Latent Tuberculosis Treatment among Hard-to-Reach Ethiopian Immigrants: Nurse-Managed Directly Observed versus Self-Administered Isoniazid Therapy

Hashem Bishara, Manfred Green, Amer Saffouri, Daniel Weiler-Ravell

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The treatment of latent tuberculosis infection (LTBI) among high-risk populations is an essential component of Tuberculosis (TB) elimination. However, non-compliance with LTBI treatment remains a major obstacle hindering TB elimination efforts. We have previously reported high treatment compliance with nurse-managed, twice-weekly, directly observed Isoniazid treatment (DOT) for LTBI among hard-to-reach Ethiopian immigrants (EI's).

OBJECTIVES: to compare rate of completion of treatment, cost, and major adverse drug events with daily self-administered Isoniazid treatment (SAT) to nurse-managed Isoniazid DOT among hard-to-reach EIs.

MATERIALS AND METHODS: We conducted a retrospective study and compared self-administered LTBI treatment outcomes among EIs housed in reception centers during 2008-2012 to EIs treated with DOT.

RESULTS: Overall, 455 EIs were included (231 DOT, 224 SAT) in the study. We found no significant difference in treatment completion rates between the two groups (93.0% DOT vs. 87.9% SAT, p = 0.08). However, cases of grade III, drug-induced hepatitis were significantly fewer and treatment costs were significantly lower with the nurse-managed DOT compared with SAT (0% vs. 2.2%, p = 0.028, 363 vs. 521 United States Dollars, p < 0.001, respectively).

CONCLUSIONS: Nurse-managed, twice-weekly DOT among hard-to-reach EIs housed in reception centers had less severe drug-related adverse events and reduced treatment cost compared with daily isoniazid SAT, yet we found no significant difference in treatment completion between the two strategies in this population.

Original languageEnglish
Article number123
JournalTropical Medicine and Infectious Disease
Issue number2
StatePublished - 16 Feb 2023

Bibliographical note

Funding Information:
This research was partially funded by “The Israel National Institute for Health Policy and Health Services Research (NIHP)”, grant number R/2012/38. The study was a part of the PhD thesis of H.B. at the School of Public Health, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Publisher Copyright:
© 2023 by the authors.


  • cost
  • Ethiopian
  • immigrants
  • latent tuberculosis
  • preventive therapy
  • reception centers
  • treatment
  • treatment completion

ASJC Scopus subject areas

  • Immunology and Microbiology (all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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