Time to Progress Through the Latent Tuberculosis Infection Care Cascade in Primary Care

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Control

Background:

• Latent tuberculosis infection (LTBI) treatment is key to preventing active tuberculosis disease.
• The LTBI care cascade framework identifies essential clinical steps for successful treatment.
• Characterizing the timing of LTBI care cascade progression is poorly understood.

Purpose of the Study:

• To calculate the timing of each step in the LTBI care cascade.
• To assess if timing influences progression through the LTBI care cascade.

Main Methods:

• Observational study using electronic health records (2020-2022, N=693,254 patients).
• Calculated median times for LTBI care cascade steps.
• Identified optimal maximum times (OMTs) using ROC curves.
• Compared cascade progression rates based on OMT adherence.

Main Results:

• Median LTBI care cascade completion time was 150 days.
• Key median times: test result (3 days), imaging order (7 days), treatment prescription (17 days), treatment start (0 days), treatment completion (116 days).
• Patients completing steps faster than OMTs had marginally higher cascade progression rates (RR 1.10-2.81).

Conclusions:

• Timely progression through the LTBI care cascade is associated with higher treatment success.
• Emphasizes the need for sustained follow-up and avoiding early 'lost to care' classification.
• Supports public health strategies focused on long-term patient engagement for LTBI treatment.