Tuberculosis Prevention in Mexican ImmigrantsLimitations of Short-Course Therapy
Namratha R. Kandula, MD, MPH, Mark S. Dworkin, MD, MHTPM, Margaret R. Carroll, RN, BS,Diane S. Lauderdale, PhD
Background: Two months of rifampin and pyrazinamide (RIF/PZA) for tuberculosis prevention ha been advocated as a way to improve adherence in mobile populations, such as recen immigrants. However, RIF/PZA requires intensive patient and laboratory monitoring for hepatotoxicity.
Objectives: To describe the feasibility and outcomes of using RIF/PZA for TB prevention during a tuberculosis outbreak in a Mexican immigrant community, where 23 adults and 11 children were treated with RIF/PZA between August 2001 and October 2001.
Methods: Retrospective chart review and interviews with health department employees were conducted to assess completion rates, hepatotoxicity, cost, and feasibility of monitoring.
Results: Ten (91%) children and 13 (57%) adults completed RIF/PZA. One child (9%) and four adults (17%) developed drug-induced hepatitis. Cultural barriers affected care. The adult resisted the biweekly blood draw, believing it would “drain them of energy.” RIF/PZA, plumonitoring, was twice as costly as 4 months of rifampin.
Conclusions: RIF/PZA was associated with significant hepatotoxicity, poor completion, and cultura barriers to monitoring, and was more costly than standard therapy. Tuberculosis prevention must address potential clinical, cultural, and economic barriers to completion and monitoring of short-course therapy in immigrants.
(Am J Prev Med 2004;26(2):163–166) © 2004 American Journal of Preventive Medicine