***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Few studies have examined predictors of latent tuberculosis infection ( LTBI ) treatment completion in inner city population s in the United States . OBJECTIVE To assess LTBI treatment completion rates and predictors in an inner city cohort . METHODS Data from control groups of two sequentially conducted r and omized controlled trials of LTBI treatment were analyzed for treatment completion rates . Participants in Study A ( n = 191 ) , conducted in 1996 - 1999 , self administered daily isoniazid ( INH ) for 6 - 12 months , while participants in Study B ( n = 123 ) , conducted in 2002 - 2005 , self administered daily INH for 9 months . RESULTS Overall , 44.6 % of participants completed therapy , with significantly higher completion rates in Study B than Study A ( 37.0 % vs. 56.1 % , P = 0.001 ) . Marriage and alcohol use were significant predictors of completion ( aOR = 2.153 , 95%CI 1.301 - 3.562 ) and non-completion ( aOR = 0.530 , 95%CI 0.320 - 0.877 ) , respectively ; multivariate analysis indicated increased completion among married persons of foreign birth and among alcohol users who were homeless . Knowledge of and attitudes to tuberculosis were not significant predictors . CONCLUSIONS The design provided an opportunity to assess predictors of  LTBI treatment completion in this inner city population . Social circumstances were the strongest predictors of treatment completion , suggesting that tangible social services may be more effective than educational programs in encouraging treatment completion BACKGROUND Drug users are at increased risk for latent tuberculosis infection ( LTBI ) and also at increased risk for noncompletion of medication regimens for treatment of LTBI or tuberculosis disease . Directly observed therapy ( DOT ) provided by outreach workers , the use of incentives , or both have been suggested as a means to increase adherence . OBJECTIVE To compare the independent and combined effects of monetary incentives and outreach worker provision of DOT for LTBI treatment in a sample of active drug users . METHODS The research design was a r and omized controlled trial in a community outreach program setting . Participants consisted of a volunteer sample of 163 active injection drug and crack cocaine users placed on twice weekly DOT .  Condition 1 of the interventions consisted of provision of DOT by an outreach worker at a location chosen by the participant ( active outreach ) and a $ 5 per visit incentive . Condition 2 was comprised of active outreach with no monetary incentive , and Condition 3 , provision of DOT at the study community site and a $ 5 per visit incentive . The main outcome measures were percentage of medication taken as prescribed and completion of medication regimen . RESULTS The percentage of prescribed medication taken was higher for those who received incentives , either with ( 71 % ) or without ( 68 % ) active outreach , compared to those who received active outreach alone ( 13 % ) . Only 4 % of participants assigned to Condition 2 completed treatment , compared to 53 % of Condition 1 participants , and 60 % of Condition 3 participants . CONCLUSIONS Monetary incentives were clearly superior to active outreach . Active outreach in combination with monetary incentives did not increase adherence over incentives alone BACKGROUND Cases of severe and fatal liver injury were reported after a 2-month course of rifampin-pyrazinamide therapy was recommended in 2000 as an alternative to isoniazid for treatment of latent tuberculosis infection . We estimated rates of rifampin-pyrazinamide-associated liver injury and compared these with historical rates for isoniazid . METHODS We conducted a survey of state and city tuberculosis programs and other health care setting s in the United States where  rifampin-pyrazinamide was prescribed . The number of rifampin-pyrazinamide therapy initiations was collected , as well as the number of occurrences of ( 1 ) asymptomatic aspartate aminotransferase serum concentration > 5 times the upper limit of normal , ( 2 ) symptomatic hepatitis ( in which the patient was not hospitalized ) , ( 3 ) hospitalization for liver injury , ( 4 ) death with liver injury , and ( 5 ) treatment completion . We also search ed a national pharmacy cl aims data base ( Verispan ) . Rates of these events were calculated . RESULTS Among 139 programs , 110 ( 79 % ) responded ; 87 ( 79 % ) had initiated rifampin-pyrazinamide therapy for a total of 8087 patients between January 2000 and June 2002 .  