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U.S. Department of Health and Human Services

  

TB Challenge: Partnering to Eliminate TB
in African Americans

Chicago Communities Working Together to Eliminate TB

Chris W. Caudill, MPH, Project Director, Chicago Department of Public Health

In August 2001, the Chicago TB Program received supplemental funding as part of CDC's grant, “Intensification of TB Elimination Activities in African-American Communities in the Southeastern United States.” Using these funds, Chicago started the “TB Reduction Activities Project” (Project) to address African-American communities' disproportionately high burden of TB. The disparity in TB case rates between African Americans and non-Hispanic whites is a persistent trend. The following data highlight the striking differences between these groups:

  • From 1998 to 2002, African Americans experienced 57 % of the city's total cases (1,201) while representing only 36% of Chicago's population.


  • In 2002, the African-American case rate of 18.9 was more than four-fold higher than the rate for non-Hispanic whites (4.4 per 100,000).


  • In 2002, out of 18 Chicago community areas with case rates above 20 per 100,000, 15 have primarily African-American populations.


  • From 1998 to 2003, more than 75% of Chicago pediatric TB patients (aged 0-9) were U.S.-born African Americans.

In November 2000, Chicago Mayor Richard M. Daley and members of the City Council had already passed a resolution mandating a study of TB in Chicago to “inform, educate, and empower those communities at greatest risk to assist in the elimination of this disease.” Gaining a greater understanding of the social, racial, and cultural barriers that result in significantly higher TB rates for African Americans is central to accomplishing Mayor Daley's resolution.

A review of overall Chicago community health measures and TB program data from 2002 determined the location for the intervention: 13 contiguous but different community areas on Chicago's Southside. These areas combined have a TB case rate greater than 15 per 100,000, and twice the national percentages for unemployment and infant mortality. Also, 22% of residents live below the poverty line, and only 66% of residents have a high school diploma. Dr. Paul Draus, a sociologist and former Chicago directly observed therapy (DOT) worker, commented in a speech before the Metropolitan Chicago TB Coalition: “Place encompasses not only networks and pathways, but also history, memory, and meaning. Disease is an abstract category; illness is a lived experience. Illness cannot be separated from the social context in which it appears.” The Project formed a task force to bring neighborhood residents, community-based organizations, and public and private health care providers together to learn about these unique African-American communities most impacted by TB.

In Phase I of the program, the task force assessed the study communities' perspectives on TB and the type of intervention desired. A total of 15 focus groups were held, with four involving Chicago TB Program staff and 11 comprising community residents. Using the results of surveys conducted for each group, as well as the minutes from community meetings, the task force eventually decided on a three-tiered intervention approach.

The first component of the intervention is to review Chicago TB Program procedures and practices as they relate to African-American communities. The TB Program is performing a retrospective data study and conducting patient interviews to compare TB program actions in primarily African-American communities and other communities. Study variables include DOT assignment, case reporting by private medical doctors, patient compliance, improving health care utilization, and TB education efforts. The Project will work with the TB Program to implement suggested changes. The response to and value of implemented changes will be assessed quarterly.

The second component is describing the existing health-care provider networks in African-American communities and evaluating the current referral systems that affect TB case finding and treatment. The results of the focus groups and a review of TB case reporting institutions helped identify major community TB care providers. The Project is forming a working group of community health-care agencies to discuss and implement referral system improvements. The project is also partnering with a private hospital to develop a satellite TB clinic in the intervention area.

The third component is developing specialized TB messages targeted to specific African-American audiences. The project health educator will conduct 20 randomized client interviews and review focus group responses to help build a social marketing campaign. Messages will be piloted at 10 community sites to determine the strength of content and effectiveness of delivery channels. The project evaluator will use a pretest and posttest tool to measure message retention. Specialized TB messages and delivery channels will be monitored monthly and adjusted as needed.

The African-American communities that are the focus of these interventions have a great need for intensified TB prevention, control, and elimination activities. Within their geographic boundaries are numerous, varied groups and individuals, each with their own definitions of community and their places in it. The Project must recognize, evaluate, and address these differences to improve the health status in African-American communities.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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CDC/Division of Tuberculosis Elimination
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