Although latent tuberculosis infection (LTBI) is a curable condition, research indicates that treatment completion rates are inconsistent. “Inconsistent rates of treatment completion are oftentimes due to the duration of LTBI treatment and medication-related side effects,” explains Bernadette Jakeman, PharmD, PhC, BCPS, AAHIVP. To determine whether a collaborative care model could be effective in the treatment of LTBI, Dr. Jakeman and colleagues conducted a prospective pilot study in collaboration with community pharmacies and the New Mexico Department of Health, and published their results in Preventing Chronic Disease.
“Pharmacies provide the convenience of location, access, and extended hours, and pharmacists are trained to provide adherence counseling and to identify and manage potential medication side effects,” highlights Dr. Jakeman. Collaborating with local pharmacy locations, the research team administered LTBI treatment using once-weekly isoniazid and rifapentine via directly observed therapy. Patients received initial evaluation and diagnosis at department of health sites and were offered to continue treatment there or at a community pharmacy. Patients who chose the community pharmacy received adherence and medication counseling, as well as assessment for medication adverse events, along with treatment.
Among patients who received treatment at a community pharmacy, 75% completed treatment. Patients of Hispanic ethnicity were more likely to complete treatment than were non-Hispanic patients (76.7% vs 40.0%). Most patients (60%) experienced >1 potential adverse drug events, including dark urine (27.5%), excessive fatigue (22.5%), and nausea/vomiting (22.5%). “Pharmacists were able to address adherence barriers, manage mild non-serious medication side effects, and encourage patients to complete therapy,” adds Dr. Jakeman. “They also had direct communication with the health department in cases for which additional evaluation of potential medication side effects was warranted.”
“Our study showed that pharmacies could serve as additional sites for patients to safely receive LTBI treatment, especially in areas where the department of health is over-burdened,” says Dr. Jakeman. “With an estimated 13 million people in the US affected by LTBI, I would like to see more health departments around the country working with their community pharmacies to tackle this public health issue. To that end, pharmacists are in a great position to provide these services.”
Rebecca Shover