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TB Challenge: Partnering to Eliminate TB in African AmericansReturn to Summer 2005 Main Menu This is an archived document. The links and content are no longer being updated. Alabama's Three-Part Strategy to “Put TB on the Run” In the African-American CommunityJ. Scott Jones, Senior Public Health Advisor, State of Alabama, Department of Public HealthWhen the discussion of health disparities between African Americans and white persons in Alabama comes around to her end of the table, Nancy Keenon leans forward to emphasize her point. “We have a plan, and that plan is working.” Keenon is the Director of Alabama's Division of Tuberculosis (TB) Control. Her division has two primary responsibilities: tracking TB and treating it. The control of TB, which was once the leading cause of death in the state of Alabama, is a core public health function. A committed group of physicians, labora-torians, nurses, and field staff (also known as disease intervention specialists [DIS]) have made the control of TB in Alabama a reality. To illustrate her point, Keenon states that Alabama counted more than 2,600 persons with TB in 1951. This number contrasts with the 211 cases of TB reported in 2004. Keenon credits the work of those who provided leadership throughout the division over the years and the dedicated field staff. However, she knows that the work isn't over yet. “TB is retreating, but the battle is far from over,” she warns. Although blacks make up about 25% of the total population in Alabama, nearly 53% of all reported TB cases between 1999 and 2003 were found in this population. In 2003 alone, 78% of TB cases reported among children less than 15 years of age were in non-Hispanic blacks. The clearest measure of this disparity is the case rate for TB: the 5-year average for case rates among blacks is 12.7 per 100,000 population when compared to the 3.5 per 100,000 population among whites. Or, stated another way, for every 13 blacks in the state diagnosed with TB, there are fewer than 4 whites with the disease. A review and analysis of TB morbidity conducted by Keenon and her staff has led to the development of a three-part plan at the state level to reduce the burden of TB in the African-American community. The Division has discovered a common factor when investigating reports of active TB disease among African-American children. This factor, “diagnostic delay,” has been observed in three separate areas across the state. The first part of the Division's strategy will be to expand training opportunities for health care providers serving this high-risk community. Reducing diagnostic delays is critical to the interruption of transmission and the prevention of secondary cases (often found in young children). In 2005, the Division will develop and test targeted provider training. Beginning in 2006, the Division will conduct at least one targeted-provider training in each major metropolitan area of the state. The three-part plan is listed below:
The Division’s DIS will visit each prison and review charts monthly after the completion of each case or contact investigation. These monthly visits are currently expected of the DIS, as is the requirement that staff remain engaged with wardens to ensure inmates with latent infection complete therapy. “Our goal is to gradually reduce the burden of disease over the next 5 years; we know this plan will work, and there may be ways to accelerate the decline.” Keenon is not looking for a magic bullet; she knows that TB will be difficult to eliminate. “It will require us to communicate the advantages of preventive therapy more clearly, and this will require more than words.” Keenon adds, “Once the community sees and believes in the actions of our staff, and once we have earned the trust of the community--then we will have TB on the run.”
Last Reviewed: 05/18/2008 |
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Centers for Disease Control & Prevention |