Development and implementation of a cohort review for latent tuberculosis infection

The Centers for Disease Control and Prevention (CDC) recommends that, in low-incidence settings for tuberculosis (TB), health departments periodically review their cases of latent TB infection (LTBI). The objective of this study was to evaluate the design and implementation of an LTBI cohort review that can be used to assess program performance. The methods used for the LTBI cohort review were developed and modified from those described previously by the CDC for TB disease. A stratified random sample of LTBI cases was selected from three U.S. Army installations to compare program outcomes. A total of 295 TB tests were performed on 215 patients. Sixty-one (76%) of the 80 repeat tests performed were positive. Of the 194 patients who were recommended therapy, 146 (75%) initiated therapy and 114 (59%) completed therapy. The U.S. Army's TB control program can be improved by reducing unnecessary testing of low-risk groups, increasing completion of LTBI treatment, reducing treatment delays, and ensuring data accuracy. The LTBI cohort review should be performed at least annually at the installation level to improve the quality of TB control programs.