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.

Arun Janakiraman, MD; Franklin Yates, MD; Anna Headly, MD; Darren R. Linkin, MD, MSCE; Christopher Vinnard, MD; Medicine, Cooper University Hospital, Camden, NJ; Infectious Diseases, Drexel University College of Medicine/ Hahnemann University Hospital, Philadelphia, PA; Cooper University Hospital, Camden, NJ; University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA

e14175 Background: Colorectal cancer is the third cause of cancer death in the U.S., yet only 53% of adults over 50 are screened. Rates for minorities and patients without a high school education are lower. Colonoscopy may prevent 65% of cancers; identifying obstacles to screening could save lives. Our objective was to investigate obstacles and improve screening in Camden, NJ, a city that is 95% minority, only half of adults have completed high school, and 44% of families live below poverty level. Methods: In coordination with the American Cancer Society and Horizon Medicaid, we obtained data on Horizon enrollees at a primary care practice of Cooper University Hospital in Camden. All patients 50 and above with no insurance claims for screening in the last 10 years were included. 92 patients met criteria. We attempted to contact each by phone (via interpretation service if Spanish speaking). A standardized template was used to explain benefits of screening, ask for reasons for not having screening, offering transportation to the procedure, and asking if they were willing to have a colonoscopy. Patients who agreed were scheduled for colonoscopy. Results: 92 patients were identified. 30 could not be contacted after 3 attempts. Of 62 contacted, 12 agreed to colonoscopy; 25 stated they had already had screening; and 25 declined. Of 12 who agreed, reasons for not having had screening were: lack of awareness (6 patients, 5 Spanish speaking); not having transportation (3, 1 Spanish); and simply having put it off (3). Of 25 who declined, reasons were: desire to schedule themselves (8); the subject was too uncomfortable (4); mistrust of doctors (1); and being too scared (1). 10 (7 Spanish) gave no reason, and 1 had moved. Conclusions: Obstacles identified to colorectal screening were 1) lack of awareness (50% of patients who agreed to procedure); 2) transportation (25% of patients who agreed); 3) language barriers (83% of those who were unaware of recommendations were Spanish speaking); 4) fear/mistrust (8%); and 5) having lost contact with the system (33%). Efforts toward increasing screening should be targeted accordingly. We acknowledge the ACS and the Walmart Foundation for their participation and support. Findings and conclusions do not necessarily represent the views of ACS and the Walmart Foundation.