Background: Treating Latent tuberculosis infection (LTBI) which is asymptomatic and a reservoir for TB disease is essential to end tuberculosis. This project focused on identifying gaps in programmatic management of LTBI in the state of Maine and the creation of minimum data metrics to serve as a framework for potential quality improvement initiatives. Methods: Participants included Maine Medical Center/TB Clinic, referring primary care sites, their staff, and the Public Health Nursing Central Referral Office. The number of referrals to TB Clinic, number of attendances, number of individuals diagnosed and prescribed with LTBI treatment, number of treatment initiations, number of treatment refusals, number of clients lost to follow-up were retrospectively collected from existing published reports and electronic medical records for 2019. An online survey monkey was used to collect data from partner organizations. Results: A total of 169 LTBI cases were identified where individual were diagnosed and prescribed treatment by Public Health. The level of adherence to LTBI treatment was 38% which is low, but consistent with average rates in the United States. In the online survey staff had adequate knowledge about LTBI (100%) on integration of preventive therapy and TB disease treatment and 80% agreed that follow up after referral is the primary care provider’s responsibility. Identified barriers included lack of a structure, resources, and follow-up systems to ensure optimal outcomes along with lack of recognition of the importance of screening and management of LTBI in the medical community. Most respondents (80%) were supportive of LTBI awareness raising interventions, particularly migrant communities and the screening of new immigrants without delay. Reach scored low for awareness and screening with a lack of data on outreach to at-high risk groups and effectiveness due to lack of a strategic plan and budget. Conclusion: Adequate planning, implementation and evaluation that apply systems thinking, sector wide approach, data and implementation sciences are needed to narrow identified performance gaps. Additional resources are needed in terms of policies, guidelines and human infrastructure for the state’s monitoring and treatment of LTBI. Keywords: latent tuberculosis infection, treatment, cascade of care, gaps, compliance