Breaking barriers: Implementation of a tuberculosis preventive treatment protocol among newly eligible populations...

The World Health Organization emphasizes tuberculosis preventive treatment (TPT) as key to TB elimination. Implementation faces risk-benefit and adherence challenges. We implemented a structured TPT protocol at Hospital Gregorio Marañón with telephone support, personalized selection of currently available regimens, and toxicity management.

To assess the structured TPT protocol in achieving complete preventive treatment (CPT) and identify factors associated with non-completion (NCPT).

Retrospective analysis of a prospective cohort (2017-2024) of adults referred to the TB Unit. All causes of TPT were included per Spanish guidelines, except people living with HIV, who are followed in a separate clinic. Demographics, comorbidities, and outcomes were prospective collected. Univariate and multivariable logistic regression were used to identify predictors.

Of 554 patients, 542 (97.8%) initiated TPT: close TB contacts (37.6%), immunosuppression (27.9%), and indications for immunomodulatory therapy (34.5%). Overall CPT was 86.5% (80.3% in those > 75 years; 90.7% in ages 35-54). Cancer predicted NCPT (aOR 2.25; 95% CI 1.21-4.21; p = 0.011). Among 73 NCPT cases, toxicity was the main cause (42.5%), followed by voluntary withdrawal (27.4%), social problems (20.5%, mainly in young immigrants), intercurrent disease (9.6%, notably cancer). Polypharmacy (aOR 2.51; 95% CI 1.13-5.60; p = 0.023) and inflammatory disease (aOR 2.25; 95% CI 1.06-4.75; p = 0.034) independently predicted toxicity-related NCPT.

The structured TPT protocol was associated with high CPT rates (86.5%), with excellent safety. Cancer predicted NCPT, polypharmacy and inflammatory disease predicted toxicity leading to NCPT. Similar studies are needed to compare our results.