What
This cohort study examined the burden of latent tuberculosis infection (LTBI) and determinants of treatment interruption among residents and employees in long-term care facilities (LTCFs) in Taipei, Taiwan. Recognizing LTCFs as high-risk congregate settings for tuberculosis transmission, the study aimed to identify populations most vulnerable to LTBI and to determine which preventive therapy regimens best support treatment completion. Understanding these factors is critical for optimizing TB prevention strategies, particularly in aging populations and institutional care environments where outbreaks can spread rapidly and cause significant morbidity.
Among 2,207 participants included in the analysis, the overall LTBI prevalence was 16.8%, with a higher prevalence among residents (19.5%) compared with employees (11.3%). Individuals with LTBI were more likely to be older, male, smokers, and residents of public LTCFs. After adjusting for covariates, residents in public LTCFs had a significantly higher likelihood of LTBI than those in private facilities (adjusted odds ratio [AOR] 1.37; 95% CI: 1.08–1.74). Age also emerged as a strong independent predictor, with individuals aged 50 years and older having more than twice the risk of LTBI compared with younger participants, underscoring the vulnerability of elderly institutional populations.
Of the 371 individuals diagnosed with LTBI, 73.9% initiated preventive therapy, and 72.3% completed treatment. However, treatment interruption occurred in 19.7% of cases, highlighting persistent adherence challenges even within structured prevention programs. The most common causes of treatment interruption included drug-induced liver injury (28.8%), patient refusal (28.8%), and flu-like symptoms (23.1%). These findings emphasize that adverse drug reactions and patient tolerance remain critical barriers to successful LTBI management in long-term care settings.
The study further demonstrated that treatment regimen selection influenced adherence and safety outcomes. Individuals receiving the 3HP regimen were significantly less likely to interrupt treatment than those receiving the traditional 9-month isoniazid regimen (AOR 0.22; 95% CI: 0.07–0.71). Additionally, hepatotoxicity occurred in 5.8% of participants receiving 9H, whereas no hepatotoxicity cases were observed in the 3HP group. These results suggest that shorter, safer regimens may enhance treatment completion and reduce adverse events, particularly among older populations in institutional care.
How
This research employed a cohort design using LTBI surveillance data from 20 long-term care facilities in Taipei, Taiwan, between May 2017 and September 2020. All participants underwent chest radiography and QuantiFERON-TB Gold In-Tube (QFT) testing for LTBI screening at enrollment. Individuals who tested positive were offered preventive therapy and followed until treatment completion, death, treatment interruption, or the study end date of December 31, 2020. Treatment interruption was defined as missing seven or more consecutive days of medication or failing to complete the required regimen.
Preventive therapy followed national Taiwan LTBI Eradication Program guidelines, which included three regimens: nine months of isoniazid (9H), four months of rifampin (4R), and three months of weekly isoniazid plus rifapentine (3HP). Treatment decisions were made collaboratively among physicians, patients, and families, with the 4R regimen prioritized for individuals exposed to isoniazid-resistant TB. All treatment costs were subsidized by the government, minimizing financial barriers and improving accessibility to preventive therapy.
To improve adherence, the study implemented directly observed preventive therapy (DOPT), a program initiated by Taiwan CDC in 2016. Trained observers monitored medication adherence and adverse events daily, while public health nurses coordinated medical follow-up for participants experiencing side effects. Monthly laboratory monitoring, including blood counts and liver function tests, was conducted to detect hepatotoxicity early and ensure treatment safety. Preventive therapy was discontinued if participants developed significant liver injury or adverse reactions.
Participant characteristics were collected at baseline, including demographic factors, smoking status, BMI, TB contact history, and LTCF characteristics such as facility type (public vs. private). Statistical analyses evaluated predictors of LTBI and treatment interruption, using multivariate models to control for confounding factors. Subgroup analyses further explored differences between residents and employees, allowing the study to identify population-specific risks and inform targeted TB prevention strategies in long-term care environments.
Source: Chiu, T. F., Yen, M. Y., Shie, Y. H., Huang, H. L., Chen, C. C., & Yen, Y. F. (2022). Determinants of latent tuberculosis infection and treatment interruption in long-term care facilities: A retrospective cohort study in Taiwan. Journal of Microbiology, Immunology and Infection, 55(6), 1310-1317.
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