The latest research from two Centers for Disease Control and Prevention (CDC) studies looking at the epidemiology of tuberculosis (TB) in the United States was presented at the American Thoracic Society 2007 International Conference on May 20 in San Francisco. The studies focus on two groups with higher-than-average rates of TB: foreign-born persons and African Americans living in the southeastern United States.
"We're doing pretty well all over the United States in eliminating tuberculosis, but among people who are born in a foreign country, the incidence of TB is declining much more slowly," says Dolly Katz, Ph.D., M.P.H., who will present data from the CDC's study on the Epidemiology of TB in Foreign-Born Persons in the United States. "The incidence of TB is nine times higher in foreign-born persons than in U.S-born persons, which indicates a problem," she says. "We really don't know very much about the circumstances of foreign-born people who have TB."
Current surveillance information provides very minimal information, she points out. "We decided to do a study of foreign-born people with TB to get a better picture of TB among this population."
The study was conducted at 22 sites in the United States and Canada, and included about 1,700 foreign-born people with TB, including 200 children. The researchers interviewed subjects for an hour, asking questions including:
- What kind of symptoms did you have before you came to the doctor"
- How long did the symptoms last"
- Did you treat yourself, go to an emergency room, or a doctor, or a healer"
- When you went for treatment, what tests and treatments were you given"
- How was your illness explained to you by the doctor"
- What language did the doctor use in talking to you"
- What happened to you next" Where did you go for further treatment"
- Did you have a TB test before you came to the United States" What did they tell you results were"
- What did you know about TB" Do you think it's a serious illness"
- Were you scared to go to doctor"
- Do you think you're in control of curing your disease"
Dr. Katz said. "The findings are going to help us focus on where we can improve our outreach and control efforts, and give us places to focus our efforts on enhanced prevention and control."
TB in African Americans in the Southeastern U.S.
The second study to be presented at the session will look at the issue of the excess burden of tuberculosis among African Americans in eight southeastern states. Rachel Royce, PhD, MPH, from RTI International, will be presenting new data from the study, called "Addressing Tuberculosis (TB) among African Americans in the Southeast: Identifying and Overcoming Barriers to Treatment Adherence for Latent Tuberculosis Infection (LTBI) and TB Disease."
The study, conducted by researchers at the Centers for Disease Control and Prevention's Division of Tuberculosis Elimination and RTI International, is a multi-phase research project developed to understand the individual, institutional, and community-level barriers and facilitators to TB control in African Americans in the southeastern region of the U.S.
Nationally, the TB rate among African Americans is more than eight times the rate among whites and has been for some time. Over one-third of the TB cases in African Americans are in the southeastern United States.
During the first phase of this study, researchers gathered information about knowledge, attitudes, and beliefs about TB from six perspectives: TB patients, people with latent TB infection, at-risk individuals, and TB community leaders, providers and health departments who serve TB patients, people with latent TB infection, and at-risk individuals, through individual interviews and focus group discussions.
Dr. Royce presented study results gathered from one rural community and two urban communities in North Carolina, Georgia and Tennessee.
She noted, "Unless new action is taken we will miss the Healthy People 2010 TB goals in the African-American community. Our findings, along with the research of others will help us develop effective interventions to address TB prevention and control in the African-American community and help close the gap for the elimination of TB."
Data from the first phase will be used to develop and implement the intervention phase that aims to help reduce the disparity of TB among African Americans in the southeastern U.S.
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