| |
Fact Sheets
Treatment of Latent Tuberculosis Infection:
Maximizing Adherence
Last Updated: May 2005
Introduction
Latent tuberculosis infection (LTBI) is the presence of M. tuberculosis
organisms (tubercle bacilli) without symptoms or radiographic or
bacteriologic evidence of TB disease. Approximately 90%–95% of
those infected are able to mount an immune response that halts the
progression from LTBI to TB disease. However, because prevention
of TB has major public health implications, it is essential to identify
and treat all those with risk factors for TB disease. Health care
providers must communicate the risks and benefits of treatment to
their patients and encourage adherence and treatment completion.
Communicating the Value of LTBI Treatment
A patient's acceptance of LTBI treatment is often influenced by
the initial approach of the health care provider. When discussing
the risks and benefits of treatment it is important to explain that
- As long as TB germs are in the body, they can begin to multiply
and cause disease
- Certain individuals are at especially high risk for progression
to TB disease. They include persons with recent TB infection and
certain medical conditions, and those taking medication that may
alter immunity
- Completing treatment for LTBI can reduce the risk of TB disease
by 90%
- Treatment decisions are based on the results of scientific
research
- TB infection is treated with one medication, whereas TB disease
initially requires four drugs
Certain groups such as the homeless, the elderly, substance abusers,
the foreign-born, and migrant workers present unique challenges
and have needs that require special consideration.
Identifying Barriers to Adherence
Many variables affect a patient's adherence to the recommended
treatment regimen, including
- Appointment hours that conflict with patient's schedule
- Misinformation about TB
- Health beliefs and practices
- Limited financial resources
- Co-existing medical conditions
- Medication side effects
- Language barriers
- Real or perceived stigma related to LTBI treatment
Strategies for Maximizing Adherence
Collaboration with community agencies
Partner with local health departments and community-based organizations
that can provide
- Case management to ensure continuity of services
- Directly observed therapy (DOT), whereby a health care
worker observes the ingestion of medication; highly recommended
when using intermittent regimens and for high-risk patients, such
as those whose treatment has been interrupted or who often miss
appointments for medication refills
- Incentives, which are small rewards that encourage or
motivate patients. Local businesses and organizations may be a
resource for incentives such as grocery store vouchers, nutritional
supplements, movie tickets, or restaurant coupons
- Enablers such as free van transportation or bus tickets,
reminder letters or phone calls, and other assistance that makes
it easier to keep appointments
Effective patient education
- Have materials available in patient's primary language and
at appropriate literacy level
- Include patient’s family in health education whenever possible,
because they can offer support
- Reinforce educational messages at each visit
- Give clear instructions regarding side effects and when to
report them to a health care provider
- Allow opportunities for questions and answers
Patient-focused strategies
- Obtain patient’s agreement to complete treatment before actually
starting (patient contract)
- Recommend reminders such as watches, alarm clocks, notes to
self, pill boxes with days of the week
- Schedule monthly appointments to monitor progress
- Reinforce importance of treatment completion at each visit
to help maintain patient's commitment
- Tailor treatment regimen to patient's needs (daily vs intermittent
dosing, alternate regimens)
- Recommend taking medication at same time every day and associate
it with a daily activity such as mealtime, brushing teeth, etc.
- Recommend taking isoniazid with food if gastrointestinal upset
is a problem
References
ATS/CDC. Targeted
tuberculin testing and treatment of latent TB infection. MMWR
2000;49 (No. RR- 6).
ATS/CDC. Treatment
of tuberculosis. MMWR 2003;49 (No. RR-11).
Additional Resources
Website:
TB Education and Training
Resources website
The following resources can be viewed and downloaded from the CDC
website at www.cdc.gov/tb.
Slide Set:
Fact Sheets:
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
|
| |
Back to Top of Page
If you would like to order any of the DTBE publications please visit the online order form.
You will need Adobe Acrobat™ Reader v5.0 or higher to read pages that are in PDF format. Download the Adobe Acrobat™ Reader.
If you have difficulty accessing any material on the DTBE Web site because of a disability, please contact us
in writing or via telephone and we will work with you to make the information available.
Division of Tuberculosis Elimination
Attn: Content Manager, DTBE Web site
Centers for Disease Control and Prevention
1600 Clifton Rd., NE Mailstop E-10
Atlanta, GA 30333
CDC-INFO at (1-800) 232-4636
TTY: 1 (888) 232-6348
E-mail: cdcinfo@cdc.gov
Home | Site Map
| Contact Us
Accessibility
| Privacy Policy Notice |
FOIA
| USA.gov
CDC Home |
Search |
Health Topics A-Z
Centers for Disease Control & Prevention
National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination
Please send comments/suggestions/requests to: CDCINFO@cdc.gov
|
