The cascade of care for latent tuberculosis infection in Malaysia: a cohort analysis

This study aimed to examine the cascade of care for individuals with latent tuberculosis infection (LTBI) in Malaysia and explore the determinants of non-initiation and non-completion of tuberculosis preventive treatment (TPT). A retrospective cohort study was conducted using the national LTBI surveillance database, including all individuals diagnosed with LTBI from 2021 to 2022. LTBI was diagnosed based on a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA). Logistic regression analyses were performed to examine the determinants of TPT non-initiation and non-completion. Of the 10,820 individuals diagnosed with LTBI, 7,516 (69.5%) initiated TPT; of these, 5,169 (68.8%) completed TPT. Healthcare workers had higher odds of TPT non-initiation (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.10–1.47). Conversely, those aged < 18 years (aOR, 0.78; 95% CI, 0.68–0.88), aged ≥ 65 years (aOR, 0.71; 95% CI, 0.57–0.87), history of TB contact (aOR, 0.49; 95% CI, 0.43–0.56), and diabetes mellitus (aOR, 0.56; 95% CI, 0.39–0.78) had lower odds of non-initiation. Non-Malaysians had increased odds of non-initiation (aOR, 2.89; 95% CI, 2.38–3.52) and non-completion (aOR, 1.48; 95% CI, 1.04–2.08). Individuals who tested only TST-positive also had increased odds of non-initiation (aOR, 2.29; 95% CI, 2.08–2.51) and non-completion (aOR, 1.42; 95% CI, 1.24–1.61) compared to those who underwent IGRA testing. Finally, individuals in congregate settings had lower odds of non-initiation (aOR, 0.10; 95% CI, 0.03–0.23) and non-completion (aOR, 0.30; 95% CI, 0.14–0.56). This study estimated that two-thirds of individuals with LTBI initiated TPT, and that two-thirds of those who initiated TPT completed it. The identified determinants offer evidence to inform future efforts to improve LTBI programmatic management.