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U.S. Department of Health and Human Services


TB Challenge: Partnering to Eliminate TB
in African Americans

Controlling and Eliminating Tuberculosis in African-American Communities (CETBA): Fulton County, Georgia's Experience

Background Information
The project “Intensification of Tuberculosis (TB) Elimination Activities in African-American Communities in the Southeastern U.S.” is directed toward identifying gaps, developing opportunities for TB prevention, and reducing disparities in TB. Georgia's TB program, located in the Georgia Department of Human Resources, Prevention Services Branch, was one of three sites that received grant funding in August 2002 from CDC's Division of Tuberculosis Elimination for this special initiative. The project is being implemented in Fulton County. A major goal is to develop strategies and interventions that will improve access of the African-American community to culturally competent, effective, and affordable TB program services. A comprehensive plan of action is being developed through these activities to accelerate the reduction of TB cases among African Americans in Fulton County. Toward this end, collaborative partnerships have been established with community-based organizations, academic institutions, health care providers, hospitals, faith communities, and other associations working to advance the health and wellness of African Americans in Fulton County. This article briefly summarizes activities to support this goal.

Development of Advisory Board
In May 2003, Georgia's initiative established a CETBA advisory board consisting of Fulton County health, social service, and community-based professionals. Community stakeholders meet monthly. This group includes, but is not limited to, staff from the Fulton County Department of Health and Wellness Tuberculosis Program (both medical and administrative), Georgia Department of Human Resources/ Division of Public Health/Prevention Services Branch/Tuberculosis Program, the American Lung Association of Georgia, Fulton County Emergency Shelters and Transitional Housing, Grady Health Systems, the Atlanta Union Mission, Wilkerson Properties/City of Atlanta Housing Authority, Emory University Adolescent Mental Health Department, Embracing Hospice Care, Fulton County Substance Abuse and Alcohol Treatment Center, Concerned Black Clergy, Morehouse School of Medicine Community and Preventive Medicine Department, and the Fulton County Jail.

Neighborhood Planning Unit Meetings
Eight zip codes in the Fulton County area are reporting higher-than-normal numbers of cases of TB, when compared to the State of Georgia. These zip codes are 30303, 30308, 30309, 30310, 30312, 30314, 30315, and 30318. A very productive partnership was forged with the City of Atlanta Bureau of Planning. Each of the zip codes with high rates of reported TB cases has a Neighborhood Planning Unit (NPU) that meets monthly. The presentations are interactive and allow those in attendance to share any information and issues they have regarding the disease.

Three Needs Assessments Completed

TB Knowledge and Awareness in the African-American Community As It Relates to Former TB Patients

DHR contracted with VCS & Associates, a local consulting group, to conduct focus groups and individual interviews with African-American women and men between 25 and 54 years of age. Members of the target population were identified as recipients of human services (e.g., public health care, temporary housing, transitional housing, substance abuse treatment) in Fulton County, Georgia. Sixty-seven individuals participated in the 10 focus groups and the 10 individual interviews during July and August 2003.

We found that, overall, participants were aware of the basics about tuberculosis, diagnostic procedures, and treatment. The findings indicated a low level of knowledge regarding disease progression, even among respondents who had previously been diagnosed with TB. Furthermore, respondents had a great deal of misinformation regarding transmission and prevention of the disease.

Recommendations include the following:

  • Provide better access to community-based health facilities,
  • Provide more information about TB to the public,
  • Increase access to health care for TB-infected low-income/under-or unemployed clients, and
  • Implement strategies to overcome stigma associated with the diagnosis of TB.

Health Care Providers' Experiences in Serving At-Risk TB Populations
The Georgia Department of Human Resources (DHS) awarded a contract to Wellsolve, Inc., to conduct a cross-sectional study to assist DHR in identifying the various factors leading to disparities. As directed by DHR, the study consisted of collecting qualitative and quantitative data from health care providers of TB care within Fulton County. The purpose of this information was twofold: to obtain an updated description of the current TB services and to seek a better understanding of the barriers that inhibit the decrease of TB incidence in Fulton County, Georgia. There were 27 public and private health care facilities participating in key-informant interviews. The survey sought to ascertain the following:

  • Were there undocumented differences in referral procedures regarding TB cases and contacts for African American vs. other racial/ethnic groups?
  • Are selected programs having greater success in reducing TB incidence, administering DOT, and educating constituents about risk and protective factors compared to others?
  • Do agencies have an internal plan for increasing early detection?
  • What causes of health disparities are prevalent where TB prevention and treatment are concerned?

Based on the data that Wellsolve, Inc., submitted, the study showed that TB patients still have lengthy wait times at various facilities; physicians and clinicians cite the need for increased awareness of TB in the community at large, and in the low-income community specifically; and better follow-up mechanisms need to be in place for TB patients referred from the private sector to public health. For example, a key contact person for TB should be assigned to the Fulton County Department of Health and Wellness.

Based on the surveys, the following recommendations were made:

  • Ensure that staff who work with this population comply with tuberculosis skin test (TST) programs.
  • Implement a consistent peer group review process between the public and private sector health care facilities.
  • Develop strategies for addressing the issue of increasing multidrug resistant TB through policy, training, media, and social marketing.
  • Provide an improved telecommunication system for the Fulton County TB Program (e.g., voice mail).

TB in Fulton County, Georgia, Homeless Population
DHR is concerned about the increasing incidence of TB in the homeless population. DHR contracted with Fisher, Sheehan, & Colton, a public finance-general economics consulting firm, to perform a needs assessment in homeless shelters in Fulton County, Georgia. Twenty-three homeless shelters were surveyed and six site visits to area homeless shelters were completed.

In shelters that required a TB test during the clients' first stay, with the staff making all arrangements, the reported compliance rate approached 100%. Shelters that required a TB test during the clients' first stay but left the arrangements up to the client were less successful in obtaining the TB tests. Shelters that encouraged TB testing during the first stay but left the decision to the client seldom were successful in having TB testing performed. The shelters that neither encouraged nor discouraged TB testing during the first stay but left the decision to the client were the least successful in testing.

Recommendations include the following:

  • Develop a plan to increase universal testing of all first-time clients of homeless shelters in Fulton County, with shelter staff arranging for screening,
  • Provide training and education to Fulton County shelter staff regarding TB and universal testing policy,
  • Continually disseminate information in the shelters to clients, and
  • Develop strategies to communicate with and inform shelter leadership and staff.

For more information, please contact Karen Sturdivant at (404) 463-0802, or email her at

Article submitted by Karen Sturdivant, Beverly DeVoe, Dr. Rose Sales, and Karen Buford


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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