Personal, Provider and Systematic Barriers
Patient level barriers
- fear of side effects
- duration of treatment
- stigma
- financial concerns (losing pay and taking time off work)
- lack of knowledge of LTBI
- confusion about the effectiveness and coverage of the Bacillus Calmette-Guerin (BCG) vaccine
- unsatisfactory relationships with healthcare workers in the past (Katrak & Flood, 2018; Liu et al., 2018; Oren et al., 2017)
Provider level barriers
- limited resources
- longer appointments needed for these patients due to complex health needs
- lack of support from specialists
- knowledge gaps in healthcare workers on testing and interpretation of results
- lack of compensation for LTBI care
- lack of perceived benefit to patients
- inadequate methods of charting (Alsdurf & Menzies, 2020; Katrak & Flood, 2018; Liu et al., 2018; Oren et al., 2017)
System level barriers
- lack of funding
- perceived low priority for LTBI testing and treatment
- absence of comprehensive LTBI management strategies
- lack of research
- gaps in identification of household contacts
- need for increased public awareness and education
- global inconsistency in testing and treatment
- the need to incorporate recommendations of USPSTF into practice (Alsdurf & Menzies, 2020; Liu et al., 2018; Palmer et al., 2017; Pareek et al., 2016; Sotgiu et al., 2017)
Alsdurf, H., & Menzies, D. (2020). Identifying Gaps in the Quality of Latent Tuberculosis Infection Care. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 18. doi:10.1016/j.jctube.2020.100142
Katrak, S., & Flood, J. (2018). Latent Tuberculosis and Current Health Disparities in California: Making the Invisible Visible. American Journal of Public Health, 108(S4), 245. doi:10.2105/AJPH.2018.304529
Liu, Y., Birch, S., Newbold, K., & Essue, B. (2018). Barriers to treatment adherence for individuals with latent tuberculosis infection: A systematic search and narrative synthesis of the literature. The International Journal of Health Planning and Management, 33(2), 433. doi:10.1002/hpm.2495
Oren, E., Bell, M., Garcia, F., Perez-Velez, C., & Gerald, L. (2017). Promoting adherence to treatment for latent tb infection through mobile phone text messaging: Study protocol for a pilot randomized controlled trial. Pilot and Feasibility Studies, 3, 15-15. doi:10.1186/s40814-017-0128-9
Palmer, J., Allen, L., & Walton, W. (2017). CE: Tuberculosis: A New Screening Recommendation and an Expanded Approach to Elimination in the United States. The American Journal of Nursing, 117(8), 24-34. doi:10.1097/01.NAJ.0000521946.45448.90
Pareek, M., Greenaway, C., Noori, T., Munoz, J., & Zenner, D. (2016). The impact of migration on tuberculosis epidemiology and control in high-income countries: A review. BMC Medicine, 14.
Sotgiu, G., Dara, M., Centis, R., Matteelli, A., Solovic, I., Gratziou, C., . . . Battista, M. (2017). Breaking the barriers: Migrants and tuberculosis. Presse Medicale (paris, France : 198, 46(2), 11. doi:10.1016/j.lpm.2017.01.013