Project Title: Primary Care Management of Latent Tuberculosis Infection (LTBI) and Tuberculosis Disease Among Immigrant Populations: A Study of Barriers and Facilitators

Principal Investigator(s): Jenny Pang, MD, MPH1; J. Carey Jackson, MD, MPH, MA2; Nickolas DeLuca, PhD, MA2;

Project Dates: October, 2003 - September, 2008

Project Overview: The Centers for Disease Control and Prevention (CDC), Seattle & King County Public Health Department, and the University of Washington have partnered to develop and conduct a study to understand the barriers and facilitators that influence primary care management of latent and active tuberculosis (TB) among immigrant populations. Epidemiologic data indicates that United States (US) populations with the highest incidence of acute TB disease are recent immigrants from Mexico, the Philippines, and Vietnam. Most newly arrived foreign-born individuals present for general medical care in "safety net" settings: community clinics, public clinics, and private practitioners caring for these communities. Effective TB control strategies require that primary care providers be adept at screening for and managing latent TB infection (LTBI) and include active TB disease in their differential diagnosis in certain clinical settings. This 3-year, multi-phase study was developed to elicit and clarify the knowledge, attitudes, and practices of primary care providers who see foreign-born patients at risk for LTBI and active tuberculosis (TB) disease. Ultimately, this project will develop and implement educational strategies for successfully addressing identified barriers and limitations.

Objectives: The objectives of this study are to: 1) conduct formative research to describe the factors influencing the efficient management of latent and active tuberculosis among primary care providers caring for immigrants from Mexico, the Philippines, and Vietnam; and, 2) design, implement, and assess the impact of an intervention to address the knowledge, attitudes, and practice factors amenable to an intervention

Target Audience: Non-public health providers with large foreign-born patient populations from high burden TB disease and LTBI incidence areas (e.g., Mexico, the Philippines, and Vietnam)

Methods: This study will be conducted in three phases. During the first phase (Phase I), qualitative interviews will be conducted, including a combination of focus groups and individual interviews with health care providers to elucidate aspects of primary care practice that impact TB screening and management. The next two phases (Phase II-III), the intervention phases, will be designed, executed and evaluated using the information and knowledge gained from Phase I.

Contact Information:
Jenny Pang, MD
Seattle & King County Public Health Department
999 3rd Avenue
Suite 1200
Seattle, WA 9810

J. Carey Jackson, MD
University of Washington
School of Medicine
Department of General Internal Medicine
325 9th Avenue
Box 359959
Seattle, WA 98104

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


Relative Content:

1 Seattle & King County Public Health Department, Seattle, Washington
2 University of Washington, Seattle, Washington
3 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia