Successful management of latent tuberculosis infection in an underserved community by a student-run free clinic

The management of latent tuberculosis infection (LTBI) most commonly consists of a nine- month course of isoniazid (INH) therapy and is complicated by low adherence and completion rates. The Latent Tuberculosis Initiative at the HAVEN Free Clinic was developed to provide LTBI treatment to an underserved, high- risk, foreign- born population. We conducted a retrospective chart review to evaluate the program. Of 39 patients enrolled, 26 (67%) successfully completed nine months of INH, eight (21%) discontinued, and five (12%) were lost to follow-up. Patients had a median of nine encounters during the course of treatment and mean self- reported medication adherence was 29/ 30 pills/ month (96%). Median days- of-treatment was 273, 95, and 63 among completion, discontinuation, and lost to follow-up groups, respectively (p <.0001). There was one death in the program, related to a complication of a diagnostic procedure in a patient who had developed INH toxicity. These results are comparable to the most successful published programs (50- 65% six- month completion rates), suggesting that student- run clinics serving high- risk populations may contribute to LTBI management and TB control efforts.