Tuberculosis therapy compliance among foreign-born persons with active tuberculosis disease in the four states with the highest disease burden, 1993-2003

Background: The foreign-born population in the US continues to be disproportionately burdened with Tuberculosis. Therapy completion is vital to reducing this burden and as a result the current Healthy People goal is 90% for completion rates. Currently, rates among the foreign-born are closer to 75-77%. Objective: To characterize therapy compliance among foreign-born persons with active TB disease as well as to ascertain the role of Directly Observed Therapy (DOT) in therapy compliance. Design: A cross-sectional study design was used. Setting: All TB incidence case reports from California, Florida, New York and Texas for the years 1993-2003 were included. Measurements: Chi-square analyses and risk estimates were used to show associations between therapy compliance and gender, race, years in the US as well as exposure to DOT. Results: Hispanics, males and people who have lived in the US less than one year before diagnosis with TB are all least compliant for therapy completion. However, the results of the study also showed that these general findings should not be applied to each state specifically. Within each state, there were variations between which factors such as race or gender were associated with therapy compliance. Inclusion of DOT improved therapy compliance in California, Florida and Texas but decreased compliance among the foreign-born in New York.Limitations: Estimates of foreign-born populations are not accurate. Concurrently, the online tuberculosis information system (OTIS) only has information on reported cases of TB. Thus, our results could be overestimating the effects of gender, race, years in the US and DOT exposure on therapy compliance. Furthermore, OTIS does not give any variables to determine socioeconomic status which could affect therapy compliance among the foreign-born. Conclusions: If states are to meet the Healthy People Goal of 90% therapy completion rates, they each must do their own assessment of their foreign-born population as well as any needs they may have. Cultural sensitivity and community-based organizations should be utilized in both the assessment as well as any planning to implement new programs to improve compliance