Successes and challenges of latent TB screening and treatment in a high-prevalence US region

BACKGROUND: South Texas has higher TB disease incidence than much of the United States. We evaluated a multi-site South Texas interferon-gamma release assay (IGRA)-based testing and latent TB infection (LTBI) treatment program targeting high-risk populations. METHODS: Number of IGRA tests, test results, LTBI confirmation, and treatment outcomes were collected over 2.5 years. Sixteen semi-structured patient inter-views and 10 site-based focus groups were conducted with providers, nurses, and administrators. Grounded theory identified themes associated with successful outcomes. RESULTS: Of 9,050 IGRA tests, 687 (8%) were positive; 340 (49%) confirmed as LTBI; 191 initiated LTBI treatment; and 130 (68% of initiators) completed treatment. Patient barriers to treatment completion included lack of knowledge, misconceptions, and treatment toxicities. Clinic staff concurred that toxicity was a barrier to treatment and requiring new processes with limited resources were implementation barriers. CONCLUSIONS: Over 9,000 patients were screened with a high prevalence of IGRA positivity, but confirm-ing LTBI, initiating, and completing treatment were challenging. Qualitative evaluation supports low literacy patient education on LTBI and toxicities and expanded support for process implementation and provider training. These findings highlight challenges at all levels of the LTBI care cascade and provide patient, staff, and provider perspectives on implementation of these programs.

Automated summary

In South Texas, a multi-site IGRA-based testing and LTBI treatment program targeted high-risk populations, with over 9,000 patients screened and a high prevalence of IGRA positivity. However, confirming LTBI, initiating, and completing treatment were challenging, with patient barriers including lack of knowledge, misconceptions, and treatment toxicities. Clinic staff also identified toxicity as a barrier to treatment, along with limited resources for new process implementation.