Diagnosis and treatment of latent tuberculosis infection: Working with community health clinics and undertaking a separate project with foreign-born physicians

Pierce County, located in the southern Puget Sound region of Washington State, has a population of about 805,000. About 8.7% of residents are foreign-born, with nearly half from Asia and about one-quarter from Latin America. Since closure of the Tacoma-Pierce County Health Department's clinics in 1996, the Health Department has contracted with community health clinics and other primary care practitioners to diagnose and treat latent tuberculosis infection (LTBI). Because these clinics serve primarily low income individuals, they see many foreign-born patients. In 2000, the local board of health passed an ordinance requiring reports of positive tuberculin skin tests to the Health Department, which has facilitated the Department's learning of residents with LTBI and follow-up with their providers to encourage treatment. The presentation will describe the Department's work with clinic providers to overcome barriers to LTBI testing and treatment. It will explain annual LTBI audit data for 2005 through 2008. The clinics are switching to electronic medical records, and the impact of this change on data collection will be discussed. As part of a Washington State Health Department grant, the Tacoma-Pierce County Health Department in 2006 recruited four Vietnamese physicians to participate in a study to encourage LTBI testing and treatment in their patient populations. After providing them, through the American Lung Association, with training on LTBI, the Health Department provided free LTBI diagnostics and isoniazid to these physicians, and monitored their use. Study results and attempts to overcome difficulties encountered will be presented.