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Role-play Demonstration

Latent Tuberculosis: Adherence to Preventive Treatment

infectious-diseaseOutpatient ClinicTreatment Discussionintermediate

Your Role — Doctor

Infectious Diseases Clinic

Your 40-year-old patient screened positive for latent tuberculosis (TB) after contact tracing. They feel completely well and are reluctant to take several months of preventive antibiotics for an infection with no symptoms. You need to explain latent TB, why treatment is recommended, address concerns about side effects and duration, and support adherence.

  • •Explain the difference between latent and active TB in plain terms — the patient carries dormant bacteria but is not ill or infectious now.
  • •Explain why preventive treatment is recommended: to stop it 'waking up' into active, infectious TB in the future.
  • •Explore and address the patient's reluctance to take medication when they feel well, and concerns about duration and side effects.
  • •Explain the treatment practicalities (course length, monitoring for liver effects, avoiding alcohol excess, what side effects to report).
  • •Agree a shared plan that supports adherence (reminders, follow-up, contact point) and check understanding.

The Interlocutor

Played by the actor / assessor

You are 40 and were tested after a colleague was diagnosed with TB. You feel perfectly healthy and were surprised to be told you carry the infection. You don't like taking medication, especially for months, when you have no symptoms, and you've heard TB tablets can affect the liver.

  • •Say you feel completely well and don't see the point of taking medicine for something that isn't making you ill.
  • •Ask whether you're infectious and whether your family is at risk.
  • •Express reluctance about taking tablets for several months and worry about side effects, especially the liver.
  • •Ask whether you could just wait and only treat it if you actually get ill.
  • •If the doctor explains the risks and benefits clearly and offers monitoring and support, agree to start the preventive course.

Sample Role-play

0:00Listen to a model performance · 0:00
Doctor

Hello Ms Adeyemi, I'm Dr Grant. Thanks for coming in to talk about your test results after the contact screening. How much do you know about what the test showed?

Introduce, signpost, and check baseline understanding.
Patient

Just that something came back positive for TB. But I feel totally fine, so I don't really understand it.

Doctor

That makes sense, and it's good that you feel well. What you have is called latent TB. It means some TB bacteria are in your body but they're dormant — asleep. You're not ill, and importantly you're not infectious, so your family is not at risk right now. It's quite different from active TB, where people are unwell and can pass it on.

Explain latent vs active TB clearly and directly reassure about the family's safety.
Patient

So if I'm not ill and can't pass it on, why do I need to take anything?

Doctor

That's a really fair question. The concern is the future: in some people those dormant bacteria can 'wake up' later — sometimes years on — and turn into active TB, which does make you ill and infectious. Taking a preventive course now greatly lowers that chance. It's a bit like fixing a small leak before it becomes a flood.

Give the clinical rationale using an accessible analogy rather than just instructing.
Patient

Months of tablets though, when I feel fine? And don't TB drugs damage your liver?

Doctor

You've clearly done some reading, which is great. It is a few months, and I won't pretend that's nothing. The medicine can occasionally affect the liver, so we check your blood tests before and during treatment, and we'd ask you to avoid heavy drinking and to report things like yellowing of the eyes, dark urine, or feeling sick. For most people it's very well tolerated.

Acknowledge the burden honestly, address the liver concern with a concrete monitoring plan and red flags.
Patient

Couldn't I just wait, and only treat it if I actually become ill?

Doctor

You could in theory, but active TB is a much bigger deal — a longer, more intensive treatment, time off work, and a risk of infecting people you love before it's even diagnosed. Preventing it now is far simpler and safer. That said, it's your choice, and I'd like to help you make the one that's right for you.

Compare the alternatives honestly to inform the decision while respecting autonomy.
Patient

When you put it that way, prevention sounds better. But I know I'll forget to take them.

Doctor

That's a common and honest concern — let's build in support. We can set up phone reminders, link the tablets to a daily routine like brushing your teeth, and I'll give you a clear plan. You'll also have a nurse as a point of contact, and we'll review you regularly. Would you be willing to start?

Normalise adherence difficulty and offer concrete practical support before asking for commitment.
Patient

Yes, okay. If you're monitoring me and I've got someone to call, I'll do it.

Doctor

That's a really sensible decision. We'll do a baseline blood test, start the course, and I'll book your reviews. Call the nurse if any of those warning signs appear or if side effects bother you. Thank you for thinking it through so carefully.

Confirm the plan, reiterate safety-netting, and affirm the patient's engagement.

Useful Phrases

“Latent TB means the bacteria are in your body but dormant — you're not ill and not infectious.”
“In some people it can 'wake up' into active TB years later — treatment now greatly lowers that chance.”
“It's a bit like fixing a small leak before it becomes a flood.”
“We check your liver with blood tests before and during treatment, and you'd report yellowing of the eyes or dark urine.”
“Let's build in reminders and link the tablets to a daily routine so they're easier to remember.”

Clinical Background

Latent TB infection (LTBI) is asymptomatic, non-infectious, and detected by IGRA or tuberculin skin test, usually via contact tracing or pre-immunosuppression screening. Preventive treatment (e.g., isoniazid plus rifampicin for 3 months, or isoniazid for 6 months) substantially reduces progression to active TB. Monitor for hepatotoxicity (baseline and periodic LFTs), counsel on alcohol and hepatitis red flags. Adherence is the main challenge given the asymptomatic state; motivational approaches and practical supports improve completion.

Common Mistakes to Avoid

  • ✕Failing to distinguish latent from active TB, leaving the patient confused about infectiousness and risk.
  • ✕Instructing the patient to take a long course without addressing their reasonable reluctance and side-effect fears.
  • ✕Not building in adherence supports for a lengthy, asymptomatic treatment.