Attitudes Towards Latent Tuberculosis Among Physicians in Training: The Role of BCG Vaccination

Prior work has demonstrated that international medical graduates physicians are less likely to recommend treatment of latent tuberculosis infection (LTBI) for themselves or their patients. Our objective was to measure differences in LTBI treatment attitudes among resident physicians when diagnosis is established with a positive tuberculin skin test (TST), as compared with a positive interferon gamma release assay (IGRA), and to determine whether a resident physician’s personal history of Bacillus Calmette–Guerin (BCG) vaccination was associated with these attitudes. We conducted a cross-sectional survey of Internal Medicine resident physicians at two different training sites. Based on the country and year of birth, each respondent was assigned a putative BCG vaccination status based on a query of the BCG World Atlas (bcgworldatlas.​org). We then asked whether the respondent agreed or disagreed with offering LTBI treatment in several clinical scenarios. Among their patients with a history of BCG vaccination, we found that resident physicians were least likely to agree with LTBI treatment for a first-ever positive TST, and most likely to agree with treatment for a converted IGRA. Contrary to our hypothesis, a resident physician’s personal history of BCG vaccination was not associated with their LTBI treatment attitudes. Resident physicians broadly disagreed with LTBI treatment guidelines from the Centers for Disease Control and Prevention. Educational interventions designed to improve adherence to LTBI treatment recommendations should be broadly implemented, without regard to the educational or cultural backgrounds of physician.