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High Completion Rate for 12 Weekly Doses of Isoniazid and Rifapentine as Treatment for Latent Mycobacterium tuberculosis Infection in the Federal Bureau of Prisons

Schmit, Kristine M., MD; Lobato, Mark N., MD; Lang, Simona G., MPH; Wheeler, Sherri, DNP; Kendig, Newton E., MD; Bur, Sarah, MPH

Journal of Public Health Management and Practice: March/April 2019 - Volume 25 - Issue 2 - p E1–E6
doi: 10.1097/PHH.0000000000000822
Research Reports: Research Full Report
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Context: Correctional facilities provide unique opportunities to diagnose and treat persons with latent tuberculosis infection (LTBI). Studies have shown that 12 weekly doses of isoniazid and rifapentine (INH-RPT) to treat LTBI resulted in high completion rates with good tolerability.

Objective: To evaluate completion rates and clinical signs or reported symptoms associated with discontinuation of 12 weekly doses of INH-RPT for LTBI treatment.

Setting/Participants: During July 2012 to February 2015, 7 Federal Bureau of Prisons facilities participated in an assessment of 12 weekly doses of INH-RPT for LTBI treatment among 463 inmates.

Main Outcome Measures: Fisher exact test was used to assess the associations between patient sociodemographic characteristics and clinical signs or symptoms with discontinuation of treatment.

Results: Of 463 inmates treated with INH-RPT, 424 (92%) completed treatment. Reasons for discontinuation of treatment for 39 (8%) inmates included the following: 17 (44%) signs/symptoms, 9 (23%) transfer or release, 8 (21%) treatment refusal, and 5 (13%) provider error. A total of 229 (49.5%) inmates reported experiencing at least 1 sign or symptom during treatment; most frequently reported were fatigue (16%), nausea (13%), and abdominal pain (7%). Among these 229 inmates, signs/symptoms significantly associated with discontinuation of treatment included abdominal pain (P < .001), appetite loss (P = .02), fever/chills (P = .01), nausea (P = .03), sore muscles (P = .002), and elevation of liver transaminases 5× upper limits of normal or greater (P = .03).

Conclusions: The LTBI completion rates were high for the INH-RPT regimen, with few inmates discontinuing because of signs or symptoms related to treatment. This regimen also has practical advantages to aid in treatment completion in the correctional setting and can be considered a viable alternative to standard LTBI regimens.

Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Schmit and Lobato); CDC/CSTE Applied Epidemiology Fellowship Program, Hartford, Connecticut (Ms Lang); Connecticut Department of Public Health, Hartford, Connecticut (Ms Lang); and Health Services Division, Federal Bureau of Prisons, Washington, District of Columbia (Drs Wheeler and Kendig and Ms Bur).

Correspondence: Sarah Bur, MPH, Health Services Division, Federal Bureau of Prisons, 320 First St, NW, Ste 424, Washington, DC 20534 (sbur@bop.gov).

The authors acknowledge the following people for their valuable contributions to this work: Kaylene Elliott, Jessica Figlenski, Brent Hamilton, Christine Ho, A. Martin Johnston, Heather Miosi, Nwabunie Nwana, Tushar Patel, Sue Reynolds, Roxie Schoppet, Amy Sandul, Salvador Villalon, and Rena Walker.

The findings and conclusions are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, the Federal Bureau of Prisons, or the Department of Justice.

K.M.S. contributed to data analysis and interpretation, writing and revision of the manuscript for important intellectual concept, and response to reviewers' comments. M.N.L., S.G.L., S.W., N.E.K., and S.B. contributed to the study concept, design, data analysis and interpretation, revision of the manuscript, and response to reviewers' comments. All authors approved the study concept and critically reviewed draft and final manuscripts.

This assessment was supported with funding provided by the Federal Bureau of Prisons with in-kind support from the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

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