TB Challenge: Partnering to Eliminate TB
in African Americans
Controlling and Eliminating Tuberculosis in African-American
Communities (CETBA): Fulton County, Georgia's Experience
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
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
- 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
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,
- Develop strategies to communicate with and inform shelter leadership
For more information, please contact Karen Sturdivant at (404)
463-0802, or email her at email@example.com.
Article submitted by Karen Sturdivant, Beverly DeVoe, Dr. Rose
Sales, and Karen Buford