Am. J. Respir. Crit. Care Med.,
Volume 162, Number 5, November 2000, 1653-1655
Supervised Preventive Therapy for Latent Tuberculosis
Infection in Illegal Immigrants in Italy
ALBERTO
MATTEELLI,
CATERINA
CASALINI,
MARIO C.
RAVIGLIONE,
ISSA
EL-HAMAD,
CARLA
SCOLARI,
ENRICO
BOMBANA,
MASSIMILIANO
BUGIANI,
MARIA
CAPUTO,
CARMELO
SCARCELLA,
and
GIAMPIERO
CAROSI
Clinic of Infectious and Tropical Diseases, University of Brescia, and District Health Department, Brescia, Italy; Communicable Disease Cluster,
World Health Organisation, Geneva, Switzerland; and Tuberculosis Clinic, District Health Department, Turin, Italy
In a multicenter, prospective, randomized, open-label study of isoniazid-preventive therapy (IPT) for latent tuberculosis infection, illegal immigrants from countries where tuberculosis is highly endemic were enrolled at two clinical sites in Northern Italy. Of 208 eligible subjects, 82 received supervised IPT at a dose of 900 mg
twice weekly for 6 mo (Regimen A), 73 received unsupervised IPT
900 mg twice weekly for 6 mo (Regimen B), and 53 received unsupervised IPT 300 mg daily for 6 mo (Regimen C). Supervised IPT
was delivered at either one tuberculosis clinic or one migrant
clinic. The probability of completing a 26-wk regimen was 7, 26, and 41% in Regimens A, B, and C, respectively (p < 0.005, Log-
rank test calculated using Kaplan-Meier plots). The mean time to
dropout was 3.8, 6, and 6.2 wk in Regimens A, B, and C, respectively (p = 0.003 for regimen A versus either Regimens B or C).
Treatment was stopped in five subjects (2.4%) because of adverse
events. The rate of completion of preventive therapy for latent tuberculosis infection among illegal immigrants was low. Supervised, clinic-based administration of IPT significantly reduced adherence. Alternative strategies to implement preventive therapy
in illegal immigrants are clearly required.
