Identifying Gaps in Tuberculosis Preventive Care for Non-U.S.-born Persons at Community Health Clinics in the United States

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Abstract
Background: Treating asymptomatic tuberculosis (TB) infection prevents TB disease and is critical for TB elimination in the United States (U.S.). In the U.S., TB disease disproportionately affects those born outside of the U.S. The quality of TB preventive care in primary care settings for non-U.S.-born populations is poorly characterized. We aimed to measure gaps in TB preventive care among non-U.S.-born persons receiving primary care at community health clinics across the U.S. Method: We conducted a retrospective cohort study at 12 community health clinics in the U.S. Per clinic, individual-level demographic and TB clinical data were extracted for approximately 700 non-U.S.-born persons aged ≥18 years seeking care between June and December 2019. We constructed a care cascade describing gaps in TB infection testing and treatment and used multivariable mixed effects logistic models to evaluate associations between individual and clinic-level characteristics and observed gaps. Results: Among 8460 non-U.S.-born individuals included, 68% were female, and the median age was 50 years (interquartile range 38–63). Of those included, 2765 (33%) had a TB infection test ordered. Among 1022 with a positive test, 787 (77%) were diagnosed with TB infection, of whom 377 (48%) were offered preventive treatment. Among 173 who were treated at study clinics, 141 (82%) completed treatment. Conclusions: Gaps in testing and treatment initiation for non-U.S.-born individuals were pervasive at the 12 community health clinics in this study. Research is needed to identify strategies that increase TB preventive care among populations who face the disproportionate burden of disease. Article summary: In this multi-site study of U.S. community health clinics, substantial gaps in tuberculosis infection testing and treatment initiation were identified for non-U.S.-born persons, a population that bears the disproportionate burden of TB disease in the U.S.
Funding Information
  • U.S. Centers for Disease Control and Prevention
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (K12HL138046, R38HL143581)
  • National Institute of Allergy and Infectious Diseases (R25AI147375)

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