GANY AND CHANGRANI RESPOND

Abstract

As Xia writes, creative tuberculosis (TB) prevention strategies and programs are indeed necessary to reach the large numbers of medically underserved immigrants in the United States. Rates of TB among foreign-born persons in the United States continue to increase,1 and there is a vast reservoir of latent tuberculosis infection (LTBI) among immigrants.2 Many at-risk immigrants face linguistic, cultural, economic, legal, and structural obstacles to early TB screening and treatment.3 The community must be an integral partner in the planning, implementation, and evaluation of TB control programs for immigrants. These programs should include active advisory boards; formative research (e.g., focus groups and needs assessments); materials development; community capacity building and technical assistance; community-based outreach, education, and screening by trusted community members; a seamless care referral and follow-up system; and ongoing program monitoring and evaluation. The Community Tuberculosis Prevention Program (CTPP) at the Center for Immigrant Health, New York University School of Medicine, is an active partnership of community members, the New York City Department of Health and Mental Hygiene, and the Center for Immigrant Health. This partnership has enabled successful culturally and linguistically appropriate TB control interventions. CTPP goes to where the community lives, works, studies, prays, and plays. It reaches a broad range of immigrants, including many who are newly arrived and some who do not have Immigration and Naturalization Service documentation. More than 25 000 high-risk immigrants have been screened during CTPP’s 10 years of existence. When the program recently screened 400 immigrants in a church in a bustling immigrant parish in Queens, 118 individuals were found to have LTBI, and 1 active case was detected. Through CTPP’s close linkages, all received prompt evaluation and treatment. Their cases will be managed by bilingual, bicultural staff until they have completed therapy. Another CTPP initiative, the School Intervention Program, manages the cases of more than 300 high-risk immigrant high school students with LTBI per year, with an 80% therapy completion rate. The School Intervention Program also has an LTBI directly observed therapy program serving a different cohort of students, and this program has a 96% completion rate. Similar results have been described for other community-driven programs. In a cultural case management program for LTBI in Seattle, Wash, the 6-month isoniazid therapy completion rate for refugees from the former Soviet Union, the former Yugoslavia, and So-malia were reported at 82%.4 TB in the United States can be better controlled with the provision of adequate resources to ensure targeted testing of those at risk, with prompt and effective treatment and follow-up provided in a culturally and linguistically sensitive manner. Sufficient funding for such programs is necessary to reach Healthy People 2010 objectives 14–11 (to decrease the TB case rate to 1 per 100 000 people) and 14–13 (to increase the proportion of high-risk individuals with LTBI who complete therapy to 85%.)5