TABLE 5.
Overview of determinants of LTBI treatment initiation, adherence, and completion in the general population diagnosed with LTBIa
| Determinant | Specification determinant (vs. reference group) | No. of articles | |||
|---|---|---|---|---|---|
| Positive association | Inverse association | ||||
| P (reference) | R (reference) | P (reference) | R (reference) | ||
| Determinants of LTBI treatment initiation | |||||
| Age | Older age (vs younger age) | 1 (187) | 2 (188, 189) | ||
| Gender | Men (vs women) | 1 (189) | 1 (187) | ||
| Subpopulation within general population with LTBI | Refugee/immigrants (vs born in country of study) | 1 (190) | 1 (189) | ||
| Immigrants born in WHO category 3 or 5 country (vs category 1 country)b | 1 (190) | ||||
| HCW (vs no HCW) | 2 (55, 188) | ||||
| Case contact (vs no case contact) | 1 (191) | 2 (55, 188) | |||
| Education | Lower education level (vs NR) | 1 (191) | |||
| Behavior | Alcohol use reported at baseline (vs no alcohol use reported) | 1 (187) | |||
| Other | Continuity of primary care by consulting a regular physician (vs NR) | 1 (191) | |||
| Pregnant (vs not pregnant) | 1 (169) | ||||
| Prior incarceration (vs NR) | 1 (191) | ||||
| Fear of getting sick with TB without medicine (vs no fear of getting sick) | 1 (191) | ||||
| Previous BCG vaccination (vs NR) | 1 (188) | ||||
| Abnormal chest X-ray findings consistent with previous TB (vs NR) | 1 (188) | ||||
| A nonemployment reason for screening (vs NR) | 1 (191) | ||||
| Determinants of LTBI treatment adherence | |||||
| Age | Older age (vs younger age) | 1 (192) | |||
| Ethnicity | Biculturalc (vs Hispanic or non-Hispanic) | 1 (192) | |||
| Education | Higher grades in school (vs lower grades) | 1 (192) | |||
| Behavior | Risk behaviors (vs NR)d | 2 (192, 193) | |||
| Adverse events | Some somatic complaints (vs NR) | 1 (193) | |||
| Determinants of LTBI treatment completion | |||||
| Age | Older (vs younger) | 3 (194, 195)e,f | 4 (110, 151, 196, 197)g | 3 (91, 190, 198) | 6 (55, 114, 199–202) |
| Gender | Male (vs female) | 2 (197, 199) | |||
| Ethnicity | Hispanic/Latino ethnicity (vs Asian ethnicity) | 1 (198) | |||
| White Hispanic (vs black, non-Hispanic) | 1 (199, 201, 203) | ||||
| Country of birth (i.e., Haiti, Dominican Republic, China with Hong Kong, or Vietnam) (vs other countries) | Various results found between countries (158) | ||||
| Asian/Pacific Islander (vs white) | 2 (196, 197) | ||||
| Region of origin (i.e., Latin America and Caribbean or Asia and others) (vs USA, Canada, Europe) | 1 (114) | ||||
| Black race (vs NR) | 1 (110)g | ||||
| Ethnicity (i.e., Asian, Non-Hispanic black, or Hispanic) (vs non-Hispanic white) | 1 (151) | ||||
| Subpopulation within source population | HCW (vs no HCW) | 1 (55) | |||
| Case contact (vs no case contact) | 1 (151) | 1 (110)h | |||
| Currently homeless (vs not currently homeless) | 2 (199, 204) | ||||
| PWID (vs no PWID) | 2 (55, 203) | ||||
| Refugees/immigrants (vs born in country of study) | 1 (205) | 4 (110, 151, 199, 200)g | 2 (204, 206) | ||
| Indication for LTBI treatment immunosuppression (vs case contact) | 1 (194)f | ||||
| Health | History of hepatitis A, B, or C (vs no history of liver disease) | 1 (91) | |||
| Other medications reported at baseline (vs NR) | 1 (110)h | ||||
| Use of concomitant medications by women (vs no use of concomitant medication) | 1 (187) | ||||
| Behavior | (Excess) alcohol use (vs no alcohol use) | 4 (110, 187, 199, 204)h | |||