Rates per 1000  rifampin-pyrazinamide therapy  initiations during this period were 25.6 ( 95 % confidence interval [ CI ] , 22.3 - 29.3 ) for asymptomatic aspartate aminotransferase level > 5 times the upper limit of normal and 18.7 ( 95 % CI , 15.9 - 21.9 ) for hepatitis . Seven fatalities and 23 hospitalizations occurred , with rates of 0.9 ( 95 % CI , 0.4 - 1.9 ) and 2.8 ( 95 % CI , 1.8 - 4.3 ) per 1000 rifampin-pyrazinamide therapy initiations , respectively . Of 8087 patients , 64 % completed rifampin-pyrazinamide therapy . The Verispan search revealed 1  rifampin-pyrazinamide-associated hospitalization ( 2.9 hospitalizations per 1000 rifampin-pyrazinamide therapy initiations ; 95 % CI , 0.1 - 18.4 ) and no deaths . Articles on the use of isoniazid therapy for latent tuberculosis infection that were published after 1990 reported fatality rates of 0.0 - 0.3 deaths per 1000 persons . CONCLUSIONS Rates of liver injury , hospitalization , and death associated with rifampin-pyrazinamide therapy exceed rates reported for isoniazid therapy . Because earlier r and omized trials of rifampin-pyrazinamide lacked adequate statistical power to detect fatal events , the Centers for Disease Control and Prevention recommends that rifampin-pyrazinamide generally should not be used for treatment of latent tuberculosis infection SETTING Few studies have examined strategies for optimizing adherence to latent tuberculosis infection ( LTBI ) treatment programs in homeless population s. OBJECTIVES 1 ) To compare the effectiveness of an intervention program employing nurse case management and incentives ( NCMI ) vs. a control program with st and ard care and incentives on completion of LTBI treatment ; and 2 ) to compare the impact of the two programs on tuberculosis ( TB ) knowledge among participants . DESIGN A prospect i ve , two-group site-r and omized design conducted among 520 homeless adults residing in the Skid Row region of Los Angeles from 1998 to 2003 , assessing completion rates of a 6-month isoniazid ( INH ) treatment program and change in TB knowledge . RESULTS Using intent-to-treat analysis , 62 % of participants in the intervention program , compared with 39 % of controls , completed the full 6-month course of LTBI treatment with INH . Logistic regression modeling revealed that intervention participants had three times greater odds of completing INH treatment than controls . TB knowledge improved in both programs , but the increase was greater among the intervention participants ( P < 0.001 ) . CONCLUSIONS Nurse case management combined with education , incentives , and tracking dramatically improves both adherence to LTBI treatment and TB knowledge in homeless persons compared to a st and ard approach of outreach and incentives BACKGROUND A 9-month course of isoniazid monotherapy is currently recommended for the treatment of latent tuberculosis infection ( LTBI ) and has been shown to be effective in both children and adults . Reduced compliance with this regimen has forced physicians to explore shorter regimens . The aim of this study was to compare 3- and 4-month combination regimens of isoniazid plus rifampin with a 9-month regimen of isoniazid monotherapy for the treatment of LTBI in children . METHODS This prospect i ve , r and omized , controlled study was conducted over an 11-year period ( 1995 - 2005 ) . In period 1 ( 1995 - 1998 ) , 232 patients received isoniazid therapy for 9 months ( group A ) , and 238 patients received isoniazid and rifampin for 4 months ( group B ) . In period 2 ( 1999 - 2002 ) , 236 patients were treated with isoniazid and rifampin for 4 months ( group C ) , and 220 patients received the same regimen for 3 months ( group D ) . All patients were observed for > or = 3 years . RESULTS Overall compliance with treatment was good , but patients who received isoniazid monotherapy were less compliant than were those who received short-course combination therapy ( P=.011 , for group A vs. group B ; P=.510 , for group C vs. group D ) . No patient in any group developed clinical disease during the follow-up period . New radiographic findings suggestive of possible active disease were more common in