TB Challenge: Partnering to Eliminate TB
in African Americans
TB Programs Cannot Do It Alone: Collaborate!
Joseph Kinney, MSW, LISW, Program Coordinator,
South Carolina Department of Health and Environmental Control
South Carolina consistently ranks among the top 10 in TB incidence
rates. According to the 2000 census, South Carolina has a population of appropriately
4 million people, of whom 30% are African American.
In 2002, the Centers for Disease Control and Prevention's Division
of Tuberculosis Elimination awarded a 3-year grant to the state
of South Carolina TB control pro-gram for a demonstration project,
“Intensification of TB Prevention, Control, and Elimination Activities
in African-American Communities in the Southeastern
United States.” The state's TB control program contracted with Drs.
Ana Lòpez-DeFede and Muriel Harris at the University of South Carolina
(USC) Institute for Families in Society to develop, implement, and
conduct overall evaluation for this project.
A review of 2001 TB surveillance data and other historical data
revealed that TB has a disproportionate impact in poor and rural
African-American communities in the state of South Carolina. For the project, state program officials chose two
health districts in the northeast corridor of the state (Pee Dee and Waccamaw) where TB has been persistent but funding limited,
both of which add to the challenges of eliminating the disease in
the state. Currently, the corridor has 15% of the state's overall
population, yet it reports 34% of the TB cases. In addition, of
the TB cases in this nine-county area, over 70% are among African-American
In a report by Drs. Lòpez-DeFede and Harris (2003), Understanding
the Social and Cultural Determinants of Tuberculosis: African Americans
and Tuberculosis in South Carolina, the authors noted a strong association
among poverty, rural residence, lower educational attainment, unemployment,
and access to health care, and examined the role of these factors
in tuberculosis cases. Race was found to be an important factor
in this examination of socioeconomic factors related to TB. Disparities
between African Americans with tuberculosis and other racial groups
in the northeast corridor place this group at a higher risk for
poor health outcomes and adherence to TB treatment.
The CDC demonstration project provided for the establishment and
implementation of communication strategies with African-American
men as the primary target audience. Following are several project
activities that were implemented and found to be key to working
with the community.
Getting the Message Out:
In an effort to raise awareness and begin to change attitudes
about TB, an education campaign was designed and implemented in
collaboration with the community. The campaign relied heavily on
partnerships for message distribution. Billboards in the targeted
health districts were the first step for the dissemination of TB
messages. While the project team felt the campaign was successful,
they did encounter a few challenges with the billboards. For example,
it was difficult for them to find pictures that depict both African-American
males as well as African-American families (intergenerational) for
tailoring TB health messages. They found a few persons who had
not noticed the billboards and/or did not understand the TB message.
The eight communities targeted for the campaign in the Pee
Dee and Waccamaw health districts had been selected based on recommendations
from the GIS mapping provided to the SC TB control program by the
University of South Carolina (USC) Institute for Families in Society.
After descriptions of signs and symptoms of TB were added to
the billboard, over 200 posters with the same design were placed
in the two health districts in bars, pool halls, barber shops, beauty
salons, restaurants, liquor stores, and other facilities, organizations,
and agencies that cater to and provide services to the African-American
Participants from the business community were trained through
a TB lesson plan that was developed by Sherry Poole, health education
consultant for the demonstration project. The lesson plan, which
consists of four parts or modules, was presented to these stakeholders
so that they could educate others from their community. Some of
the stakeholders included persons from various community action
agencies, homeless organizations, The Fatherhood Initiative, the
state's HIV agencies, and corrections agencies; some of these persons
also serve on the state's African-American TB Advisory Board, which
was formed during the first phase of this project.
