Barriers to Treatment for Latent Tuberculosis Infection among Low-income Populations
Background: Low-income populations including immigrants experience complex social-cultural barriers to accepting and completing TLTBI. National completion rates for TLTBI continue to fall short of the Healthy People 2020 goal of 79% for persons who were diagnosed with latent TB infection that started and completed a course of treatment. Current literature lacks data describing barriers to TLTBI reported by patients from various racial/ethnic groups. A better understanding of these barriers will help inform current practice to improve acceptance and completion rates thus reducing the number of active TB cases in the future.
Methods: This retrospective, descriptive study examined barriers to accepting and completing TLTBI from both the Public Health Department’s LTBI database and chart review of all eligible patients within the time frame specified. Descriptive statistics and chi-square analysis were used to identify barriers and predictors related to treatment acceptance and completion.
Results: The study population consisted of 854 males (50.6%) and 832 (49.3%) females categorized as White, Black, Asian and Hispanic. The largest age group was 18-44 years of age (32.0%). Of the 1687 persons diagnosed with LTBI, 1660 were eligible for TLTBI and 1280 (77.1%) accepted. A total of 380 (22.9%) patients declined treatment primarily due to concerns with medication side effects (23.4%). Of the 1280 patients that accepted TLTBI, treatment was not completed by 429 (33.5%). Reasons for treatment dropout include patients’ decision to stop (7.1%) and lost to follow-up (5.6%). Race was not a significant predictor of treatment non-completion among this study group. Barriers to LTBI compliance were identified as fear of side effects and personal illness beliefs that reduced their access to care.
Implications: Findings from this study informs health care providers of the barriers immigrants commonly encounter when deciding to accept, initiate, or complete TLTBI. Future interventions aimed at improving overall TLTBI completion rates among immigrants should consider these barriers and tailor current treatment practices to address the concerns identified.