S39 Is the treatment of latent tuberculosis infection amongst recent migrants safe and effective in primary care?

<h3>Introduction</h3> The control of latent tuberculosis infection (LTBI) is a key priority in national and global strategies to eliminate tuberculosis (TB). We tested whether a novel community model of care delivered by general practitioners (family physicians) and community pharmacists to treat LTBI amongst recent migrants was effective and safe. Criteria for LTBI testing followed national guidelines. <h3>Methods</h3> The CATAPuLT trial (Completion and Acceptability of Treatment Across Primary Care and the community for Latent Tuberculosis) was a pragmatic cluster-randomised, parallel group, superiority trial conducted in 34 general practices in London, UK, comparing LTBI treatment in recent migrants in primary care to secondary care. The primary outcome was treatment completion. Secondary outcomes included treatment adherence, treatment acceptance, adverse events, patient satisfaction, the incidence of active TB and a comparison of costs per case completing treatment. <h3>Results</h3> Between September 2016 and May 2019, 7495 patients were offered testing for LTBI, 3624 were tested and 807 returned positive interferon-gamma release assay (IGRA) results. In the primary care arm, 224 were offered and 146 patients accepted treatment. In the secondary care arm, 138 were offered and 130 patients accepted treatment. In primary care, 82.6% of patients accepting LTBI treatment completed it, compared to 86·0% in secondary care. There was no significant difference in treatment completion between the two arms (aOR:0·64, 95%CI:0·31–1·29). There was also no difference in treatment adherence (aOR:0·64, 95%CI:0·32–1·28), drug induced liver injury (DILI) (0·7% vs 2·3%, aOR:0·29, 95%CI:0·03–2·84) or patient satisfaction (aOR:1·80, 95%CI:0·84–3.86). Treatment acceptance was lower in primary care (65·2% vs 94.2%, aOR:0·10, 95%CI:0·03–0·31). The cost per patient completing treatment was lower in primary care with an incremental saving of £315.26. <h3>Conclusions</h3> The treatment of LTBI in recent migrants within primary care is effective and safe with lower costs when compared to treatment within secondary care.