Management of Latent Tuberculosis Infection Among an Inner-city Population with Psychosocial Barriers to Treatment Adherence

• Author / Creator

  Heyd, Amber T

• BACKGROUND: In Canada, preventive therapy for LTBI has meant long durations and frequent dosing. This contributes to poor adherence and completion rates. In response, a shortened treatment regimen, once weekly rifapentine plus isoniazid for 3 months (3HP), is now available, though there has been no formal evaluation of it use. This study explored perceptions of latency and the need for preventive therapy, and barriers and facilitators to treatment adherence and completion in inner-city clients offered 3HP and their health care providers.

  DESIGN/METHODS: This qualitative descriptive study involved semi-structured individual interviews. Unstably housed or homeless individuals in Edmonton and Fort McMurray, Alberta, Canada offered directly observed preventive therapy (DOPT) with 3HP, and their health care providers were eligible. The data were systematically organized and analyzed using latent content analysis.

  RESULTS: Analysis of interviews revealed incomplete understandings of LTBI and the need for preventive therapy. Clients self-motivation and desire to be healthy, alongside education, health care outreach, relationships through DOPT, ease of treatment regimen, incentives and collaboration were described as supporting successful treatment outcomes. Competing priorities, difficulty in reaching clients, undesirable aspects of the regimen (e.g. side effects, pill burden and drug interactions) and arduousness related to obtaining and initiating 3HP were barriers to access, uptake, and completion. Perceptions of stigma related to LTBI and TB were described by clients as well as feelings of shame or embarrassment related to their diagnosis

  CONCLUSIONS: This study was the first in Canada to qualitatively explore the use of 3HP. Our study used qualitative descriptive methods to explore the understandings of LTBI and the barriers and facilitators to preventive therapy access, uptake, and adherence among individuals experiencing homelessness and their health care providers. Our study provided insight into the knowledge and understandings of LTBI and the multiple interacting psychosocial factors that influence preventive therapy access, uptake, and adherence. Findings from this study can be used to inform health policy and TB programming aimed at removal of the LTBI reservoir and to address TB specific inequities among individuals experiencing homelessness.

• Subjects / Keywords

  • Substance Use
  • Homelessness
  • Tuberculosis
  • Latent Tuberculosis Infection
  • Inner-city
  • Psychosocial
  • Adherence

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-hjbs-tg84

• License

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