title: Completion of Latent Tuberculosis Therapy in Children: Impact of Country of Origin and Neighborhood Clinics.
abstract: BACKGROUND
  Successful treatment of latent tuberculosis infection (LTBI) is an important objective in the United States' strategy for tuberculosis (TB) control. We review the impact of demographic variables and community treatment upon completion of medical therapy of LTBI in a large pediatric cohort.
  
  
  METHODS
  We performed a retrospective analysis of prospectively collected data from children referred for evaluation and treatment of LTBI. Children were followed in the main hospital TB clinic or in 1 of 2 hospital-run neighborhood clinics. Those completing and not completing medical treatment were compared based on demographic and history variables, clinic location, and distance to clinic. Propensity score techniques were used to match children treated at the main hospital and neighborhood clinics on collected demographic and history variables.
  
  
  RESULTS
  Of 1516 children evaluated, 1184 (78.1%) initiated medical therapy and returned for at least 1 visit. Of these, treatment was completed by 89.2% (166 of 186) of children in the neighborhood clinics versus 83.2% (830 of 998) of children in the main hospital TB clinic (P < .037). Neighborhood and main hospital clinic children did not differ in rates of completion when propensity score-matched groups were compared. Country of origin was the most important factor in determining both initiation and completion of therapy.
  
  
  CONCLUSIONS
  Obstacles remain for successful initiation and treatment of children from identified geographic regions. Most of the dropout occurs early in treatment, and use of neighborhood clinics does not provide an obvious advantage when similar patient groups are compared. Emphasis upon initial education and early non-clinic follow-up may be useful in enhancing therapy completion.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine Section of Infectious Diseases, Nationwide Children's Hospital.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Spicer
authors.affiliation: Section of Infectious Diseases, Nationwide Children's Hospital.
authors.forename: Lori
authors.initials: L
authors.lastname: Perkins
authors.affiliation: Columbus Public Health.
authors.forename: Ben
authors.initials: B
authors.lastname: DeJesus
authors.affiliation: Columbus Public Health Deparment of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine Section of Infectious Diseases, Nationwide Children's Hospital.
authors.forename: Dwight A
authors.initials: DA
authors.lastname: Powell