186426 Tuberculosis Knowledge of High-Risk Individuals in the Endemic Border City of Tijuana, Mexico

Tuesday, October 28, 2008: 11:15 AM

Robert Deiss, MD , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Rafael Laniado-Laborín, MD, MPH , Facultad de Medicina y Psicología, Universidad Autonoma de Baja California, Tijuana, Mexico
Jose Luis Burgos, MD, MPH , Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA
Maria Remedios Lozada, MD , Patronato Pro-COMUSIDA, Tijuana, Mexico
Steffanie Strathdee, PhD , Division of Global Public Health, University of California, San Diego, La Jolla, CA
Paris Cerecer, MD , ISESALUD, Tijuana, Mexico
Prisci Orozovich, MPH , Refugee Health Program, California Department of Public Health, Sacramento, CA
Jazmine Cuevas, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Richard S. Garfein, PhD, MPH , Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
Background: The majority of tuberculosis (TB) cases in the U.S. occur among foreign-born individuals, and TB is endemic in the border city of Tijuana, Mexico. Since drug users and homeless individuals are at risk for TB infection, we assessed their knowledge surrounding TB transmission and risk.

Methods: Street outreach was used to recruit high-risk individuals (e.g. drug users, commercial sex workers and homeless persons) for a behavioral risk assessment interview, HIV testing, and TB screening in Tijuana. Study participants were asked about TB knowledge/beliefs and medical history and were tested for latent TB infection (LTBI) using QuantiFERON®TB-Gold. Descriptive statistics were used to characterize responses.

Results: Of 503 participants, 59% were male, median age was 36 years (IQR: 29-42); 87% were current drug users and 14% were homeless. Approximately 6% and 7% reported lifetime diagnosis of active TB or LTBI, respectively, 90% of whom reported receiving anti-TB medication. Overall LTBI prevalence was 57%. Most individuals (88%) believed that TB can be cured with medicine and correctly identified TB transmission as airborne (80%). However, 88% believed that TB could spread through indirect contact (e.g., sharing dishes, bottles), and 70% believed that bacille Calmette-Guérin (BCG) vaccination offered permanent protection against TB. Paradoxically, individuals who reported being diagnosed with latent TB were more likely to answer this question incorrectly (92% vs. 67%, p<0.01).

Conclusions: We found frequent misperceptions of TB, placing this population at even higher risk for disease. TB education should be expanded and incorporated into programs serving high-risk populations in Tijuana.

Learning Objectives:
1. Identify misperceptions of tuberculosis (TB) among individuals at high-risk for TB infection and disease. 2. Identify opportunities for education and awareness that are unique to the border city of Tijuana, Mexico. 3. Understand why attention must be paid to high-risk groups in border communities, as more cases of TB are imported from Mexico than any other country.

Keywords: Education, Tuberculosis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Post-Doctoral Fellow in International Health at the University of California, San Diego. I have published articles on HIV risk behaviors and also have written on the relationship between tuberculosis and drug use. I have previously presented at the International AIDS Society Conference and the North American International Union of Tuberculosis and Lung Disease.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.