Latent tuberculosis infection care cascade outcomes in primary care clinics in the tuberculosis epidemiologic studies consortium-III

Purpose Tuberculosis (TB) was the leading infectious cause of death worldwide in 2023. U.S. tuberculosis (TB) cases mostly result from reactivation of latent TB infection (LTBI). LTBI treatment is about 90% effective in preventing TB disease; thus, screening and treatment are essential for U.S. TB elimination efforts. Persons at higher risk of infection seek care at primary care clinics, which represent a critical setting for scaling up TB testing and LTBI treatment. Methods Using longitudinal electronic health record (EHR) data, we described a comprehensive LTBI care cascade among individuals at higher risk of infection seeking care in U.S. primary care clinics - from identification of higher-risk persons through testing, diagnosis, and treatment. Results Among 3.5 million patients, 48% were determined to be at higher risk; 86% were not tested. Among those tested, there was a 17% test positivity rate. Only 61% of persons diagnosed with LTBI were prescribed treatment; 44% did not complete treatment. Conclusions We established baseline rates of TB infection testing and LTBI treatment outcomes within U.S. primary care clinics. Results highlight opportunities for expanding U.S. TB prevention efforts by implementing targeted interventions to improve testing and treatment outcomes within primary care settings to ultimately reduce TB morbidity.