Infectious Disease Provider Perspectives on Shorter Tuberculosis Treatment Regimens

Area of Science:

• Infectious Diseases
• Pulmonology
• Clinical Practice Guidelines

Background:

• Current guidelines recommend shorter rifamycin-based regimens (≤4 months) for tuberculosis infection.
• Newer all-oral regimens include 6-month options for drug-resistant tuberculosis (bedaquiline, pretomanid, linezolid [BPaL/BPaL-M]) and a 4-month regimen for drug-susceptible disease (rifapentine, isoniazid, moxifloxacin [HPMZ]).
• Implementation of these updated tuberculosis treatment regimens often lags behind guideline recommendations.

Purpose of the Study:

• To assess current tuberculosis treatment practices among infectious disease clinicians.
• To identify barriers hindering the adoption of newly recommended tuberculosis treatment regimens.

Main Methods:

• A survey was distributed to 1501 North American adult infectious disease physician members of the IDSA's Emerging Infections Network.
• Quantitative analysis of survey responses (percentages) and qualitative analysis of open comments were performed.

Main Results:

• Ninety-three percent of 349 respondents favored ≤4-month tuberculosis treatment regimens.
• Low adoption rates were observed for HPMZ (1% use, 5% experience) and BPaL/BPaL-M (39% intended use, 40% unsure).
• Key barriers included concerns regarding treatment toxicities (HPMZ, linezolid), drug interactions, and medication availability.

Conclusions:

• Infectious disease physicians prioritize shorter tuberculosis treatment durations but exhibit low uptake of newer guideline-recommended regimens.
• Concerns about effectiveness and treatment toxicities impede the implementation of novel tuberculosis therapies.
• Optimizing implementation requires enhanced adverse effect management, monitoring, and shared decision-making strategies.