Latent Tuberculosis Infection Screening in Foreign-Born Populations: A Successful Mobile Clinic Outreach Model

• Published in: American journal of public health (1971) 2014-08, Vol.104 (8), p.1508-1515
• Main Authors: MORANO, Jamie P, ZELENEV, Alexei, WALTON, Mary R, BRUCE, R. Douglas, ALTICE, Frederick L
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Addictions; Adult; AIDS; Alcohol; Bacterial diseases; Biological and medical sciences; Connecticut - epidemiology; Continental Population Groups - statistics & numerical data; Deportation; Drugs; Emigrants and Immigrants - statistics & numerical data; Family medical history; Female; General aspects; Health care; Health care policy; Hepatitis; Hispanic people; HIV; Homeless people; Housing; Human bacterial diseases; Human immunodeficiency virus; Humans; Immigration; Infections; Infectious diseases; Latent Tuberculosis - diagnosis; Latent Tuberculosis - epidemiology; Male; Mass Screening - methods; Medical records; Medical sciences; Medical screening; Miscellaneous; Mobile Health Units - organization & administration; Population; Prevalence; Prevention and actions; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research and Practice; Risk Factors; Screening; Substance-Related Disorders - epidemiology; Tuberculin Test - methods; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Urban Health
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2014.301897

We evaluated the efficacy of a mobile medical clinic (MMC) screening program for detecting latent tuberculosis infection (LTBI) and active tuberculosis. A LTBI screening program in a MMC in New Haven, Connecticut, used medical surveys to examine risk factors and tuberculin skin test (TST) screening eligibility. We assessed clinically relevant correlates of total (prevalent; n = 4650) and newly diagnosed (incident; n = 4159) LTBI from 2003 to 2011. Among 8322 individuals, 4159 (55.6%) met TST screening eligibility criteria, of which 1325 (31.9%) had TST assessed. Similar to LTBI prevalence (16.8%; 779 of 4650), newly diagnosed LTBI (25.6%; 339 of 1325) was independently correlated with being foreign-born (adjusted odds ratio [AOR] = 8.49; 95% confidence interval [CI] = 5.54, 13.02), Hispanic (AOR = 3.12; 95% CI = 1.88, 5.20), Black (AOR = 2.16; 95% CI = 1.31, 3.55), employed (AOR = 1.61; 95% CI = 1.14, 2.28), and of increased age (AOR = 1.04; 95% CI = 1.02, 1.05). Unstable housing (AOR = 4.95; 95% CI = 3.43, 7.14) and marijuana use (AOR = 1.57; 95% CI = 1.05, 2.37) were significantly correlated with incident LTBI, and being male, heroin use, interpersonal violence, employment, not having health insurance, and not completing high school were significantly correlated with prevalent LTBI. Screening for TST in MMCs successfully identifies high-risk foreign-born, Hispanic, working, and uninsured populations and innovatively identifies LTBI in urban settings.