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
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.
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.
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.