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Tuberculosis Epidemiologic Studies Consortium (TBESC)
Task Order 11: Addressing TB among African Americans in the
Southeast: Identifying and overcoming barriers to treatment
adherence for LTBI and TB disease
Task Order 11 aims to investigate multi-level facilitators and
barriers to TB control measures for African Americans in
high-morbidity areas in the Southeastern United States to aid in
devising effective interventions. Nationally, the tuberculosis (TB)
rate among African Americans has been persistently eight to nine
times the rate among whites. A large proportion of these cases are
reported from eight Southeastern states where African Americans
reside in relatively large numbers. Task Order 11 seeks to address
this disparity by first seeking to understand the personal,
institutional, and community-level barriers to TB control in African
Americans in the Southeastern United States and the individual-level
response to these barriers in Phase 1 of the project; and then in
Phase 2 to assess an intervention of the project that will be
developed based on the knowledge gained in the first phase. Also, we
designed, conducted, and evaluated a national summit entitled Stop
TB in the African-American Community to raise awareness and catalyze
mobilization on a political level around this issue.
Sites
The RTI International site of the TBESC completed Phase 1 in
Montgomery County, NC; Dekalb County, GA; and Davison County,TN.
Selection of sites for Phase 2 is pending.
Study Objectives
- Understand institutional and community-level barriers to TB
control in African Americans in the Southeastern United States
and the individual-level response to these barriers.
- Develop, implement and evaluate interventions that
ultimately: a) increase awareness about the excess of TB in
African American communities and b) reduce the TB disparity
- Examine the TB knowledge, attitudes, beliefs, and practices
of African Americans with TB, and those at risk for TB, in the
Southeast United States.
- Examine the knowledge, attitudes, beliefs and practices of
providers who serve these populations with respect to: a) TB
diagnosis; b) screening; c) treatment (LTBI and TB disease); d)
contact investigations; e) relationships with local TB programs;
and f) cultural competence.
- Identify ways to overcome the identified barriers to
increase health seeking behavior, as well as adherence to LTBI
and TB disease treatment among the target populations.
Study Design
Phase 1 utilized a combination of qualitative individual and
group interviews to gain information about the knowledge, attitudes,
and beliefs of African American TB and latent TB infection patients,
and those at-risk of TB as well as three sets of providers who serve
them – TB control staff, health care providers, and community
leaders. Surveillance data, administrative databases linked to
census track, and other data were analyzed to help locate field
sites within some of the highest TB morbidity among African
Americans in the region. Qualitative methods were used summarize the
data. The different perspectives of individuals in these six groups
will help provide a comprehensive understanding that will suggest
new avenues to help close the gap in TB elimination for African
Americans. In Phase 2 one of these avenues will be developed into a
specific intervention that will be formally evaluated. At all phases
of Task 11 RTI has gathered input into the work from representatives
of the eight Southeastern states and others.
Study Progress
RTI completed Phase 1 involving a total of 131 study participants
among the six groups at each of three sites - rural site in
Montgomery County, NC and urban sites in Dekalb County, GA, and
Davison County, TN. The final report from this phase has been
drafted and is under review by CDC. Planning for Phase 2 is
underway.
Last Modified: 07/25/2007
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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