Improving screening and management of latent tuberculosis infection: Development and evaluation of latent tuberculosis infection primary care model

BMC Infectious DiseasesKunin M, Timlin M, Lemoh C, et al. | January 14, 2022


In order to meet the demand for specialist infectious diseases services required to provide timely management of latent tuberculosis infection (LTBI) in areas of high refugee and asylum seeker settlement in Australia, a model for treating LTBI patients in primary care was developed and piloted in a refugee-focused primary health service (Monash Health Refugee Health and Wellbeing [MHRHW]) and a universal primary care clinic. In this study, the development and evaluation of the model are described, focusing on the model feasibility, and barriers and enablers to its success.

  • Using a convergent mix-methods design, evaluation of the model for treating LTBI patients in primary care was done, where the model feasibility was determined by a prospective cohort study of patients initiating treatment either at MHRHW or the universal primary care clinic, while barriers and enablers to sustainability and success of the model were determined by focus groups with clinicians directly involved in managing these patients.

  • Among 65 LTBI positive patients who presented at participating services from January 2017 to April 2018, 31 (48%) patients accepted treatment; 15 of these (48%) underwent treatment at MHRHW and 16 (52%) at the universal primary care clinic.

  • Findings suggest that there are some barriers for treating LTBI patients that are relevant regardless of the treatment setting; these include patients’ low levels of motivation, difficulty in processing diagnosis-related information and competing priorities, along with the limitations of LTBI medication (isoniazid), such as the length of treatment and adverse reactions.

  • Improvement in the confidence of primary care clinicians could be achieved by extended support from infectious diseases physicians and greater in-depth reference resources, with multiple anticipated problems and suggested solutions, for the primary care clinicians to refer to during the patient consultation.

  • At the organizational level, there was inconsistency in the availability of dedicated resources to deliver and support patient education and follow-up across the participating sites.

  • This discrepancy in resource availability may largely explain the statistically significant difference noted in the completion rate between the two sites, indicating that patient compliance and ultimately treatment success may improve with consistent and ongoing patient education and follow-up.

  • Overall findings suggest that by accounting barriers and enablers at patient, provider, organizational and clinical levels, improvement in screening and management of LTBI patients could be achieved at the primary care setting.

  • Supporting primary care clinics will be required with resources to employ dedicated clinical staff for patient education, follow-up communication and monitoring medication adherence in order to upscale a primary care response to the management of LTBI.

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