Adherence to Tuberculosis Infection Treatment and Tuberculosis Reactivation

A study hypothesized that higher adherence to latent tuberculosis infection (TBI) treatment would lower the risk of tuberculosis (TB) reactivation. Conducted in northern Taiwan, it evaluated treatment completion rates, factors influencing adherence, and their association with TB reactivation in a large patient cohort.

The retrospective analysis included de-identified clinical data collected between 2016 and 2021. Patients were 13 years or older, with either a TBI diagnosis or documented exposure to TB. The goal was to identify high-risk groups and determine how treatment adherence influenced TB prevention.

TBI was defined by diagnostic codes or positive IGRA results. Patients were categorized into four groups: non-initiation (N), incomplete treatment (IC), complete treatment (C), and a control group of TB contacts without IGRA positivity. Adherence above 90% was considered complete.

The final cohort included 1,432 patients: 378 in group N, 330 in IC, 430 in C, and 294 in controls. Over three years, TB developed in 34 patients (2.3%). Risks varied widely, from 6.1% in group N to just 0.5% in group C, showing a strong protective effect of treatment completion.

Patients in the non-initiation group were older and had higher rates of diabetes, chronic kidney disease, end-stage kidney disease, and active cancer. Significant differences in sex distribution, underweight status, smoking history, and HIV prevalence were also seen between groups.

Multivariable Cox regression confirmed that treatment reduced TB risk. Compared with group N, hazard ratios were 0.32 for IC and 0.05 for C. Each 10% increase in adherence lowered risk by about 23–24%. These results remained consistent even after accounting for death as a competing risk.

Overall, 67% of patients were prescribed TBI treatment, but only 38% completed it. Completion was strongly associated with protection against reactivation, underscoring the importance of initiating and finishing therapy, especially in high-risk populations. 

Source: Chien, Y.C., Chang, C.H., Shu, C.C., Wang, H.C. and Yu, C.J., 2025. Adherence to Tuberculosis Infection Treatment and its Impact on Prevention of Tuberculosis Reactivation: A Retrospective Cohort Study from Taiwan. Journal of Infection and Public Health, p.102917.