Tuberculosis (TB) rates in the U.S. have declined in recent years, shifting policy efforts from tertiary prevention (i.e. DOT and detention) of active TB to secondary prevention (i.e. TB screening and preventive therapy) of latent TB infection. TB prevention strategies targeting high-risk populations for TB (including foreign-born persons, prison inmates, and substance users) are being re-visited. Because of its potential community impact, public health debate around TB policies often focuses on balancing the rights of society and the individual's right to bodily freedom and choice. Further complicating the debate, TB control policy is predicated on the actual and immediate threat of disease, whereas TB policies for latent TB infection is premised on the potential and distal threat of disease. TB policies are framed around issues of adherence with legal and ethical discussions incorporating the concept of "the least restrictive alternative." The presentation will explore ethical and legal issues regarding TB prevention for active substance abusers. Long stigmatized and marginalized by society, substance users are often perceived with hostility or disinterest by providers, who may presume that they are disinterested in receiving primary health care services and that they are non-compliant with interventions. However, recent data on providing DOPT to active substance users question this assumption, namely, that substance users do not accept nor adhere to TB prevention efforts. The literature on adherence to TB treatment medication, provider and client attitudes, and historical precedents relevant to TB policy on prevention and elimination will also be reviewed and discussed.
Learning Objectives: At the end of the session, the learner will be able to: 1. understand the concept of the least restrictive alternative with regard to tuberculosis prevention and control policies for populations at high risk of tuberculosis, 2. apply the concept of the least restrictive alternative and consider ethical dilemmas in relationship to other public health problems 3. understand how public health policy is often intertwined with ethical and legal questions and dilemmas that places the individual at odds with societal interests
Keywords: Bioethics, Tuberculosis
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.