5005.1: Wednesday, November 15, 2000 - Board 0

Abstract #12131

Obstacles to providing directly observed therapy for latent tuberculosis infection (LTBI) among children and families of drug users with active tuberculosis: The Chicago COIP experience

Nikhil G Prachand, MPH1, Afsaneh Rahimian, PhD1, Antonio D Jimenez, MA1, William S Paul, MD2, and Ronald C Hershow, MD1. (1) Department of Epidemiology and Biostatistics, University of Illinois School of Public Health, 2121 West Taylor, Chicago, IL 60612, 312-996-1014, nprach1@uic.edu, (2) Tuberculosis Control Program, Chicago Department of Public Health, West Side Center for Disease Control, 2160 W Ogden Avenue, Chicago, IL 60612

Community Outreach Intervention Projects (COIP) of the University of Illinois at Chicago School of Public Health, in collaboration with the Chicago Department of Public Health, began conducting TB treatment among active drug users on the west side of Chicago. The intervention involved using former addicts to perform field TB control activities for this subpopulation.

Contact investigation began by identifying locations where each index patient spent time prior to TB diagnosis. Despite the fact that most index patients were unstably housed, patients often spent the period immediately prior to TB diagnosis at a boyfriend/girlfriend's or relative's residence. These were settings most likely to include children less than 4 years of age, a group at high risk of developing TB disease once infected. Index patient cooperation was instrumental for gaining access to this group. Through the course of the intervention, several obstacles to identification, evaluation and treatment of children were elucidated:

1) Reluctance to involve family members in index case's personal business (e.g. their health) often because of existing strained personal relationships as a result of their addiction (unpaid debts, theft, shame, estrangement)

2) Reluctance to introduce "outsiders" into their family world where active drug selling was taking place

3) Chaotic, high-density households involving overlapping families of relatives and friends making continuity and follow-up difficult

The design of public health interventions to control TB among high risk groups should take into account lifestyle and environmental factors which may inhibit successful access and treatment of children and other close contacts of active TB cases.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to:

  1. Identify obstacles to providing DOT to children and families of drug users with active TB
  2. Describe how the obstacles outlined may inhibit access and treatment
  3. Develop strategies to address and overcome barriers to gaining access and providing treatment to families and children of drug users

Keywords: TB, Community Outreach

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA