Rhode Island Department of HealthState of Rhode Island
Department of Health
Rhode Island Department of HealthState of Rhode Island
Department of Health
Treatment of latent Tuberculosis Infection (LTBI) greatly reduces the risk that TB infection will progress to disease. Certain groups are at very high risk of developing TB disease once infected. Every effort should be made to begin appropriate treatment and to ensure those persons complete the entire course of treatment for LTBI.
CDC and the National Tuberculosis Controllers Association (NTCA) preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens over 6- or 9-month isoniazid monotherapy. Short course regimens include:
Short-course treatment regimens, like 3HP and 4R, are effective, safe, and have higher completion rates than longer 6 to 9 months of isoniazid monotherapy (6H/9H). Shorter, rifamycin-based treatment regimens generally have a lower risk of hepatotoxicity than 6H and 9H.
If short-course treatment regimens are not a feasible or an available option, 6H and 9H are alternative, effective latent TB infection treatment regimens. Although effective, 6H and 9H have higher toxicity risk and lower treatment completion rates than most short-term treatment regimens.
All treatment must be modified if the patient is a contact of an individual with drug-resistant TB disease. Clinicians should choose the appropriate treatment regimen based on drug susceptibility results of the presumed source case (if known), coexisting medical conditions (e.g., HIV), and potential for drug-drug interactions. Consultation with a TB expert is advised if the known source of TB infection has drug-resistant TB.
Read Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 to learn more about treatment regimens for latent TB infection.
Persons suspected of having TB disease should be referred to the RISE Clinic.
The RISE Clinic is the state-funded TB clinic in Rhode Island. Patients with suspect or confirmed TB disease or LTBI can be referred to the RISE Clinic for specialty care. The RISE Clinic is a referral only clinic; walk-ins and patient self-referrals are not accepted.
To refer a patient to the RISE Clinic, the provider must complete the referral form, confirm the appointment time with the patient, and fax the form to the RISE Clinic. Contact the RISE Clinic to obtain available appointments and facilitate appropriate triage.
The RISE Clinic will triage the patient. If you suspect that the patient has active TB and/or an abnormal chest x-ray, you must speak with the RISE Clinic physician to discuss the case. The RISE staff will then collect any pertinent information so that the patient can be seen as soon as possible.
Directly observed therapy (DOT) is the standard of care for all TB disease cases in the state. Upon receiving a report of a new TB disease case and a prescription from the TB clinician for the case, the TB Program will match the case with a DOT outreach worker based on culture and language needs. Every treatment dose will be administered to the patient under direct observation by the DOT outreach worker.