Physician attitudes regarding bacille Calmette-Guérin vaccination and treatment of latent tuberculosis infection.

OBJECTIVE

To investigate the attitudes of international medical graduates (IMGs) about treatment of latent tuberculosis infection (LTBI).

DESIGN

Anonymous survey among physicians in training, all IMGs from TB endemic countries. Attitudes were assessed through hypothetical scenarios regarding the protective effect of BCG and LTBI treatment.

RESULTS

Of 77 participants, 72.4% were male, the mean age was 31.4 years, and mean years post-graduation 8. Positive tuberculin skin tests (TSTs) were reported among 64.0%, and 89.6% had received BCG vaccine. Over a quarter of IMGs (27.4%) believed that BCG protects for many years. Only 59.2% believed that LTBI treatment was effective and 16% that the risks of treatment were greater than the benefits. Most would treat BCG-vaccinated patients with positive TST in various scenarios (63-94.7%), with less agreement about treating themselves (49.3%) or their family members (54.2%). For recent converters, more than 80% would recommend LTBI treatment. Over half felt that LTBI treatment should be mandatory for new immigrants with positive TST.

CONCLUSIONS

IMGs are cautious about LTBI treatment except for recent converters. They are less likely to treat themselves and family members than others. Educational efforts should address discrepancies between these physicians' attitudes and current guidelines for treating LTBI in the US.