| Smoking (vs nonsmoking) | 1 (194)f | ||||
| Treatment | Treatment without H (vs treatment with H) | 1 (194)f | 5 (111, 114, 151, 196, 207) | ||
| 9 mo of H (vs other regimens) | 1 (55) | ||||
| Regimen choice offered (vs no regimen choice offered) | 1 (202) | ||||
| Twice-wkly RZ (vs daily RZ) | 1 (69) | ||||
| DOT (vs SAT) | 3 (151, 197, 208) | ||||
| Adverse events | Adverse events (vs no adverse events) | 7 (114, 169, 187, 199, 201, 206, 209) | |||
| Adverse events (i.e., grade 1 or 2 hepatotoxicity, grade 3 or 4 hepatotoxicity, or adverse events other than hepatotoxicity) (vs NR) | Conflicting results found between adverse events (68) | ||||
| Other | Not having been incarcerated within 6 mo of diagnosis (vs NR) | 1 (189) | |||
| Referral reason (i.e., correctional/rehabilitation or postpartum women) (vs TST positive from screening) | 1 (199) | ||||
| Risk group (i.e., contact, medical risk,i population riskj) (vs low riskk) | 1 (152) | ||||
| Cause of screening/referral (i.e., asylum seekers or contacts) (vs anti-TNF-α candidates) | 1 (209) | ||||
| Fear for venipuncture (vs NR) | 1 (158) | ||||
| Low TB risk perception (vs NR) | 1 (158) | ||||
| Plan to tell friends or family about LTBI diagnosis (vs NR) | 1 (190) | ||||
| Home situation (i.e., child living with no or one natural parent) (vs living with both natural parents) | 1 (204) | ||||
| Spanish language (vs non-Spanish language) | 1 (210) | ||||
| Resident in a congregate setting (vs never or unknown) | 1 (55) | ||||
| Missed appointment call or letter (vs no missed appointment call) | 1 (210) | ||||
| No medical insurance (vs medical insurance) | 1 (169) | ||||
| Clinic attendance before treatment (vs clinic nonattendance before treatment) | 1 (201) | ||||
| Presumed nonrecent TB infection (vs presumed recent TB infection) | 1 (202) | ||||
| Public health nurse referral (vs no public health nurse referral) | 1 (210) | ||||
Reprinted from reference 97, under the International CC-BY 4.0 license. Abbreviations: P, ••; R, ••; HCW, health care worker; NR, none reported; PWID, ••; H, ••; RZ, ••; SAT, ••.
The WHO defined 5 categories of TB prevalence based on 1st (least prevalent) to 5th (most prevalent).
“Bicultural” is defined by questions separated into the domains Hispanic and non-Hispanic, considering language use, linguistic proficiency, and electronic media use. Individuals scoring high in both domains are considered bicultural.
Risk behaviors: ever having used alcohol, cigarettes, or marijuana, been expelled or suspended from school, or been in a physical fight.
Data analyzed for individuals that underwent three QFT-GIT.
Data analyzed for individuals who underwent at least one serial QFT-GIT.
Data analyzed for non-Hispanic subjects for one study.
Data analyzed for Hispanic subjects for one study.
Persons with medical risk factors such as having a TST conversion within 2 years of a negative TST, HIV infection, untreated or partially treated prior TB, suspected TB with an abnormal chest radiograph, being younger than 5 years of age with a positive TST, or having a clinical condition associated with an increased risk of TB disease.
Persons with population risk factors, such as recent immigrants to the United States (5 years) from countries with high TB prevalence, homeless persons, and residents and employees of congregate settings such as prisons, jails, and health care facilities.
Persons with low risk for developing TB disease (no case contact, no medical risk, and no population risk factors).