American Public Health Association, Atlanta, GA, October
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)
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.
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.
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.
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