Seven-year retrospective study understanding the latent TB infection treatment cascade of care among adults in a low incidence country

Table 2 Reason for losses within the Ottawa latent tuberculosis cascade of care (n = 1412) with comparison between patients followed at the TB Clinic and the Primary Care Team

Reason treatment not offered at the TB clinic
	All Individuals (n = 436)	TB Clinic	Primary Care Team
Discordance^a	236 (54.1%)	-	-
Lost to follow up^b	120 (27.5%)	-	-
Age^c	31 (7.1%)	-	-
Other^h	26 (6.0%)	-	-
Did not specify^d	12 (2.8%)	-	-
Comorbidities^c	10 (2.3%)	-	-
Polypharmacy^c	1 (0.2%)	-	-
Reason treatment not accepted
	All Individuals (n = 568)	TB Clinic (n = 544)	Primary Care Team (n = 24)
Did not specify^d	275 (48.4%)	274 (50.4%)	1 (4.2%)
Lost to follow up^b	165 (29.0%)	163 (30.0%)	2 (8.3%)
Accepted but did not start treatmentⁱ	49 (8.6%)	34 (6.3%)	15 (62.5%)
Worried about side effects	19 (3.3%)	18 (3.3%)	1 (4.2%)
Discordance^a	14 (2.5%)	14 (2.6%)	-
Does not want to take medications	11 (2.1%)	11 (2.0%)	-
Does not believe treatment is necessary	10 (1.9%)	8 (1.5%)	2 (8.3%)
Travelling	8 (1.4%)	8 (1.5%)	-
Drinking alcohol	6 (1.1%)	6 (1.1%)	-
Other^h	6 (1.1%)	3 (0.6%)	3 (12.5%)
Treatment too long	4 (0.7%)	4 (0.7%)	-
Side effects + treatment too long	1 (0.2%)	1 (0.2%)	-
Reason treatment incomplete
	All Individuals (n = 408)	TB Clinic (n = 272)	Primary Care Team (n = 136)
Lost to follow up^b	207 (50.7%)	155 (57.0%)	52 (38.2%)
Adverse Event^f	93 (22.8%)	84 (30.9%)	9 (6.6%)
Unknown^e	56 (13.7%)	-	56 (41.2%)
Other^h	28 (6.9%)	13 (4.8%)	15 (11%)
Did not specify^d	10 (2.5%)	10 (3.7%)	-
Pregnancy	5 (1.1%)	4 (1.5%)	1 (0.7%)
Missed too many doses	4 (1.2%)	2 (0.7%)	2 (1.5%)
Change in health	3 (0.6%)	3 (1.1%)	-
Elected for another LTBI Tx^g	1 (0.7%)	1 (0.4%)	-
Change in medication that interacts with LTBI treatment	1 (0.7%)	-	1 (0.7%)

^aPatients with a positive TST and negative IGRA. ^bPatients that: 1) required further baseline investigations prior to being offered treatment; 2) wanted another appointment prior to accepting treatment; 3) did not start treatment following accepting treatment; and 4) did not return to clinic for subsequent appointments. ^cRisk of side effects with treatment is high given patient age, other medications, or comorbid medical conditions. ^dThe clinic note did not specify why the patient did not complete that step. ^eUnknown if treatment started or completed due to no information received from the primary care team about the treatment course after leaving the TB Clinic. ^fAdverse events that was felt to be treatment related and led to the LTBI treatment being stopped at the discretion of the TB physician or the patient. ^gPatients who stopped their current treatment course in order to receive another regimen (i.e. patients that stopped isoniazid because they preferred to take rifampin). ^hOther reason for losses within the cascade of care are outlined in the appendix.ⁱIndividuals who initially accepted treatment but never received a prescription and subsequently declined treatment or were lost to follow up

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