Latent tuberculosis infection in the outpatient general medicine clinic: Efficacy of a nurse-run electronic directly observed treatment program

Tuberculosis (TB) is a leading cause of infectious death worldwide, with nearly 2 billion currently infected globally. While the largest burden of active TB resides in low to middle-income countries, the US contributes to the global epidemic and can play a significant role in interrupting the spread of TB by recognizing and treating latent TB infection (LTBI). The vast majority of active TB in the US originates from the reactivation of LTBI. This cross-sectional study examines the prevalence of LTBI in a general medicine practice and explores the efficacy of a primary care nurse-run electronic directly observed therapy (eDOT) treatment program. 1221 patients were screened for the presence of historical risk factors for LTBI. Of those screened, 192 were offered QuantiFERON-TB Gold Plus (QFT-Plus) testing and a CXR if indicated, resulting in 35 being offered treatment for LTBI. After an initial provider visit to decide on the treatment regimen, patients received weekly nurse calls to verify adherence, assess for side effects and answer additional patient questions. Provider follow-up appointments occurred at the midpoint and completion of treatment. 33 (94%) of patients with LTBI completed treatment. Patients found the nurse calls very helpful to reassure them about their treatment and to address treatment concerns. Primary care providers are particularly well-positioned to identify and treat LTBI. Screening is simple and treatment is generally well tolerated. Utilization of a nurse-run eDOT) program can be quite helpful in facilitating adherence and treatment completion.