Determinants of latent tuberculosis infection and treatment interruption in long-term care facilities: A retrospective cohort study in Taiwan.

BACKGROUND/PURPOSE: Latent tuberculosis infection (LTBI) treatment is challenging in long-term care facilities (LTCFs) residents due to the occurrence of medical complexities. However, factors associated with treatment interruption have not been extensively studied. This retrospective cohort study aimed to determine LTBI-associated factors and treatment interruption in LTCF residents and employees in Taiwan. METHODS: From May 2017 through September 2020, the residents and employees of 20 LTCFs in Taipei, Taiwan, were screened for LTBI by using QuantiFERON-TB Gold In-Tube test. The LTBI individuals underwent directly observed preventive therapy (DOPT), including regimens of 9-month daily isoniazid (9H) and 3-month weekly isoniazid plus rifapentine (3HP). All the LTBI cases were followed up till treatment completion, death, or treatment interruption. RESULTS: Among 2207 LTCF subjects, 16.8% had LTBI. After controlling for other covariates, residents of public facilities had a significantly higher LTBI prevalence than those of private facilities (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI]: 1.08-1.88). Among 264 LTBI cases receiving preventive therapy, 52 (19.7%) had treatment interruption. LTBI cases receiving 3HP were less likely to have treatment interruption than those receiving 9H (AOR = 0.22; 95% CI: 0.07-0.71). CONCLUSIONS: LTCF residents, particular those living in public facilities, had a high LTBI prevalence. 3HP with DOPT is considered the priority regimen for preventive therapy among LTBI cases in LTCFs.

Latent tuberculosis among injection drug users in a methadone maintenance treatment program, Taipei, Taiwan: TSPOT.TB versus tuberculin skin test.

BACKGROUND: Taiwan has a growing HIV/AIDS epidemic that has recently shifted to an increase among injection drug users (IDUs). IDUs co-infected with HIV and tuberculosis (TB) have a high risk of progression from latent tuberculosis infection (LTBI) to active TB. METHODS: This study aimed to determine the prevalence and correlates of LTBI among IDUs by TSPOT.TB and tuberculin skin test (TST), in a large methadone program in Taipei, Taiwan. Consenting participants were interviewed by a trained worker regarding sociodemographics, substance use history, and health factors. RESULTS: Multivariate analysis was used to determine risks associated with each test outcome. Of 287 participants, 165 (58.7%) tested TSPOT.TB-positive and 244 (85.0%) tested TST-positive. The mean age was 44 y, and 7.3% were HIV-infected. Kappa statistics indicated slight concordance between TSPOT.TB and TST. In multivariate analysis, after controlling for potential confounders, TSPOT.TB positivity was significantly associated with age ≥ 50 y (reference, 20-34 y). A history of ever having had contact with a TB-infected person was associated with TST positivity, whereas HIV infection was inversely associated with TSPOT.TB positivity and TST positivity. CONCLUSIONS: This study shows a high prevalence of LTBI in individuals at risk for HIV infection in Taipei, Taiwan. Future TB prevention programs should particularly focus on IDUs.