Published ahead of print on January 19, 2006, doi:10.1164/rccm.200510-1563OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 8, April 2006, 927-931
A more recent version of this article appeared on April 15, 2006
Submitted on October 4, 2005
Accepted on January 19, 2006
The Scope and Impact of Treatment of Latent Tuberculosis Infection in the United States and Canada
Timothy R Sterling1*, James Bethel2, Stefan Goldberg3, Paul Weinfurter2, Lourdes Yun4, and C. Robert Horsburgh5
1 Division of Infectious Diseases and Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA,
2 Westat, Rockville, MD, USA,
3 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA,
4 Denver Public Health and Hospitals Authority, Denver, CO, USA,
5 Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
* To whom correspondence should be addressed. E-mail: timothy.sterling{at}vanderbilt.edu.
Rationale: The scope of treatment of latent tuberculosis infection (LTBI) in the U.S. and Canada is unknown. Identifying the types of clinics that administer such treatment and patients who receive it could guide resource utilization and improve treatment initiation and completion.
Objectives: Estimate the number of persons started on LTBI treatment; describe the types of clinics that treat LTBI.
Methods: The Tuberculosis Epidemiologic Studies Consortium, consisting of 19 U.S. and 2 Canadian sites, conducted a survey among clinics that initiated LTBI treatment for  10 patients in 2002.
Results:Study catchment areas from the 19 U.S. sites represented 8.6% of the U.S. population and 12.7% of all tuberculosis cases in 2000. An estimated 37,857 patients started LTBI treatment during 2002 at 244 clinics surveyed. Of these treatment starts, 29,970 (79%) occurred at general public health clinics; immigrant/refugee clinics (2,409; 6.4%) and correctional/detention facilities (2,325; 6.1%) were the next most common sites. Based on these data, U.S. tuberculosis case rates, and U.S. population data, the estimated total number of LTBI treatment starts in the U.S. was approximately 291,000 - 433,000. When the 37,145 persons who initiated LTBI treatment in the U.S. were extrapolated to the entire U.S. population, with a 5% lifetime risk of tuberculosis without treatment, and 20-60% treatment effectiveness, approximately 4,000 - 11,000 tuberculosis cases were prevented in the U.S.
Conclusions: LTBI treatment is initiated among a substantial number of persons in the U.S. and Canada, primarily in the public sector. Treatment of LTBI can significantly decrease the tuberculosis burden.
Key words: tuberculosis, treatment of latent tuberculosis infection, M. tuberculosis
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