Abstract
Despite widespread use of the interferon-gamma release assay for the diagnosis of latent tuberculosis infection (LTBI), the initiation rate of and factors associated with LTBI treatment among healthcare workers (HCWs) have not been studied in depth. The aim of this study was to evaluate the initiation rate of LTBI treatment and also to identify any factors associated with non-initiation of LTBI treatment among HCWs. A retrospective cohort study of 293 HCWs with LTBI was performed at a teaching hospital in Korea. LTBI was diagnosed using QuantiFERON-TB Gold In-Tube tests (Cellestis Ltd., Carnegie, VIC, Australia). Of the 293 HCWs with LTBI, 189 HCWs (64.5%) visited an outpatient clinic for a medical consultation regarding LTBI treatment. Of these, 128 (67.7%) consented to LTBI treatment for a 43.7% LTBI treatment initiation rate. Upon multivariable analysis, having a liver disease or currently taking hepatotoxic drugs (adjusted odds ratio [OR] = 12.03, 95% confidence interval [CI] = 3.12–46.35), being a physician (adjusted OR = 14.01, 95% CI = 2.82–69.74) and other patient-related HCWs (adjusted OR = 3.58, 95% CI = 1.46–8.78), and years of employment ≥20 years (adjusted OR = 4.77, 95% CI = 1.74–13.12) were independent factors associated with the non-initiation of LTBI treatment. Upon bivariate multivariable analysis, while having a liver disease or currently taking hepatotoxic drugs (adjusted OR = 12.85, 95% CI = 3.06–55.92), being a physician (adjusted OR = 28.43, 95% CI = 4.78–169.28) and other patient-related HCWs (adjusted OR = 4.80, 95% CI = 1.56–14.74), and years of employment ≥20 years (adjusted OR = 4.55, 95% CI = 1.37–15.15) were factors associated with no outpatient clinic visit for a consultation of LTBI treatment, having a liver disease or currently taking hepatotoxic drugs (adjusted OR = 11.76, 95% CI = 2.68–51.73) and years of employment ≥20 years (adjusted OR = 5.29, 95% CI = 1.38–20.19) were factors associated with refusal of LTBI treatment after a consultation. The overall initiation rate of LTBI treatment was suboptimal in HCWs with LTBI diagnosed using an interferon-gamma releasing assay. Having a liver disease or currently taking hepatotoxic drugs, being a physician and other patient-related HCWs, and years of employment ≥20 years were associated with non-initiation of LTBI treatment.
Highlights
Healthcare workers (HCWs) are at higher risk of M. tuberculosis infection due to their risk of occupational exposure to patients with active pulmonary tuberculosis[1,2]
In an era of interferon gamma releasing assay (IGRA)-based latent tuberculosis infection (LTBI) diagnoses, the initiation rate of and factors associated with the acceptance of LTBI treatment among healthcare workers (HCWs) might be different from those performed for LTBI diagnoses based upon the TST
The present study evaluated factors associated with non-initiation of LTBI treatment among HCWs in a teaching hospital
Summary
Healthcare workers (HCWs) are at higher risk of M. tuberculosis infection due to their risk of occupational exposure to patients with active pulmonary tuberculosis[1,2]. The latent tuberculosis infection (LTBI) rate among HCWs was reported to range from 4–64%; this rate varied widely according to the burden of the study population[3,4]. Recent studies have shown that the LTBI rate among HCWs in Korea, an intermediate-tuberculosis (TB) burden country, was from 15–37%5–10. The successful treatment of LTBI among HCWs is important for two clinical reasons. HCWs diagnosed with LTBI via a positive tuberculin skin test (TST) who had received a prior BCG vaccination were more likely to refuse LTBI treatment[13,15]. In an era of IGRA-based LTBI diagnoses, the initiation rate of and factors associated with the acceptance of LTBI treatment among HCWs might be different from those performed for LTBI diagnoses based upon the TST.
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