Last Updated: December 2017

Author: Tuberculosis Program, Vermont Department of Health

Transmission of the bacterium that causes tuberculosis may cause Latent Tuberculosis Infection (LTBI) in people who are exposed. This indicator measures the proportion of newly-infected people that start LTBI treatment and subsequently complete this treatment.

The Healthy Vermonters 2020 goal is to maintain the percent of treatment completion to above 90%. The HP2020 national target is 81%. Due to the small number of TB cases reported annually in Vermont, the Health Department uses a five-year aggregate to report this indicator. The Vermont five year average for 2013-2017 is 100%, while the U.S. average for 2015 was 75.3%. As Vermont has surpassed both state and national goals, focus will shift to maintaining the high completion rate.

Although LTBI treatment is recommended for most infected people, newly-infected contacts to pulmonary cases are a priority because these individuals are most likely to develop active TB within the first 1-2 years of becoming infected. Treatment for LTBI breaks the chain of transmission as these treated individuals then do not go on to develop active TB disease.

LTBI treatment can take up to nine months. Patients must be monitored closely with routine healthcare provider visits for the duration of treatment due to the possibility of adverse side effect from the medications. As a result, acceptance and completion of treatment is often problematic. People with LTBI do not feel ill, so it is sometimes difficult to convince them of the importance of taking a lengthy course of medication that may cause disruptions to their lives due to possible adverse side effects and frequent healthcare provider visits.

Collection and analysis of these data help TB programs evaluate how well they are identifying newly-infected people and ensuring their complete treatment. By finding, evaluating, and treating people diagnosed with latent TB infection, further transmission is prevented.

• Office of Local Health District Offices, Vermont Department of Health
• Infectious Disease Unit, University of Vermont Medical Center
• Outpatient Pharmacy, University of Vermont Medical Center
• Community healthcare providers

Many things affect whether a patient completes treatment for LTBI. Missed doses should be recognized and addressed as soon as possible to identify and remove barriers and ensure treatment completion. Providing native-language medical education along with incentives and enablers tailored to the individual has been shown to be beneficial. Examples include providing snacks to be taken with medication to alleviate nausea and assistance with co-pays for the numerous healthcare provider visits.

As federal and state funding levels permit, the Health Department plans to continue to:

• Use translation services to conduct interviews and provide education in the patient’s native language.
• Remove financial barriers by serving as the payer of last resort, as needed.
• Contract with the Outpatient Pharmacy at the University of Vermont Medical Center to ensure timely and convenient access to treatment medications.
• Refer treating physicians to medical experts at the Infectious Disease Unit at the University of Vermont Medical Center for consultation about monitoring for and managing any adverse effects of treatment.

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.