Health care workers and the initiation of treatment for latent tuberculosis infection.
BACKGROUND
Despite strong evidence and recommendations supporting the treatment of latent tuberculosis infection, many affected health care workers at risk of acquiring tuberculosis from and potentially transmitting tuberculosis to their patients do not receive treatment. The objective of this study was to determine whether health care workers were less likely than non-health care workers to initiate treatment for latent tuberculosis infection.


METHODS
In this retrospective cohort study that used the disease management database from a specialized downtown Toronto tuberculosis clinic, patients with latent tuberculosis infection were included if they had risk factors for progression of disease and were excluded if they had contraindications to treatment.


RESULTS
Our final cohort consisted of 308 patients with latent tuberculosis infection. The overall treatment initiation rate was 58%. We found that, when a number of confounding variables, including age, foreign birth, contact with persons with active tuberculosis, tuberculosis skin test conversion, bacille Calmette-Guérin vaccination, abnormal chest radiograph findings, comorbidities, and income, were considered and/or controlled for, the odds of a health care worker initiating treatment were approximately one-half of those of a non-health care worker (adjusted odds ratio, 0.55; 95% confidence interval, 0.32-0.93).


CONCLUSIONS
We conclude that, in our clinic, health care workers are less likely than non-health care workers to initiate treatment for latent tuberculosis infection.
Gershon
Andrea S
AS
University of Toronto, Toronto, Ontario. andrea.gershon@utoronto.ca
McGeer
Allison
A
Bayoumi
Ahmed M
AM
Raboud
Janet
J
Yang
Jae
J
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends; D015986:Confounding Factors, Epidemiologic; D016358:Contact Tracing / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006282:Health Personnel / Q000639:trends*; D006801:Humans; D017053:Infection Control / Q000379:methods; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000379:methods / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology / Q000302:isolation & purification; D010356:Patient Isolation / Q000379:methods; D012189:Retrospective Studies; D014374:Tuberculin Test / Q000379:methods; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control
D000995:Antitubercular Agents; D001500:BCG Vaccine