Adherence to LTBI Treament by recent Chinese American Immigrants

BACKGROUND: Eradication of tuberculosis in the U.S. increasingly focuses on treatment of foreign-born persons with Latent TB Infection (LTBI). The Charles B. Wang Community Health Center is a FQHC in New York City serving predominantly transient Chinese-speaking recent immigrants. Since 1995 it has utilized case managers to increase adherence to treatment of LTIB.

METHODS: Retrospective review of treatment outcomes of patients agreeing to LTBI treatment at a community health center using an administrative database.

RESULTS: Between 1995 and 2007 9,335 patients consented to receive treatment for LTBI. Reflecting the clinic population, 99.4% were Asian. Of these, 59% were female with a. mean age of 28.5 (SD: 14.0). Most were born in Mainland China (80.9%), with a minority from Hong Kong (6.2%), the U.S. (5.3%). Mean arrival to the U.S. was 5.6 (SD: 5.9) years previously. Less than half (48.6%) completed treatment, 6.4% stopped due to an adverse reaction, 11.2% declined to complete treatment, and 32.8% were lost to follow-up. In multivariate logistic regression, those older than 17 years were least likely to adhere to LTBI therapy (AOR: 0.3; 95% CI: 0.26-0.34). In contrast, those more likely to complete therapy were males (AOR: 1.2, 1.0-1.3), born in Hong Kong (AOR: 1.5; 1.2-1.9) or the U.S. (AOR: 1.7; 1.3-2.4), and those living in the U.S. for more than 18 years.

CONCLUSION: Despite case managers, adherence rates for LTBI treatment remain low in this transient community of recent immigrants. Interventions to promote adherence may target those at higher risk of non-adherence.