Supervised preventive therapy for latent tuberculosis infection in illegalimmigrants in Italy

In a multicenter, prospective, randomized, open-label study of isoniazid-pr eventive therapy (IPT) for latent tuberculosis infection, illegal immigrant s from countries where tuberculosis is highly endemic were enrolled at two clinical sites in Northern Italy. Of 208 eligible subjects, 82 received sup ervised IPT at a dose of 900 mg twice weekly for 6 mo (Regimen A), 73 recei ved unsupervised IPT 900 mg twice weekly for 6 mo (Regimen B), and 53 recei ved unsupervised IPT 300 mg daily for 6 mo (Regimen C). Supervised IPT was delivered at either one tuberculosis clinic or one migrant clinic. The prob ability of completing a 26-wk regimen was 7, 26, and 41% in Regimens A, B, and C, respectively (p < 0.005, Log-rank test calculated using Kaplan-Meier plots). The mean time to dropout was 3.8, 6, and 6.2 wk in Regimens A, B, and C, respectively (p = 0.003 for regimen A versus either Regimens B or C) . Treatment was stopped in five subjects (2.4%) because of adverse events. The rate of completion of preventive therapy for latent tuberculosis infect ion among illegal immigrants was low. Supervised, clinic-based administrati on of IPT significantly reduced adherence. Alternative strategies to implem ent preventive therapy in illegal immigrants are clearly required.