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Missed Opportunities for Tuberculosis Prevention in New York City, 2003

Slopen, Meredith E. MSW; Laraque, Fabienne MD, MPH; Piatek, Amy S. MS; Ahuja, Shama D. PhD, MPH

Journal of Public Health Management & Practice: September/October 2011 - Volume 17 - Issue 5 - p 421–426
doi: 10.1097/PHH.0b013e31820759b8
Commentary

Background: Proper management and prevention can radically decrease the incidence of tuberculosis (TB). To further decrease TB cases in New York City, every opportunity for prevention must be utilized. This study sought to identify patients whose disease could have been prevented and describe missed opportunities for TB prevention.

Methods: Patients diagnosed with TB from April to July, 2003 were identified using the New York City TB registry. Surveillance data, medical records, and patient interviews were used to determine whether patients missed a prevention opportunity or potential for screening. Preventable TB was defined as inappropriate screening of contacts and immigrants, inappropriate treatment of persons with prior TB diagnoses, or those who tested positive for latent TB infection (LTBI) as contacts, immigration, or in community settings. Potentially preventable TB was defined as occurring when those eligible for LTBI screening in community settings were not screened more than 1 year before TB diagnosis. Patients classified as having preventable or potentially preventable TB were grouped as patients with missed opportunities. We calculated the odds of missing a prevention opportunity using logistic regression.

Results: Among the 218 study patients, 22% had preventable TB and 35% had potentially preventable TB. The most common missed opportunity among patients with preventable TB was the failure to initiate LTBI treatment. Birth outside of the United States was not associated with missing a prevention opportunity (odds ratio [OR] = 1.31, confidence interval [CI] = 0.71-2.39); however, extended travel outside of the United States increased the odds (OR = 2.51, CI = 1.19-5.69), particularly among non–US-born patients (OR = 3.01, CI = 1.21-8.59). Missed screening opportunities related to pregnancy, employment, or school attendance were encountered by over half of the study patients.

Conclusions: The majority of New York City TB patients in our cohort experienced at least 1 missed opportunity for prevention. Further study is warranted to determine whether LTBI treatment eligibility should be extended to those who travel for extended periods, particularly among the non–US-born patients.

This study seeks to decrease tuberculosis cases in New York City by identifying patients whose disease could have been prevented.

New York City Department of Health and Mental Hygiene, Bureau of TB Control, New York.

Correspondence: Meredith Slopen, MSW, New York City Department of Health and Mental Hygiene, 42-09 28th Street Long Island City, NY 11101 (mslopen1@health.nyc.gov).

The authors thank Dr Sonal Munsiff for guidance and assistance during the design and drafting of the manuscript, Dr Chrispin Kambili for critical review, and the interviewers and abstractors without whom the study would not have been possible.

Disclosure: The authors report no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.