Abstract Over80% of tuberculosis cases in the United States are due to reactivation ofuntreated latent tuberculosis infection (LTBI), most of whom were foreign born.LTBI treatment can greatly lower the risk of progression to active TB disease,and shorter treatment regimens increase the potential of migrants and otherpersons in vulnerable conditions, to complete treatment. We conducted across-sectional study to assess willingness to complete a one-month course ofLTBI treatment among internal and international migrants living in Tijuana, BC,Mexico, and to identify factors associated with treatment unwillingness betweenNovember 2020 and April 2021. Prior to administering TB skin tests (TST),participants were asked if they would accept LTBI treatment if indicated bytest results and clinical examination. Recruitment occurred in migrant sheltersthroughout Tijuana and at a storefront office conducting research and harmreduction services for people who use drugs. Among 595 participants, 80.4% wereliving in shelters, 3.5% were recruited at shelters but living independently,and 16.1% were recruited through the storefront office. Overall, 71 (11.9%) indicatedthat they were unwilling to take LTBI treatment and 109 (18.3%) had positive TSTresults. Unwillingness to take LTBI treatment was more common amongparticipants from the storefront office compared to the shelter (64.6% vs.1.8%, p<0.001). Since only 1.8% of shelter participants were unwilling toreceive treatment, multivariable Poisson regression with robust varianceestimation via GEE for identifying factors independently associated with LTBItreatment unwillingness was restricted to storefront participants. Treatmentunwillingness among storefront participants was positively associated with perceivinghealth status as “good” or “very good” (prevalence ratio PR=2.37, 95%confidence interval CI: 1.52,3.99) and heroin use in the past six months (PR=1.70; 95% CI: 1.33, 2.19). Unstablehousing was reported as a barrier to treatment. These findings suggest thatmost migrants in Tijuana were willing to receive short-course LTBI treatment ifindicated, yet willingness was lower among those at greatest risk of TB.Efforts to increase testing and treatment, as well as further research onovercoming barriers to treatment willingness are needed.
Garfein et al. (Sun,) studied this question.