Latent Tuberculosis Infection Care

to the editor—We note with interest the article from Holzman et al [1], which is an important and clinically useful piece not only for the United States (US) but also many other countries with low tuberculosis (TB) incidence and latent TB infection (LTBI) screening programs. We applaud their endeavors using large-scale, “real-world” public health LTBI data collection, collation, and analysis, and believe this needs to be replicated elsewhere. We would be interested to have the authors comment on the following: Though the stated study objective was to quantify the “LTBI care cascade … and identify factors associated with failure to complete each cascade step,” only limited data were presented on those associated with loss at every step. We appreciate, and the authors acknowledged, the difficulty of assessing the impact of more than demographic and clinical factors, such as potentially modifiable within-system factors, yet they could report these from one site with a particularly high proportion of preemployment assessments. Might it be possible to obtain these for other populations and study sites, and so improve the applicability of their findings for other public health services elsewhere? This would be particularly helpful in regard to their data on homeless individuals, who had very low levels of treatment initiation and completion.