Impact of 3HP on Latent Tuberculosis Infection (LTBI) Treatment Completion Rate in a Large, Urban City
Tuberculosis (TB) is an infectious disease causing morbidity and mortality in the United States. A key TB elimination strategy is to treat latent TB infection (LTBI) in contacts of TB cases and other high-risk groups. In Houston, Texas, these include the foreign-born, homeless, and immunocompromised. Traditional LTBI treatments are nine months of once daily Isoniazid (INH) and four months of once daily Rifampin (RIF). A 12-week regimen of once weekly INH and Rifapentine (3HP) was approved by the US Food and Drug Administration as an LTBI treatment alternative. The ability of a shorter regimen to improve LTBI completion rates in a large diverse city like Houston has not been evaluated.
Our goal was to examine if instituting the 3HP regimen would improve LTBI treatment completion percentages.
- Start eighty (80) eligible patients on 3HP.
- Improve the LTBI completion rate by 5% over the year prior through the introduction of 3HP.
This study was conducted from October 1, 2013 – September 30, 2014. LTBI populations (N= 347) were identified, of which 130 patients started 3HP treatment and 217 patients started traditional LTBI therapies.
Inclusion criteria for 3HP included otherwise healthy foreign-born and congregate setting contacts diagnosed with LTBI. All other LTBI patients were placed on traditional therapies (INH and RIF).
LTBI completion rates from the project period were compared with that of the year prior to determine any benefit of the introduction of 3HP.
Of the 130 who started 3HP, 121 completed therapy (93.1%). Of the 217 who started traditional LTBI therapies (INH, RIF), 169 completed (77.8%). The combined LTBI completion rate (INH, RIF, and 3HP) was 83.6% (290/347) during the project period.
The LTBI treatment completion rate for the year prior was 69.8%. With the introduction of 3HP, the LTBI treatment completion rate was 83.6%, an increase of 13.8%.
The introduction of the 3HP regimen improved the overall LTBI completion rate in the target population. As 3HP use increases, the overall LTBI completion rate should continue to improve, potentially reducing future TB morbidity and mortality. It is recommended that 3HP use be explored in other TB programs.
Protection of the public in relation to communicable diseases including prevention or control
Identify three LTBI treatment regimens. Compare LTBI completion rates in Houston before and after the introduction of 3HP. Describe why the 3HP regimen results in higher LTBI completion rates.
Keyword(s): Tuberculosis, Treatment Outcomes
Organization/institution whose products or services will be discussed: N/A
Qualified on the content I am responsible for because: I am the co-evaluator of the 1115 Waiver Projects related to tuberculosis. I participated in the development and management of the project described in the abstract. I continue to monitor and evaluate the effectiveness of this regimen as part of an effort to decrease TB morbidity and mortality in Houston, Texas.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.