80% of active tuberculosis cases in the U.S. originate from reactivated latent TB infection (LTBI), but existing LTBI treatments often face poor patient compliance. The standard protocols—3HP, 4R, 3HR, and 6-9H—demand months of daily or weekly dosing, while social obstacles like limited healthcare access, unstable housing, and communication gaps further hinder adherence. A newer alternative, 1HP (a one-month daily regimen combining isoniazid and rifapentine), demonstrated effectiveness in clinical trials but remains underutilized despite World Health Organization approval. Its shorter duration and comparable tolerability could help overcome some of these challenges, particularly for those affected by social determinants of health.
Research led by Starke and colleagues analyzed 1HP performance in real-world conditions across three clinics under the Cook County Department of Health between January 2024 and May 2025. The analysis covered 225 patients who began LTBI treatment after testing positive via IGRA or TST, with active TB ruled out through microbiological and radiographic assessments. Treatment assignments considered comorbidities, drug interactions, and patient preference, while follow-up occurred via telehealth every 2-4 weeks and monthly thereafter to track adherence, tolerability, and medication refills.
The study’s main objective was treatment completion, confirmed through medication receipt and patient reports. Of the 225 participants, 71% finished their regimen. Completion rates differed by protocol: 64% for 1HP versus 72% for other options. New immigrants—39% of the group—showed lower completion (58%). Adverse effects appeared in 41% of 1HP patients compared to 25% in others, though only one 1HP participant stopped treatment due to side effects. Adherence at the final check-in reached 82% for 1HP compared to 78% for alternative regimens.
Real-world 1HP results show mixed but promising outcomes
These results reflect broader trends in LTBI management. While 1HP matched longer regimens in completion rates, its reduced duration and fewer drug interactions—rifapentine interacts less than rifampin, could improve practicality for patients with limited access. However, the absence of directly observed therapy (DOT), driven by staffing shortages, may have lowered reported completion figures. The study’s small 1HP sample (22 patients) also limits strong conclusions.
Nursing follow-up played a decisive role: patients who engaged with telehealth support were more likely to complete treatment. This highlights how structured monitoring can address barriers such as language difficulties or housing instability. The study also found that 78% of treatment interruptions stemmed from missed follow-ups rather than side effects, a pattern observed in other LTBI programs. For new immigrants, who often face additional challenges like unfamiliarity with healthcare systems, 1HP’s shorter duration might help mitigate some obstacles, though the single-county focus restricts broader application.
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Unlike earlier studies conducted in controlled settings, this research marks the first evaluation of 1HP in a high-migration population. Previous trials confirmed its effectiveness under ideal conditions, but real-world data, especially in vulnerable groups, remain limited. The findings suggest 1HP could bridge gaps where longer treatments fail, provided it is paired with improved follow-up systems. Rifapentine’s drug-interaction profile also makes it safer for patients on concurrent medications, a frequent issue in LTBI care.
Study limitations call for broader testing and support
The study’s constraints, small sample size, lack of DOT, and single-department scope, emphasize the need for larger, prospective trials. Despite these limitations, the data support 1HP as a practical alternative, particularly in settings where adherence is already weak. With additional evidence, it could transform LTBI treatment, easing patient burdens and reducing reactivation risks.
The study’s reliance on self-reported adherence also raises questions about the accuracy of patient-tracked medication use, a common issue in non-DOT settings.
Overall, the findings demonstrate that LTBI treatment extends beyond clinical considerations. While 1HP provides a shorter, more tolerable option, its effectiveness depends on overcoming systemic barriers that prevent patients from finishing care. The data indicate that with enhanced follow-up and wider adoption, 1HP could help reduce reactivation risks, especially in high-risk communities.
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