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Challenges for tuberculosis elimination: knowledge and practices on latent tuberculosis infection among general practitioners in Havana
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Introduction: Preventive treatment in high-risk groups is a key but poorly implemented tuberculosis control strategy. Despite resource limitations, Cuba -a low tuberculosis-incidence country- aims at elimination. General practitioners identify individuals at risk of tuberculosis/latent tuberculosis infection, refer for testing and follow-up treatment.
Objective: We explored general practitioners’ knowledge and practices on latent tuberculosis infection.
Methods: Randomly selected general practitioners in a municipality in Havana answered a self-administered questionnaire that assessed their knowledge on 19 essential latent tuberculosis infection concept and management items. General practitioners having managed tuberculosis/latent tuberculosis infection answered six questions on practices.
Results: Among 62 general practitioners, 24% had managed tuberculosis and 20% latent tuberculosis infection cases. Overall, respondents correctly identified a median of 12 of the 19 knowledge items. There was no association between knowledge and general practitioners’ characteristics. Still, only 31% and 26% mentioned tuberculosis contacts as high-risk group and correctly conceptualised latent tuberculosis infection, respectively. On average, general practitioners discerned 3 out of the 5 items related to test execution for latent tuberculosis infection diagnosis and 2 out of the 4 on the indication of TST testing, but only 11% and 3% ascertained all the corresponding items. Respondents determined on average 2.5 of 4 items on isoniazid as preventive drug, with 14% working out all 4. Among general practitioners having managed tuberculosis/latent tuberculosis infection, 87% reported supervising isoniazid administration and 53% declared that patients not always completed treatment.
Conclusions: Tuberculosis elimination poses challenges to the health system: as incidence declines knowledge of the disease and its management dwindles, as illustrated here for latent tuberculosis infection. Continuous, effective training and improving communication between the different levels of care and the Tuberculosis program are needed.
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