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Text for Figures and Slides in TB Behavioral and Social Science Research Forum Proceedings


Masae Kawamura, M.D.
ACET Chairperson
Director, Tuberculosis Control Section
San Francisco Department of Public Health
Tuberculosis Clinic, Ward 94
San Francisco General Hospital

Slide #1: Behavior, Society and Tuberculosis Control

L. Masae Kawamura, M.D.
Director, TB Control Section
San Francisco Dept. of Public Health

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Slide #2: Program Perspective

  • If TB control was exclusively related to its biologic cause and biologic cure, we would be close to eradication
  • But TB persists…..why?
    • Root causes are imbedded in society
    • Successful TB Control depends on the behavior of individuals at all levels: patient, provider, program and society

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Slide #3: Where we are…

Good news: TB incidence is at an all time low

Take a closer look:

  • FB cases essentially unchanged (24% Mexican-born)
  • US born cases are dominated by African Americans and minorities
  • Case rates in inner cities and in poor communities in the SE US are as high as rates in developing countries
  • Outbreaks continue all over the US despite contact investigation

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Slide #4: Where we are…

TB has retreated in populations that are most difficult to reach

  • Disenfranchised homeless
  • Addicts and substance users
  • Impoverished communities
  • Incarcerated
  • New and old immigrants
  • Individuals who move freely across the border

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Slide #5: TB Control success…


We are premier experts on effective behavioral strategies to improve adherence and patient/provider relations

  • Patient centered DOT
  • Hiring culturally appropriate staff and providing cultural competence training and mentoring
  • Use of housing, food, transportation vouchers, cash, methadone, education, etc as enablers and incentives

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Slide #6: What we accomplished and continue to strive for..

TB Control is about building and maintaining supportive/trusting relationships with patients and their communities

  • Repairing societal connections with the disenfranchised
  • Creating societal connections with those who are not yet integrated in society

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Slide #7: We have done so much but it is not enough…

Long way to go in engaging patients, providers, communities and society :

  • undocumented persons and those living on both sides of the US-Mexico border
  • Minority communities
  • New immigrants

Contact investigation: methods and treatment adherence

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Slide #8: Yet to be addressed…

Health promotion and prevention

  • Integration of targeted testing and LTBI treatment as a primary care issue
  • Adherence to LTBI treatment beyond traditional approaches of education, incentives and enablers

Addressing the root causes

  • Mobilizing communities and countries to take action
  • Translating TB information into a meaningful format

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Slide #9: What behavioral and social science research can do for TB control..

  • Validate what we are doing right and wrong
  • Introduce new behavioral strategies that have been proven in other fields
  • Refine current successful behavioral strategies to improve implementation
  • Determine when integration strategies are appropriate and or harmful
  • Frame TB data in its full context with demographics, social determinants, other health disparities and incidence of other diseases so it is meaningful to society  

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Slide #10: Word of caution about research and research application

  • Research interventions must be practical and well thought through
  • If new resources will be needed for implementation, cost savings and health benefits should be well characterized

Remember: civil service front-line staff may prove to be very different than dedicated research staff

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Slide #11: TB Control story that illustrates success that goes beyond curing a patient with disease

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Slide #12: Although we may need to take a more “macro” approach to furthering our success in TB control, let us never forget the individual approaches and strategies that have made us incredibly successful.

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Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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Communications, Education, and Behavioral Studies Branch
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