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U.S. Department of Health and Human Services

  

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 publication:
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 for follow-up.

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, India, Haiti, 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 CDC guidelines.

Reported by Francesca Gany, MD, MS, Director
Jyotsna Changrani, MD, MPH, Assistant Director
Center for Immigrant Health, NYU School of Medicine

 


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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