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Latent TB Infection Treatment Maximizing Adherence Fact Sheet										Related Pages
										**Treatment of Latent Tuberculosis Infection: Maximizing Adherence**
**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 LTBI 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 LTBI 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 drugsCertain 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 LTBI 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 high-risk 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 problemReferencesATS/CDC. Targeted tuberculin testing and treatment of latent TB infection. *MMWR* 2000;49 (No. RR- 6).
USPSTF. Latent Tuberculosis Infection:Screening Recommendation.http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryDraft/latent-tuberculosis-infection-screeningAdditional ResourcesCDC Division of TB Elimination website
Targeted Tuberculosis (TB) Testing and Treatment of Latent TB Infection (Slide Set)
Targeted Tuberculosis Testing and Interpreting Tuberculin Skin Test Results (Fact sheet)
Treatment Options for Latent Tuberculosis Infection
TB Education and Training Resources website
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						Page last reviewed:  August 31, 2016					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeTuberculosisBasic TB Factsplus iconHow TB SpreadsLatent TB Infection and TB DiseaseSigns & SymptomsTB Risk FactorsExposure to TBTB PreventionVaccinesTB & HIV CoinfectionTB and DiabetesTB TermsPersonal StoriesTesting & Diagnosisplus iconWho Should be TestedTesting for TB InfectionTesting in BCG-Vaccinated PersonsTB Screening and Testing of Health Care PersonnelTesting During PregnancyDiagnosing latent TB infection and TB diseaseTreatmentplus iconDeciding When to Treat Latent TB InfectionTreatment Regimens for Latent TB Infection (LTBI)Treatment for TB DiseaseAdverse EventsTB Treatment of Persons Living with HIVTB Treatment and PregnancyTB Treatment for ChildrenFrequently Asked QuestionsDrug-Resistant TBResearchplus iconTB Epidemiologic Studies Consortiumplus iconResearch ProjectsPublicationsTB Trials Consortiumplus iconStudy DescriptionsBackgroundBehavioral & Social Science ResearchHealth Care Settingsplus iconTB Infection Control in Health Care SettingsResources for TB Screening and Testing of Health Care Personnelplus iconFrequently Asked QuestionsTB in Specific Populationsplus iconHealth DisparitiesAsian PersonsBlack or African American PersonsHispanic or Latino PersonsChildrenPregnancyCorrectional FacilitiesPeople Experiencing HomelessnessInternational TravelersLaboratory Informationplus iconDrug Susceptibility TestingFalse-Positive Investigation ToolkitInterim Laboratory Biosafety Guidance for XDR  tuberculosis strainsModel Performance Evaluation Program (MPEP)Rapid Molecular Testing to Detect Drug-Resistant TB in the USplus iconExecutive SummaryIntroductionBackground on Tests for Molecular Detection of DRGeneral Considerations and Principles for a Molecular DR Testing ServicePossible Scenarios and Scope of Testing for a Molecular DR Testing ServiceResearch NeedsGeneral Recommendations of the Expert PanelCommunication Plan for the ReportRecommendationsReferencesPanel Members and CDC ParticipantsAppendix 1Appendix 2Appendix 3The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TBplus iconGeneral ConsiderationsGeneral Recommendations of the Expert PanelRecommendations to ACET, CDC, DTBEData & Statisticsplus iconTB Incidence in the United StatesReported TB in the US, 2022 Surveillance Reportplus iconNational DataReporting Area DataRisk FactorsDemographicsTB Treatment and Case OutcomesDrug-Resistant TBMolecular SurveillanceTuberculosis in the United States, 2022 (Slide Set)Archived Surveillance Reports and Slide Sets2021 State and City ReportArchived State and City ReportsProfessional Resources & Toolsplus iconTools for Healthcare ProvidersResources for TB Programsplus iconStrengthening Civil Surgeons’ Capacity to Improve LTBI Surveillance and Outcomes Among Status AdjustersNotice of Funding Opportunity (NOFO)Program EvaluationTB Centers of ExcellenceTB Elimination AllianceTB Genotypingplus iconConventional TB GenotypingWhole Genome SequencingTB GIMSAnalytic ToolsLatent Tuberculosis Infection ResourcesPublications & Productsplus iconPatient and Public MaterialsFact SheetsGuidelinesplus iconControl & EliminationDrug-Resistant TBInfection Control & PreventionLaboratory & GenotypingTB & HIVTB in Specific PopulationsTesting & DiagnosisTreatmentVaccines & ImmunizationsArchived TB GuidelinesGuides & Toolkitsplus iconAggregate ReportsCDC TB Surveillance TrainingCore CurriculumEffective TB Interviewing for Contact InvestigationEthnographic GuidesFalse-Positive Investigation ToolkitForging Partnerships to Eliminate TuberculosisGuide to Application of GenotypingLTBI: A Guide for Primary Health Care ProvidersMantoux Tuberculin Skin Testing ProductsReport of Verified Case of Tuberculosis (RVCT)Self-Study ModulesTB Contact Investigation Interviewing Skills CourseTB eDOT ToolkitUnderstanding the TB Cohort Review ProcessNewslettersplus iconTB Notes, No. 4, 2023TB Notes, No. 3, 2023TB Notes. No. 2, 2023TB Notes. No. 1, 2023TB Notes, No. 4, 2022TB Notes, No. 3, 2022TB Notes, No. 2, 2022TB Notes, No. 1, 2022TB Notes, No. 4, 2021TB Notes, No. 3, 2021TB Notes, No. 2, 2021TB Notes, No. 1, 2021Pamphlets, Brochures, Bookletsplus iconQuestions and AnswersPatient Education SeriesTuberculosis - Get the FactsTuberculosis - The Connection between TB and HIV12-Dose Regimen for Latent TB Infection-Patient Education BrochurePostersplus iconMantoux Tuberculin Skin Test Wall ChartWorld TB DayThink TBStop TBTake on TBReports & Articlesplus iconDTBE Authored Journal ArticlesTuberculosis Laboratory Aggregate ReportsSlide Setsplus iconIntroduction to TuberculosisEpidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United States, 1993–2016Self-Study Modules on Tuberculosis, 1-5 Slide SetsThe Tuberculosis (TB) in Correctional Settingsplus iconFacilitator GuideIntroduction to TB GenotypingEpidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2017Prevention and Control of Tuberculosis in Correctional and Detention FacilitiesGuidelines for Preventing the Transmission of M. TB in Health care SettingsInvestigation of Contacts of Persons with Infectious TBEpidemiology of Pediatric Tuberculosis in the United StatesTargeted Tuberculosis Testing and Treatment of Latent Tuberculosis InfectionElectronic Tools & ResourcesWeb-Based Courses & Webinarsplus iconTB 101 for Health Care WorkersContent SyndicationInfographicsplus iconSocial Media GraphicsCustomizable Take on TB Infographic with InstructionsEventsWorld TB Dayplus iconU.S. TB ChampionsHistoryFeaturesplus iconTB Risk FactorsTreating Latent TB Infection with Short-Course RegimensWorld Tuberculosis (TB) Day 2021World Tuberculosis (TB) Day 2020Linksplus iconState TB Control OfficesAbout Usplus iconMission Statement and Activitiesplus iconDTBE Strategic PlanNational TB Program ObjectivesOrganization ChartAdvisory Groupsplus iconFederal TB Task Force To receive email updates about this page, enter your email address: Email Address			What's this?				Submit


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