patients who received isoniazid monotherapy ( 24 % ) than in those treated with shorter regimens ( 11.8 % , 13.6 % , and 11 % for groups B , C , and D , respectively ; P=.001 for group A vs. group B ; P=.418 for group C vs. group D ) . Serious drug-related adverse effects were not detected . CONCLUSIONS Short-course treatment with isoniazid and rifampin for 3 - 4 months is safe and seems to be superior to a 9-month course of isoniazid monotherapy Background Treatment of latent tuberculosis infection ( LTBI ) is a key component in U.S. tuberculosis control , assisted by recent improvements in LTBI diagnostics and therapeutic regimens . Effectiveness of LTBI therapy , however , is limited by patients ’ willingness to both initiate and complete treatment . We aim ed to evaluate the demographic , medical , behavioral , attitude-based , and geographic factors associated with LTBI treatment initiation and completion of persons presenting with LTBI to a public health tuberculosis clinic . Methods Data for this prospect i ve cohort study were collected from structured patient interviews , self-administered question naires , clinic intake forms , and U.S. census data . All adults ( > 17 years ) who met CDC guidelines for LTBI treatment between January 11 , 2008 and May 6 , 2009 at Wake County Health and Human Services Tuberculosis Clinic in Raleigh , North Carolina were included in the study . In addition to traditional social and behavioral factors , a three-level medical risk variable ( low , moderate , high ) , based on risk factors for both progression to and transmission of active tuberculosis , was included for analysis . Clinic distance and neighborhood poverty level , based on percent residents living below poverty level in a person ’s zip code , were also analyzed . Variables with a significance level < 0.10 by univariate analysis were included in log binomial models with backward elimination . Models were used to estimate risk ratios for two primary outcomes : ( 1 ) LTBI therapy initiation ( picking up one month ’s medication ) and ( 2 ) therapy completion ( picking up nine months INH therapy or four months rifampin monthly ) . Results 496 persons completed medical interviews and question naires addressing social factors and attitudes toward LTBI treatment . 26 % persons initiated LTBI therapy and 53 % of those initiating completed therapy . Treatment initiation predictors included : a non-employment reason for screening ( RR 1.6 , 95 % CI 1.0 - 2.5 ) , close contact to an infectious TB case ( RR 2.5 , 95 % CI 1.8 - 3.6 ) , regular primary care(RR 1.4 , 95 % CI 1.0 - 2.0 ) , and history of incarceration ( RR 1.7 , 95 % CI 1.0 - 2.8 ) . Persons in the “ high ” risk category for progression/transmission of TB disease had higher likelihood of treatment initiation ( p < 0.01 ) , but not completion , than those with lower risk . Conclusions Investment in social support and access to regular primary care may lead to increased LTBI therapy adherence in high-risk population Context Guidelines from the American Thoracic Society and Centers for Disease Control and Prevention for treating latent tuberculosis infection advocate 2 months of rifampin plus pyrazinamide as an effective alternative to 6 to 9 months of isoniazid or 4 months of rifampin . However , case reports have described severe liver injury in patients who were receiving the 2-month regimen . Contribution This nonr and omized , open-label trial found that the risk for grade 3 or 4 liver injury was higher in patients taking 2 months of  rifampin plus pyrazinamide ( 7.7 % ) than in patients taking 6 months of isoniazid ( 1 % ) . Clinical Implication s If clinicians use the short-course regimen , they should vigilantly follow patients ' liver enzyme levels . The Editors As rates of tuberculosis cases in the United States have decreased ( 1 , 2 ) , the focus of prevention and control efforts has shifted toward identification and treatment of persons with latent tuberculosis infection who are at increased 
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A positive effect on completion was noted in intervention studies that used short regimens and social interventions ; mixed results were found for intervention studies that used DOT or incentives .
Conclusion LTBI treatment completion can be improved by using shorter regimens and social interventions .