American Public Health Association, Atlanta, GA, October 2001

Jedlovszky V, Ajayi A, Schicchi JS, Colson P, Hirsch-Moverman Y, El-Sadr W. Physician attitudes about BCG vaccination & treatment for Latent Tuberculosis Infection (LTBI)

Objective: To investigate the attitudes of physicians-in-training on prevention and treatment of latent tuberculosis infection. Physicians trained in other countries may hold attitudes inconsistent with US practices.

Methods: Anonymous survey was distributed among medical house-staff in an inner-city teaching hospital. Questions included participant characteristics: age, gender, level of training, place of primary medical training, history of BCG, PPD status. Assessment of attitudes included questions on protective effect of BCG and LTBI treatment. Scenarios were constructed to test respondents' attitudes toward the need for LTBI treatment for BCG-vaccinated persons with positive PPD. These included a typical patient, immigrant, HIV+, family member, and self.

Results: All participants were foreign medical graduates. Of 67 participants, 73% were male, mean age of 31.3, mean years post-graduation 7.9 (range 3-18), mean years practiced in US 1.8 (range 0-5). 67.7% were PPD+ and 89.6% received BCG vaccine. Regarding attitudes, most (66.7%) believed that BCG offers protection for a short time. Only 54.5% believed that LTBI treatment offers protection against TB and 20.0% felt that LTBI involved more risks than benefits. With the scenarios, most recommended LTBI treatment for BCG-vaccinated patients with positive PPDs (62.7 - 95.5%), with less support for treating family (51.5%) and themselves (45.5%). For recent converters, more than 80% recommended LTBI treatment under all scenarios.

Conclusions: Foreign-trained physicians are cautious about prescribing LTBI treatment except for recent converters. They are less likely to prescribe medications for themselves and family than for others. Education should focus on physician attitudes regarding LTBI treatment and BCG.