Eliminating tuberculosis one neighborhood at a time

J.P. Cegielski, D.E. Griffith, P.K. McGaha, M. Wolfgang, C.B. Robinson, P.A. Clark, W.L. Hassell, V.A. Robison, K.P. Walker and C. Wallace

American Journal of Public Health, 2013, vol. 103, issue 7, 1292-1300

Abstract: Objectives. We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it. Methods. In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project. Results. Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County. Conclusions. Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States. Copyright © 2012 by the American Public Health Association®.

Keywords: isoniazid; tuberculostatic agent, adolescent; adult; African American; article; Caucasian; child; comparative study; demography; disease eradication; female; geographic mapping; Hispanic; human; incidence; lung tuberculosis; male; mass screening; methodology; middle aged; risk factor; statistics; thorax radiography; tuberculin test; United States, Adolescent; Adult; African Americans; Antitubercular Agents; Child; Disease Eradication; European Continental Ancestry Group; Female; Geographic Mapping; Hispanic Americans; Humans; Incidence; Isoniazid; Male; Mass Screening; Middle Aged; Radiography, Thoracic; Residence Characteristics; Risk Factors; Texas; Tuberculin Test; Tuberculosis, Pulmonary; Young Adult (search for similar items in EconPapers)
Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2012.300781_6

DOI: 10.2105/AJPH.2012.300781

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