TB Notes Newsletter
No. 2, 2005
HIGHLIGHTS FROM STATE AND LOCAL PROGRAMS
Thinking Outside the Box to Control TB in the Foreign-born:
Taxi Workers in New York
The data in this article were previously reported in the following
Gany F, Trinh-Shevrin C, Changrani J. Drive-by readings:
a creative strategy for tuberculosis control among immigrants. American
Journal of Public Health January 2005; 95(1):117-119.
While current strategies to find persons with TB and their close
contacts are effective for US-born populations at risk for TB, there
are missed opportunities in reaching communities disproportionately
burdened with latent TB infection (LTBI). There is a large segment
of the population, recent immigrants from high TB prevalence areas,
for which targeted testing and treatment is needed.
To effect TB control in immigrant communities, the Center for Immigrant
Health (CIH), New York University (NYU) School of Medicine, in partnership
with the New York City Department of Health and Mental Hygiene,
implemented the "Community Tuberculosis Prevention Program"
(CTPP). CTPP provides LTBI community outreach, education, screening,
and case management. Most of CTPP’s clients are recent immigrants
with no prior health care access. CTPP uses creative approaches
that consider immigrant communities’ unique circumstances.
There are over 40,000 taxi drivers in New York City. The members
of this largely immigrant workforce work long hours and face multiple
challenges to maintaining health, including occupational, economic,
linguistic, and cultural barriers. Taxi workers often hail from
countries where TB is endemic. As such, they are at risk for LTBI.
John F. Kennedy Airport (JFK) is a major site of taxi activity.
Drivers await their turn to pick up passengers in JFK’s Central
Holding Lot, in some cases for several hours. Staff of CIH saw this
as a key window of opportunity for intervention: an at-risk, mobile
population, now a captive audience.
To reach this group, six multilingual CIH staff provided TB education
and screening to 123 taxi drivers in the Holding Lot. To accommodate
the drivers’ way of life and their concerns that a loss in driving
time is a loss of income, the readings were held 2 and 3 days later
in the fire lane at a centrally located municipal hospital. The
drivers drove through the lane and held their arms out for TST measurement.
If their result was negative, they were given a letter stating the
result, and drove on. If positive, they were given appointments
In this manner, 123 taxi drivers from over 25 countries were tested
for LTBI. Most of the drivers (97%) were born outside of the United
States, with two thirds of the 123 being from
four countries: Pakistan,
and Bangladesh. As many
as 102 (83%) of the drivers had no health insurance. Only 26 (21%)
drivers had a family doctor. Nearly two thirds (81/123) of the drivers
had never before been tested for TB.
We found that 48 had TST-positive results, which was nearly 62%
of the 78 who returned and approximately 39% of the 123 total individuals
screened. Over 40% (15/34) of those scheduled for an evaluation
on a day other than the reading did not get one, most because of
concerns about convenience or cost, and one because he was advised
by his private physician that he did not need it. In addition, 64%
(16/25) of those who received a full physician evaluation were advised
not to start treatment for LTBI. Of these individuals, 37.5%
(6/16) had reported co-existing medical conditions or TB exposure
associated with a high risk for TB; nine individuals were advised
to start treatment for LTBI; eight individuals initiated treatment;
50% of them completed. Those who did not complete treatment cited
as reasons having side effects, and leaving the country for a prolonged
period of time.
This program demonstrated that innovative approaches to reaching
at-risk immigrant populations can be effective. However, such programs
must similarly include ease of follow-up after screening and provider
education to ensure that patients are receiving care according to
Reported by Francesca Gany, MD, MS, Director
Jyotsna Changrani, MD, MPH, Assistant
Center for Immigrant Health, NYU School