States, treatment of latent TB infection (LTBI) will be essential to elimination. LTBI treatment completion has improved with implementation of weekly isoniazid (INH) and rifapentine (RPT) for 3 months (3HP) by directly observed therapy (DOT). Since CDC recommended this regimen in 2011, TB programs have steadily increased its use. Despite low prevalence of TB disease, the use of 3HP in the aging Veterans Healthcare Administration (VHA) patient population has the potential advantages of lower rates of hepatotoxicity and higher completion rates. Knowledge of and barriers to 3HP use in the VA have not been evaluated.

Methods:

A VA data warehouse was queried to determine the number of patients who were prescribed RPT as a marker for the 3HP regimen between FY 2012–2015 within each of the 21 Veterans Integrated Service Networks (VISN). In addition, infectious disease providers were surveyed regarding knowledge, practices, and availability of 3HP and DOT administrators at each facility.

Results:

Although VISNs are currently undergoing administrative consolidation, we obtained information regarding prescriptions in 21 of 22. Patients in 19 VISNs received prescriptions of RPT. Per VISN, the number of patients ranged from 4 to 142, with a median of 25 and an average of 34. Survey responses were received from 46 providers in 16 VISNs. Responses included the following: 57% of providers reported that RPT was restricted in their facilities, 42% reported that 3HP education had not occurred, 47% stated that provider lack of awareness hindered use of 3HP, 54% identified that DOT requirements hindered use of 3HP, and 60% reported lack of staff to support DOT.

Conclusion:

Treatment of LTBI is a cornerstone aspect of TB control and essential to move toward TB elimination. Currently, the use of 3HP, based on patients receiving RPT, has not been adopted uniformly in the VHA system. Requirement of DOT, lack of provider education and awareness, and prescription restriction are barriers to the broader acceptance of the regimen. Given the improved LTBI treatment completion with shorter regimens, efforts should be made to increase utilization within the VHA.

Sapna Morris, MD, MBA1, Nwabunie Nwana, MPH2, Patricia Schirmer, MD3, Wendy Thanassi, MA, MD4, Roger Bedimo, MD5, Cynthia Lucero-Obusan, MD3 and David Yost, MD, Msc6, (1)Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Tuberculosis Elimination, CDC, Atlanta, GA, (3)Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, CA, (4)Emergency Medicine, Stanford Hospital and Medical Center, Palo Alto, CA, (5)Medicine, VA N Texas Health Care Systems, University of Texas, Dallas, TX, (6)Indian Health Services, Whiteriver, AZ

Disclosures:

S. Morris, None

N. Nwana, None

P. Schirmer, None

W. Thanassi, None

R. Bedimo, Merck & Co.: Scientific Advisor , Research grant
Theratechnologies: Scientific Advisor , Research grant
Bristol Myers Squibb: Scientific Advisor , Research grant
Gilead: Scientific Advisor , Consulting fee

C. Lucero-Obusan, None

D. Yost, None

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