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, the Centers for 

Disease Control and Prevention (CDC) and the 

United States Preventive Services Task Force 

(USPSTF) recommend testing populations that are 

at increased risk for TB infection and treating those 

for whom TB disease has been ruled out. 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

References

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

USPSTF. Latent Tuberculosis Infection: 

Screening Recommendation. http://

www.uspreventiveservicestaskforce.org/Page/

Document/UpdateSummaryDraft/latenttuberculosis-infection-screening

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

August 2016