Prevalence and Treatment Outcome of Tuberculosis and Latent Tuberculosis Infection Among Newly Arrived Refugees,DeKalb County,January 2015-February 2016. Public

Abstract

Background: In the United States, tuberculosis(TB) incidence among foreign-born persons (15.1 cases per 100,000) is approximately 13 times compared to incidence among US-born persons (1.2 cases per 100,000). In 2015, approximately 66.4% of new cases of TB occurred in foreign born persons. This has in part been attributed to reactivation of latent tuberculosis infection (LTBI). The Centers for Disease Control and Prevention (CDC) recommend screening and treatment of both active TB and LTBI for newly arriving refugees. However, few studies have evaluated the treatment outcomes of LTBI among newly arrived refugees. We sought to assess TB and LTBI prevalence among recently resettled refugees in DeKalb County and evaluate variables associated with LTBI treatment initiation and completion.

Methods: We did a secondary data analysis of LTBI screening results and follow up logs of 1155 refugees screened at the DeKalb County Board of Health Refugee Health Program between January 2015 and February 2016. A multivariate logistic regression was used to calculate the associations between demographic characteristics and LTBI diagnosis, treatment initiation and completion.

Results: LTBI diagnosis and treatment initiation rates among evaluated refugees were 62% and 85% respectively. Higher completion rates among refugees were associated with Asian origin and with the treatment regimen option of isoniazid and rifapentine combination therapy for 3 months. Compared with other refugees, those from Middle East were less likely to initiate and complete LTBI treatment.

Conclusion: In DeKalb County, public health interventions are required to increase LTBI initiation and treatment completion rates among refugees. Efforts should be aimed at establishing culturally competent and age appropriate interventions for all refugees, especially of Middle Eastern origin and among the 18-34 year age group.

Table of Contents

Chapter I: Introduction........................................................................................................................ 1

Introduction.................................................................................................................................. 1

Study Objectives........................................................................................................................... 3

Ethical Considerations.................................................................................................................... 4

Definition of Terms........................................................................................................................ 5

Latent Tuberculosis Infection................................................................................................... 5

Refugee............................................................................................................................... 5

LTBI Treatment Initiation........................................................................................................ 5

LTBI Treatment completion..................................................................................................... 5

Background.................................................................................................................................. 7

Global Burden of Tuberculosis................................................................................................. 7

Tuberculosis in the United States............................................................................................. 7

Refugee Health-Screening...................................................................................................... 11

Chapter II: Literature Review............................................................................................................ 14

LTBI Treatment Regimen................................................................................................................ 14

LTBI Prevalence and treatment in the United States............................................................................ 17

LTBI Prevalence and Treatment Among Refugees................................................................................ 20

Chapter III: Manuscript..................................................................................................................... 22

Abstract...................................................................................................................................... 22

Introduction................................................................................................................................. 23

Methods...................................................................................................................................... 25

Results........................................................................................................................................ 27

Discussion................................................................................................................................... 30

Limitations.................................................................................................................................. 32

Conclusion.................................................................................................................................. 32

Tables and Figures........................................................................................................................ 33

Manuscript References.................................................................................................................. 38

Chapter IV: Public Health Implications and Recommendations............................................................. 43

References:............................................................................................................................................45

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology Health Sciences, Public Health
Mot-clé	LTBI Treatment LTBI Refugees LTBI Prevalence Latent Tuberculosis Infection Treatment outcome
Committee Chair / Thesis Advisor	Castro, Kenneth G, Emory University
Committee Members	Oladele, Alawode, DeKalb County Board of Health
Partnering Agencies	Georgia state or local health department

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