|
Principal Investigator(s): Alyssa G. Robillard, PhD,1
Nickolas DeLuca, PhD,2 and Wanda Walton, PhD2
Project Dates: September 2002-present
Background: During June 1999-March 2002, a total of 16
tuberculosis (TB) cases were reported from Chickasaw County, Mississippi,
corresponding to annual TB incidence rate increases of 20.5 to 27.6 cases per
100,000 population. In comparison, annual TB incidences for Mississippi during
the same period decreased from 7.8 to 5.4 cases. Among the 16 TB patients, five
had been diagnosed previously with latent TB infection (LTBI) as a result of TB
contact investigations. The Mississippi State Department of Health (MSDH)
attempted to treat all five patients, but all had either refused or stopped
treatment. The patients subsequently progressed to active TB and became sources
of infection for an additional 10 TB patients.
Objectives: The objectives of the study were to 1) examine
cultural factors that impact patients' perception of TB; 2) understand how
health-seeking behaviors and adherence to LTBI treatment are influenced by
those perceptions; 3) identify barriers and obstacles to initiating and
completing treatment for LTBI; and 4) determine how the identified barriers and
obstacles could be overcome to increase the likelihood of initiation and
completion of treatment for LTBI.
Target Audience: Patients nonadherent to treatment for LTBI,
patients adherent to treatment for LTBI, and TB control staff
Methods:
Three separate focus group discussions were conducted with TB-control
staff, patients adherent to treatment for LTBI, and patients nonadherent to
treatment for LTBI. The findings from the focus group discussions were analyzed
using an ecological perspective.
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:
Nickolas DeLuca, PhD
Chief - Education, Training, and Behavioral Studies Team
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:
Robillard A, DeLuca N, Walton W. Barriers
associated with TB medication adherence among Chickasaw County residents with
latent TB infection. January 2003 (Unpublished report)
Transmission of Mycobacterium tuberculosis associated with failed completion of
treatment for latent tuberculosis infection - Chickasaw County, Mississippi,
June 1999-March 2002: MMWR 2003; 52 (No.11). Available in PDF at
http://www.cdc.gov/mmwr/PDF/wk/mm5211.pdf
Relative Content:
1 Rollins School of Public Health, Emory University
2 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
|