The 12-dose regimen (3HP) Experience from Seattle & King County, WA Masa Narita, MD

Background The population of King County: 1.9 million Active TB cases: cases/yr Foreign-born cases: over 80% Homeless: a challenging group for TB control (one night count: 8000) A large TB outbreak: initially detected in 2002 –67 cases in the first 2 years. The strain still seen Seattle: a site of TBTC Study 26 (PREVENT TB study)

Roll-out of the 12-dose regimen Idea: shorter process for diagnosis and treatment of LTBI –Use of QFT followed by the use of 12-dose regimen Partners: homeless shelter and day- service agencies

It takes a village… Besides augmenting partnership, support and commitment of the TB program were essential. –Medical providers, nurses, medical assistants, outreach workers, and database (and more) –Adverse events monitoring

Two cases of hepatitis 59 yo male, close contact of smear-positive pulmonary TB Baseline: GOT 45, GPT 80, T.Bili 1.2 He reported that he had nausea, fever/chills, and body aches x one day after the 3 rd dose. He was asymptomatic on the day of the 4 th dose. GOT 178, GPT 201, T. Bili 0.6. Rx d/c’d. A week later, GOT 107, GPT 157, T. Bili 0.6, HBsAg negative, HBcAb IgM positive, A& C negative (alk phos remains normal)

Another case of hepatitis 46 yo male, close contact, Hep C positive Baseline GOT 32, GPT 42 The first month: LFT normal 2 days after the 9 th dose, he complained of dark urine (no other symptoms) GOT 596, GPT 154, Rx d/c’d. 4 days later, 149/119 Then one week later 39/62