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Public Health


Bin Cai


Latent tuberculosis infection (LTBI), a product of exposure to Mycobacterium tuberculosis (Mtb), can lead to tuberculosis (TB) and further cause death if untreated. Fortunately, TB can be prevented with LTBI treatment. Targeting newly arrived visa holders for LTBI screening and treatment is an effective strategy for decreasing future TB burden. However, LTBI treatment completion rates are low, and researches had primarily focused on the nonrural U.S. setting. This study, using a retrospective cohort design under the epidemiological disease triangle framework evaluated (a) the treatment completion rates for 2 cohorts of visa holders (i.e., immigrants, N = 31 and refugees, N = 109) with LTBI residing in the rural setting using Pearson's chi-square analysis, (b) mean times on LTBI treatment using Kaplan-Meier survival analysis, and (c) predictors of time on treatment using Cox proportional hazard regression. Study findings revealed immigrants had higher treatment noncompletion rates over refugees (25.6% and 19.3%). The potential risk factors for noncompletion were being older than 24 years of age (HR = 0.18, p = 0.01). There were also significant interactions for the time on treatment between (a) being < 25 years old and visa type (HR = 0.23, p = 0.04), (b) being < 25 years and traveling longer (miles) to treatment facility (HR = 0.25, p = 0.03), or (c) being < 25 years and Mtb blood-test positive (HR = 0.35, p = 0.05). These findings suggest interventions targeting visa holders older than 24 years may increase the rate of treatment completion and decrease the future TB cases. Therefore, the study promotes social change by providing actionable, rural-population-specific information for the prioritization of visa holders at increased risk of experiencing LTBI treatment noncompletion.

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