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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
E-mail: rroyce@rti.org
Nickolas DeLuca, PhD
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination
1600 Clifton Road, NE
Mailstop E-10
Atlanta, GA 30333
E-mail: ncd4@cdc.gov
Publications:
N/A
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
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