Balancing a mosaic tuberculosis population

The City of Stamford was highest in the number of active tuberculosis cases in CT with 11 new active cases in 2008. In 2009, the Department of Health and Social Services managed 329 latent cases and an additional 11 new active cases. The successful treatment and surveillance of this disease is a result of active collaboration between the State Health Department, the local hospitals, and health department. Stamford, CT is located 25 miles outside of New York City and has a population of approximately 120,000 people speaking 58 languages. Between July and December 2009, 7 of the 11 (64%) new active cases were diagnosed, requiring follow-up by the local health department in Stamford. This rapid increase in active clients demanded significant direct observation therapy (DOT) within a 6 month period. Only one case was extra pulmonary. Eight of the 11 (73%) active cases were foreign born, 5 (45%) were uninsured, 6 (55%) were female, and the median age was 32.4 years (range 3-78 years). Because 7 cases were between 18-27 years old, it was vital to develop innovative strategies to ensure expedient compliance. The purpose of this abstract is to demonstrate that innovative and consumer friendly strategies can be employed to initiate treatment and completion of active tuberculosis. Some of the ideas included home isolation instead of hospitalization, numerous site visits and pharmaceutical deliveries which were convenient for the patient and safe for the nurse, and creative incentives. As much as possible, care was provided within the context of cultural competency. These innovative strategies resulted in social justice to each client regardless of place of birth or insurance status. Equal access to care was given through the careful planning and management of patients. Each person was treated respectfully. The innovative strategies were employed to ultimately increase DOT completion rates and help each person return to a healthier lifestyle.