CS227840_E

TB Elimination

Treatment of Latent Tuberculosis 

Infection: Maximizing Adherence

(Page 1 of 2)

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 

Division of Tuberculosis Elimination

Introduction

Latent tuberculosis infection (LTBI) is the 

presence of M. tuberculosis organisms (tubercle 

bacilli) without symptoms or radiographic 

or bacteriologic evidence of TB disease. 

Approximately 90% – 95% of those infected are 

able to mount an immune response that halts 

the progression from LTBI to TB disease. However, 

because prevention of TB has major public health 

implications, it is essential to identify and treat 

all those with risk factors for TB disease. Health 

care providers must communicate the risks 

and benefits of treatment to their patients and 

encourage adherence and treatment completion.

Communicating the Value of Latent 

TB Infection Treatment

A patient’s acceptance of LTBI treatment is often 

influenced by the initial approach of the health 

care provider. When discussing the risks and 

benefits of treatment it is important to explain 

that

• As long as TB germs are in the body, they can 

begin to multiply and cause disease 

• Certain individuals are at especially high 

risk for progression to TB disease. They 

include persons with recent TB infection and 

certain medical conditions, and those taking 

medication that may alter immunity 

• Completing treatment for latent TB infection 

can reduce the risk of TB disease by 90% 

• Treatment decisions are based on the results 

of scientific research 

• TB infection is treated with one or two drugs, 

whereas TB disease initially requires four 

drugs 

Certain groups such as the homeless, the 

elderly, substance abusers, the foreign-born, and 

migrant workers present unique challenges and 

have needs that require special consideration.

Identifying Barriers to Adherence

Many variables affect a patient’s adherence to 

the recommended treatment regimen, including

• Appointment hours that conflict with 

patient’s schedule 

• Misinformation about TB 

• Health beliefs and practices 

• Limited financial resources 

• Co-existing medical conditions 

• Medication side effects 

• Language barriers 

• Real or perceived stigma related to latent TB 

infection treatment 

Strategies for Maximizing Adherence

Collaboration with community agencies

Partner with local health departments and 

community-based organizations that can 

provide

• Case management to ensure continuity of 

services 

• Directly observed therapy (DOT), whereby a 

health care worker observes the ingestion 

of medication; highly recommended when 

using intermittent regimens and for highrisk patients, such as those whose treatment 

has been interrupted or who often miss 

appointments for medication refills 
• Incentives, which are small rewards that 

encourage or motivate patients. Local 

businesses and organizations may be a 

resource for incentives such as grocery store 

vouchers, nutritional supplements, movie 

tickets, or restaurant coupons 

• Enablers such as free van transportation or 

bus tickets, reminder letters or phone calls, 

and other assistance that makes it easier to 

keep appointments 

Effective patient education

• Have materials available in patient’s primary 

language and at appropriate literacy level 

• Include patient’s family in health education 

whenever possible, because they can offer 

support 

• Reinforce educational messages at each visit 

• Give clear instructions regarding side effects 

and when to report them to a health care 

provider 

• Allow opportunities for questions and 

answers 

Patient-focused strategies

• Obtain patient’s agreement to complete 

treatment before actually starting (patient 

contract) 

• Recommend reminders such as watches, 

alarm clocks, notes to self, pill boxes with 

days of the week 

• Schedule monthly appointments to monitor 

progress 

• Reinforce importance of treatment 

completion at each visit to help maintain 

patient’s commitment 

• Tailor treatment regimen to patient’s needs 

(daily vs. intermittent dosing, alternate 

regimens) 

• Recommend taking medication at same 

time every day and associate it with a daily 

activity such as mealtime, brushing teeth, 

etc. 

• Recommend taking isoniazid with food if 

gastrointestinal upset is a problem 

Reference

ATS/CDC. Targeted tuberculin testing and 

treatment of latent TB infection. MMWR 2000;49 

(No. RR- 6). http://www.cdc.gov/mmwr/

preview/mmwrhtml/rr4906a1.htm

Additional Resources

1. CDC Division of TB Elimination website. 

http://www.cdc.gov/tb/

2. Targeted Tuberculosis (TB) Testing and 

Treatment of Latent TB Infection (Slide 

Set). http://www.cdc.gov/tb/publications/

slidesets/LTBI/default.htm

3. Targeted Tuberculosis Testing and 

Interpreting Tuberculin Skin Test Results 

(Fact sheet). http://www.cdc.gov/

tb/publications/factsheets/testing/

skintestresults.htm

4. Treatment Options for Latent Tuberculosis 

Infection (Fact sheet). http://www.cdc.

gov/tb/publications/factsheets/treatment/

LTBItreatmentoptions.htm

5. TB Education and Training Resources 

website. http://www.findtbresources.org

http://www.cdc.gov/tb

November 2011