A comparison of treatment acceptance and adherence rates among two populations at high risk to develop tuberculosis in Tarrant County, Texas

Background: After decades of declining incidence rates, progress toward US tuberculosis (TB) elimination goals has begun to stall and perhaps even reverse. In light of this alarming trend, the strategic approach to TB control has begun to place more emphasis on carefully targeted surveillance for and treatment of latent TB infection (LTBI). Approximately 13 million people in the US have LTBI, and both LTBI and active TB are much more prevalent among homeless persons, refugees, and immigrants from high burden settings. Without treatment, 5-10% of persons with LTBI will develop active TB during their lifetime, and most ([greater than] 85%) US patients with recent incident TB have a prior history of LTBI. Still, LTBI is an asymptomatic condition that can be difficult to diagnose, and treatment acceptance and adherence are critical barriers to related prevention efforts. A 2012 report estimated that treatment acceptance and completion rates in the US were only 26% and 53%, respectively, and these vary widely by population.For instance, adherence is 7.2 times higher among the refugee population compared to the homeless population, however, the treatment completion rate is low for both. Local public health departments (PHD) are ultimately responsible for the protection of their catchments through TB surveillance, outpatient treatment, and prevention activities. A complete understanding of how patient characteristics may influence treatment acceptance and adherence is critical to successfully implementing risk targeted TB control strategies at the local level. Purpose: We analyzed acceptance and adherence for refugee and homeless patients offered treatment for diagnosed LTBI in Tarrant County Public Health’s TB and Refugee Clinic. Understanding factors associated with accepting and completing LTBI treatment in these high-risk populations inform public health action at the local level and contributes to individual and community health protections. Methods: We examined LTBI treatment acceptance and adherence among homeless and refugee research subjects in an urban public health clinic in Tarrant County, Texas during January 2013 to December 2016. Our retrospective analysis used deidentified local data collected as part of a larger project by the CDC’s Tuberculosis Epidemiologic Studies Consortium. We used multiple logistic regression and chi-square to compare outcomes while controlling for demographic, clinical, and other factors. Results: To be calculated. Conclusions: Will be complete soon.