Since 2016, 715 Coloradans have had a Centers for Disease Control and Prevention-confirmed case of active tuberculosis. Many of these cases could have been prevented by treating patients’ latent tuberculosis infection (LTBI) before it progressed to contagious, active tuberculosis disease. The care cascade for LTBI includes 1) chest x-ray completion, 2) treatment initiation, and 3) treatment completion. Patient navigators assist patients throughout the care cascade by identifying barriers to care, connecting patients to resources, and providing education and helpful reminders. We sought to explore the association between receiving LTBI-focused navigation and failure to progress along the LTBI care cascade.
Methods:
This project took place at a safety-net health system in Denver, Colorado between October 1, 2023 and September 30, 2025. Among 1,136 primary care patients with positive interferon-gamma release assay, we randomized 50% (n=566) to receive LTBI-focused care navigation and 50% (n=570) to receive standard clinic care. We used multivariable log-binomial regression modeling that accounted for clinic-level clustering to compare chest x-ray noncompletion, treatment non-initiation, and treatment noncompletion among patients with LTBI receiving LTBI-focused care navigation and those receiving standard clinic care.
Results:
We found that patients receiving care navigation had a significantly decreased risk of chest x-ray noncompletion [adjusted risk ratio (aRR) = 0.90, 95% confidence interval (CI) 0.86-0.95, p
