Assessing the tuberculosis (TB) screening compliance rates and treatment completion among international students at the University of Kentucky

Background: Tuberculosis early screening and diagnosis are cost-effective strategies for infection control. Tuberculosis elimination which is aimed for 2030 requires that both latent tuberculosis and active disease be fully treated. This study measures the tuberculosis screening rates and treatment completion rates among the international students at the University of Kentucky between 2016 and 2018.Methods: This retrospective cohort study included all J1 and F1 student visa holders enrolling from 2016 fall to 2017 fall. To accommodate the nine months treatment completion, the cohort period overlapped to 2018. Data were provided by the University Health Services and the sample size was 645 students. Screening rates and treatment completion rates were determined using Stata version 15 software. Bivariate analysis using chi-squared tests was done to study associations between rates and gender or program of study.Results; The screening rate was 74% of all those eligible, n=645.Rates were higher in 2016 than 2017, 72.8% and 56.3% respectively. Health colleges screened less than the non-health colleges. Among the two testing methods, tuberculin skin test (TST) and interferon gamma release assay (IGRA), the IGRA reported more students indicating that the majority of international students come from high TB risk countries. Treatment acceptance and completion were very low of all the 64 students recommended for treatment. Only 11 students initiated, and completion rate was 3%. Conclusion; The study reported 74% screening rates and very low treatment completion rates indicating barriers in the care cascade. Among the identified potential barriers is the financial costs of doing the blood test,$89 which is not covered by the student health plan. Lack of treatment options especially the short course regimens, may have a significant contribution to the low treatment completion rates. There is need for the University of Kentucky to invest financially toimprove the student health plan benefits. This will ensure that the shorter regimens are available as options leading to improved rates.