Tuberculosis

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Worldwide, tuberculosis (TB) kills 2 million people each year (World Health Organization). Two billion people, one in three worldwide, are infected with latent tuberculosis (LTBI). While rates of active tuberculosis are on the decline in the United States, the percentage of cases in the foreign-born has been increasing steadily since the mid-1980s. In 1999, the United States had 17,531 reported TB cases, of which 44% were in the foreign-born. In New York City, over one half of the tuberculosis cases (834/1439) are now in the foreign-born. Chinese, Haitian, Dominican and Ecuadorian immigrants account for the greatest number of cases.

Among the factors responsible for the high TB rates in immigrants are: 1) high prevalence of TB in the countries of origin, and 2) lack of adequate screening, preventive therapy and follow-up after their arrival in New York.

An alarmingly low percentage of immigrants and refugees complete PPD screening, and, of those who do and have significant results, only a small percentage receives appropriate follow-up and preventive therapy.

In response, the Center for Immigrant Health, in collaboration with the community and the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, has developed and implemented the "Community Tuberculosis Prevention Program" (CTPP). CTPP fights latent TB infection (LTBI) in New York City's foreign-born population. Initiated in conjunction with four community-based organizations, Community Association for Progressive Dominican (ACDP), Church Avenue Merchant Block Association (CAMBA), Haitian Women's Program (HWP), and African Services Committee, CTPP provides outreach, education, screening and intensive case management in the community.

The Center trains and supervises bilingual and bicultural outreach workers who identify and screen persons with no prior contact with the health care system. Outreach workers build a bridge between the immigrant client and the provider. Often times, people receiving TB treatment need help and support in successfully completing their regimen. Through CTPP, participants receive case management and other support services in their native languages. They are given incentives such as food certificates, movie tickets, and transit tokens. CTPP is an important community-based resource for immigrant patients with TB infection. It provides linkages with free, confidential TB services and is tailored to the particular needs of the various immigrant communities.

CTPP is currently in its sixth year of operation. We have educated, to date, approximately 35,500 individuals about TB, screened 17,000, referred 5,000 for medical evaluation, and identified and facilitated treatment of 43 people with active TB disease. Approximately 700 people are currently on preventive therapy, and 1048 have already completed a full course of INH prophylaxis. Through CTPP, approximately 350 persons complete INH treatment of LTBI each year. Many of these clients are recent immigrants with no prior access to the health care system.

CTPP has recently added a social marketing component for health care providers serving immigrant communities. Practitioners receive intensive education about screening for, and treatment of, latent tuberculosis infection (LTBI). This important complementary activity will increase the numbers of immigrants who receive appropriate tuberculosis education, screening and treatment.

The Center has assembled a highly qualified team to develop and implement customized TB and other health programs to serve the health and access needs of persons born outside of the United States.