Project Title: Addressing Tuberculosis (TB) among African Americans in the Southeast: Identifying and Overcoming Barriers to Treatment Adherence for Latent Tuberculosis Infection (LTBI) and TB Disease

Principal Investigator(s): Rachel Royce, PhD, MPH 1; Nickolas DeLuca, PhD2

Project Dates: October 2003 - March 2008

Project Overview: The Centers for Disease Control and Prevention's Division of Tuberculosis Elimination and RTI International are conducting a study, as a part of the Tuberculosis Epidemiologic Studies Consortium, to address the excess burden of tuberculosis (TB) among African Americans in the southeast. In the southeastern states in the United States (US), where African Americans have historically faced great social and economic disadvantages, the TB rate among African Americans is more than eight times the rate among whites. This difference is referred to as TB disparity. This multi-phase research project was developed to understand the individual, institutional, and community-level barriers and facilitators to TB control in African Americans in the southeastern region of the US. During the first phase of this study, qualitative and qualitative research methods were used to gain information about the knowledge, attitudes, and beliefs of TB patients, at-risk individuals, and the community leaders and providers who serve them. 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 US.

Objectives: The objectives of the study are to: 1) identify and understand the socio-cultural, racial, and healthcare system barriers for African-American TB patients and those who may be at-risk for TB; 2) investigate TB knowledge, attitudes, beliefs, and practices held by health care providers and community leaders in the African-American community; and 3) develop interventions in several sites that will address the identified barriers to reduce and eliminate TB disparities within the African-American community.

Target Audience: African-American TB patients; at-risk community members; providers serving African-American populations at risk for TB; community leaders; community-based organizations; faith-based organizations; health departments

Methods: During the first phase of the project, qualitative and quantitative research methods are being used to guide the development of the intervention. Literature reviews, census tract evaluations, and surveillance data were used to develop the surveying instruments for the individual interviews and the focus group discussion guides. Individual interviews and focus group discussions were conducted with African-American TB patients, persons at high-risk for TB, health care providers and community leaders. During the second phase of the project, data from the first phase of the research will be used to develop and implement an intervention that aims to reduce the disparity of TB among African Americans in the southeastern United States.

Results: Focus group participants suggested that the TB control staff's persistence and flexibility helped them adhere to treatment for LTBI, as did the participation of sex- and race-matched community outreach workers. Many participants cited fear of community and family stigma as treatment barriers and identified a need for additional information about the importance of LTBI treatment. To address patient concerns and misconceptions, ongoing individual counseling during treatment for LTBI was initiated. Furthermore, dissemination of TB-related educational messages was recommended to engage community leaders, churches, and civic organizations.

Contact Information:
Rachel A. Royce, PhD
Senior Research Epidemiologist
Research Triangle Institute
P.O. Box 12194
Research Triangle Park, NC 27709-2194

Nickolas DeLuca, PhD
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination
1600 Clifton Road, NE
Mailstop E-10
Atlanta, GA 30333


For additional information regarding project tools and instruments, please contact the Principal Investigator.

1 Research Triangle Institute, Research Triangle Park, NC
2 Centers for Disease Control and Prevention, Atlanta, GA