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Electronic Mail (email) Reminders as an Alternative to Directly Observed Therapy (DOT) for the Treatment of Latent Tuberculosis Infection (LTBI) using 12 weeks of Rifapentine and INH (R plus I) for Healthcare Workers (HCWs)

Background. HCWs with LTBI are encouraged to be treated. Obstacles to the initiation and completion of treatment include concerns about the duration (especially 9 months of INH) and about side effects. With the aim of reducing the impact of these issues, MSK introduced the newly endorsed 12-week regimen of once weekly R plus I in January 2013 for HCWs. Additionally, email reminders, urine color checks, and feedback about compliance from MSK's pharmacy were utilized in lieu of DOT.

Methods. Since January 2013, MSK HCWs with LTBI were counseled on 3 available treatment options (INH alone, rifampin alone, or R plus I). Those HCWs who opted for R plus I, were instructed to take the medications every Wednesday for 12 weeks. Email reminders were sent every Tuesday during the treatment period. Complete blood count (CBC), liver function tests (LFTs), and urine color was checked during monthly follow-up visits on Thursdays. Dates of all prescription dispensing were confirmed at MSK's pharmacy. Upon completing treatment, HCWs were asked to complete a post-treatment survey. The study was registered with the MSK IRB.

Results. 26 HCWs with LTBI opted for R plus I and all completed the course. The treatment was well tolerated with no significantly abnormal LFTs and few CBC abnormalities (one patient with mild leukopenia and mild thrombocytopenia and another with mild eosinophilia). Urine was collected starting July 2013 from 16 individuals (48 specimens). 46 urine specimens were orange and 2 specimens were normal (straw) colored. One HCW had run out of medications before the follow-up visit and the other completed treatment a week prior to the scheduled appointment.

26 HCWs responded to the survey, and 100% of responders reported that the email reminders helped them to remember to take the medications. 20 of 26 respondents indicated that the reminders prompted them to take their medications at some point. The MSK pharmacy confirmed that all prescriptions were filled in a timely manner.

Conclusion. Overall the 12-week regimen of R plus I was well tolerated. These findings suggest that in a controlled setting with highly motivated HCWs, email reminders may be an effective alternative to DOT. This may lead to higher acceptance and completion rates of LTBI treatment among HCWs

Disclosures. All authors: No reported disclosures.

Author notes