Community‐Wide Implementation of Targeted Testing for and Treatment of Latent Tuberculosis Infection

Abstract

Treatment of latent infection due to Mycobacterium tuberculosis will likely increase in importance as a strategy to prevent tuberculosis in the United States. This review was undertaken to assess how targeted testing and treatment of latent tuberculosis infection are currently organized, with a focus on the extension of those services from public health clinics to other community sites. Targeted testing programs are now being implemented in primary care neighborhood clinics, syringe-exchange programs, jails, and teen health clinics. Organizational issues at those new sites include the need for a tracking system for clinical follow-up and for incentives to promote adherence. There is increasing experience with directly observed treatment of latent tuberculosis infection. Communities that receive large numbers of immigrants and refugees should prioritize the evaluation of those whose chest radiographs are suggestive of tuberculosis. Current studies continue to point out imperfections in the current tools, such as the tuberculin skin test and isoniazid. Finally, the advent of managed care, especially for Medicaid recipients, presents both opportunities and challenges for expansion of population-based preventive health services.

Use of Intermittent Rifampin and Pyrazinamide Therapy for Latent Tuberculosis Infection in a Targeted Tuberculin Testing Program

“…The present study demonstrates that targeted tuberculin testing and treatment are an effective strategy for tuberculosis sur- veillance and prevention in high-risk populations [2,21]. The plant described herein is an example of a high-yield site, in that most employees were foreign born, 6 employees had previously developed tuberculosis, and more than one-quarter of employees had LTBI.…”

Impact of Immigration on the Molecular Epidemiology of Tuberculosis in Rhode Island

“…Therefore, expanded TB screening services that actively move into at-risk communities outside of traditional health clinic sites will be important in reaching these persons during the window period of latent infection. Involving community-based organizations has proved effective in increasing cure rates, detecting new cases, and decreasing costs compared to traditional practices (22,32,33). In addition, application of current screening guidelines that emphasize screening of recent immigrants within 5 years of immigration would miss a large proportion of the foreign-born persons who developed TB, since more than 56% of them had resided in the United States for Ͼ5 years before developing disease, and most of these remote migrants (69.4%) acquired disease through reactivation of latent infection.…”

Tuberculosis Skin Testing Among HIV-Infected Pregnant Women in Miami, 1995 to 1996

“…1,2 One TST program was implemented in 1995 at the prenatal clinics of the University of Miami/Jackson Memorial Hospital (JMH) in Miami, FL, where approximately 2.4% of the prenatal population has human immunodeficiency virus (HIV) infection and 60% is foreign-born. About 6000 women deliver there annually.…”