Project Title: Barriers Associated with TB Medication Adherence Among Chickasaw County Residents with Latent TB Infection

Principal Investigator(s): Alyssa G. Robillard, PhD,1 Nickolas DeLuca, PhD,2 and Wanda Walton, PhD2

Project Dates: September 2002-present

Background: During June 1999-March 2002, a total of 16 tuberculosis (TB) cases were reported from Chickasaw County, Mississippi, corresponding to annual TB incidence rate increases of 20.5 to 27.6 cases per 100,000 population. In comparison, annual TB incidences for Mississippi during the same period decreased from 7.8 to 5.4 cases. Among the 16 TB patients, five had been diagnosed previously with latent TB infection (LTBI) as a result of TB contact investigations. The Mississippi State Department of Health (MSDH) attempted to treat all five patients, but all had either refused or stopped treatment. The patients subsequently progressed to active TB and became sources of infection for an additional 10 TB patients.

Objectives: The objectives of the study were to 1) examine cultural factors that impact patients' perception of TB; 2) understand how health-seeking behaviors and adherence to LTBI treatment are influenced by those perceptions; 3) identify barriers and obstacles to initiating and completing treatment for LTBI; and 4) determine how the identified barriers and obstacles could be overcome to increase the likelihood of initiation and completion of treatment for LTBI.

Target Audience: Patients nonadherent to treatment for LTBI, patients adherent to treatment for LTBI, and TB control staff

Methods:  Three separate focus group discussions were conducted with TB-control staff, patients adherent to treatment for LTBI, and patients nonadherent to treatment for LTBI. The findings from the focus group discussions were analyzed using an ecological perspective.

Results: Focus group participants suggested that the TB control staff's persistence and flexibility helped them adhere to treatment for LTBI, as did the participation of sex- and race-matched community outreach workers. Many participants cited fear of community and family stigma as treatment barriers and identified a need for additional information about the importance of LTBI treatment. To address patient concerns and misconceptions, ongoing individual counseling during treatment for LTBI was initiated. Furthermore, dissemination of TB-related educational messages was recommended to engage community leaders, churches, and civic organizations.

Contact Information:
Nickolas DeLuca, PhD
Chief - Education, Training, and Behavioral Studies Team
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination
1600 Clifton Road, NE, Mailstop E-10
Atlanta, GA 30333

Robillard A, DeLuca N, Walton W. Barriers associated with TB medication adherence among Chickasaw County residents with latent TB infection. January 2003 (Unpublished report)

Transmission of Mycobacterium tuberculosis associated with failed completion of treatment for latent tuberculosis infection - Chickasaw County, Mississippi, June 1999-March 2002: MMWR 2003; 52 (No.11). Available in PDF at

Relative Content:

1 Rollins School of Public Health, Emory University
2 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention