An analysis of the effectiveness of the latent tuberculosis service in Southampton - the reasons for treatment non-adherence

Latent TB affects an estimated 2 billion worldwide. Those affected carry a 10% risk of developing active TB, with potentially serious consequences. Chemoprophylaxis reduces this risk and is part of the “Stop TB” programme, but adherence to treatment can be problematic. This study evaluates the effectiveness of a latent TB treatment programme and analyses the reasons for treatment non-adherence. <bold>Methods:</bold> A retrospective analysis of the records of patients referred to the latent TB service in Southampton between 2018 and 2023 was performed. <bold>Results:</bold>625 records were analysed. All patients referred were considered suitable for chemoprophylaxis, 558 patients commenced treatment and 506 patients completed treatment. The main reasons for not commencing treatment were side effects (48%) and pregnancy (26.9%). Side effects, many started treatments but did not wish to continue due to experiencing side effects. Pregnant patients, those planning pregnancy and those breastfeeding declined treatment due to fears over the impact of medication on their baby. 50% of those patients completed chemoprophylaxis after completing breastfeeding. <bold>Conclusions:</bold> Females of childbearing age may delay chemoprophylaxis due to fears the medication may prove toxic to their baby, which risks reactivation of TB. Patients may not commence chemoprophylaxis as they fear the adverse effects. Patients experiencing adverse effects of chemoprophylaxis were less likely to complete treatment for fear of the effects of alternative treatments. Services should evaluate the reasons why their patients do not complete chemoprophylaxis and address them locally to maximise the efficacy of the “Stop TB” programme.