Since a disproportionate number of South Carolina's TB cases are reported among African-American males,
the project team initially questioned the value of using faith-based
organizations as part of the TB awareness campaign because focus
groups indicated that very few of the TB patients participated in
faith-based organization activities. However, the African-American
TB program staff in South Carolina was aware that faith-based organizations are vital to
the communities in which they are located and should be engaged
as partners in the movement to improve health access and decrease
South Carolina TB control officials and staff established relationships
with churches in the nine county areas represented by the two health
districts. Project staff attended prayer breakfasts, where they
made TB presentations; also, they felt a turning point was reached
when the project was welcomed into the “Community Faith-Based Neighborhoods
Coalition (CFBNC)” in Myrtle
Beach, South Carolina. This coalition, which
consists of seven churches, conducted outreach efforts geared towards
addressing the counties' multineedy residents such as adults on
pardon and parole, homeless persons, and unemployed residents.
The leader of CFBNC, Mr. Benny Swann, is a member of the Mount Olive
African Methodist Episcopal Church which is located in an area within
the northeast corridor with a high incidence of TB.
CFBNC was very instrumental in sponsoring a TB awareness campaign
for the community, which included health fairs and other activities
geared to all age groups in the neighborhood. The state's TB control
program also exhibited and partnered with CFBNC on a teen work-shop
(Teens in Touch) and other activities such as a car show, which
was targeted to the African-American male.
However, the state's project team and CFBNC were aware that health
fairs and car shows were not enough to effectively combat the problems
in the community. The SC TB control program secured several weeks
of 30-minute time slots on a local television station that covers
the northeast corridor. In addition, a local black radio station
granted air time for four campaigns on TB awareness. CFBNC's objective,
through these radio campaigns, was to reach the general public as
well as the state's political leaders to gain support for TB prevention
and control efforts in South
Carolina. CFBNC worked closely with the state's TB control program
to inform local elected leaders about TB concerns in their communities.
Also, members of the coalition traveled to Washington,
DC, to talk with the South Carolina delegation and to meet with Jennifer Sullivan, Director
of Outreach, White House Office on Faith-Based and Community Initiatives.
The message resonated quite clearly: “Our church and community leaders
are alarmed and concerned about the employment and health disparities
that exist in many of the counties through South
Health Care Coalition:
The SC TB control program developed a collaboration with the
South Carolina Primary Health Care Association (SCPHCA), Little
River Medical Center, Health Care Partners of South Carolina, Inc.,
the USC's Institute for Families in Society, and district and local
health department staff.
The coalition established the following objectives:
- Contract with the SCPHCA
- Provide primary care physicians for TB patients
- Coordinate TB program services with the SCPHCA
The contract with the SCPHCA was granted and the following has
- One SC TB control program staff member provides TB education
to all the staff for the health care centers (Little River and
Health Care Partners)
- The SC TB control Medical Consultant provides TB education to
all the clinical staff at Little River and Health Care Partners
- Little River and Health Care Partners each hired an outreach
nurse to coordinate TB program activities with health care entities,
the homeless shelters, and the state's TB control program.
County Collaborative Action Network
The MCCAN is a collaboration of 30 organizations and agencies
in Marion County.
Some of the network members worked with the state on the CDC demonstration
project. These members included two county councilmen, the Chief
Executive Officer of a local hospital, members of a community action
agency, leaders from faith-based organizations, the son of a former
TB patient, and a current TB patient. The network learned through
educating the community that there was a need to address male TB
patients' confidentiality and stigma issues in order to ensure their
accessing of public health services.
Strategies through the MCCAN partnership included-
- Writing and submitting a grant proposal to the National Institutes
of Health to secure funds for community participation in health
disparities intervention research
- Setting aside the third Saturday of each month to provide health
and social services information in various communities throughout
- Working with the Marion County National Association for the
Advancement of Colored People (NAACP) as they prepared the agenda
for their annual banquet theme (Health Care Access in the African-American
Community) last year.
To raise consciousness about TB, partnerships and coalitions
must first be established and maintained within the community.
And finally, intensifying efforts to reduce TB in African-American
communities should be incorporated as a core activity in TB control