Latent tuberculosis infection screening and treatment outcomes in healthcare workers in Irish hospitals: a multi-centre cohort study.

OBJECTIVE

To evaluate factors associated with positive LTBI screening among HCWs and predictors of treatment initiation and completion across hospital sites in Ireland.

DESIGN

Multicentre retrospective cohort study.

SETTING

Five hospital sites in Ireland.

PARTICIPANTS

N = 755 healthcare workers (HCWs).

METHODS

Evaluation of latent tuberculosis infection (LTBI) by interferon gamma release assay in HCWs from high-incidence countries during 2023, identified via occupational health records. IGRA positivity rates, linkage to treatment and treatment outcomes were recorded. Demographic and occupational factors associated with these outcomes were investigated.

RESULTS

There were n = 755 HCWs from high-incidence TB countries identified via occupational health records eligible for LTBI screening. 719 underwent IGRA testing, of whom 93 (13%) were positive. Age > 50 was associated with IGRA positivity (OR 5.71; 95% CI 1.79-18.17; P = .003). In addition to these n = 93 HCWs, two additional sites provided treatment outcomes for n = 164 HCWs, and a further n = 58 IGRA-positive HCWs were referred to Site 1. Among these 313 IGRA-positive HCWs, 50% initiated therapy, with substantial variation across sites (27%-88%). Multivariable analysis showed study site, but not demographic factors, predicted treatment initiation (P < .001). Common reasons for non-initiation included treatment refusal and non-attendance. Treatment completion was high (82%) and was not associated with study site.

CONCLUSIONS

LTBI prevalence among HCWs in Ireland was lower than international estimates. While treatment initiation was low, completion was high. Treatment initiation varied by site, driven by institutional rather than individual factors. A standardised national programmatic approach is needed for HCWs within the LTBI cascade of care.