Tuberculosis Prevalence, Screening and Treatment among Filipinos in Union City, California Christine...
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Tuberculosis Prevalence, Screening and Treatment among Filipinos in Union City, California Christine Araneta PA-C, Stephanie Sario BA, Jennifer Lee MPH Asian Health Services, Oakland, California RESULTS Screening for TB infection: For a high endemic community, in a known TB “hotspot”, the rates for TB screening were below the expected standard. Given that the sample was highly insured at 81%, one-fourth were not tested or did not know their status. Treatment of latent TB infection: Latent TB infections were those who tested positive, had negative chest x-rays, and no symptoms and signs of TB. A little over half were treated preventively with anti-TB drugs anywhere from six to nine months. The other half, were not, perceiving that anti-TB prophylaxis was unnecessary or not highly recommended by their physicians. Latent infection is the reservoir of future TB infections and disease, and its eradication depends greatly on physician practices and the public’s TB-risk awareness. Stigma of TB: Because of the high TB burden among Filipinos, one would expect a greater personal awareness of the problem. For the sample however, 90% denied knowing anyone with TB. On follow-up phone-calls, interviewers noted a great reticence on the part of participants to discuss experiences. This underscores the stigma still attached to TB. Demographic characteristics (n=328) ABSTRACT BACKGROUND OBJECTIVES METHODS In 2009, the Centers for Disease Control and Prevention reported a decline in TB cases in California and the United States. However, in Alameda County, California, there was a 16% increase from 2008 to 2009 Three-fourths of the new TB cases were from immigrants from high endemic countries including the Philippines, Vietnam, China, India and Mexico. Of these, 14% were from the Philippines, the highest source country of TB infections in Alameda County. CONCLUSIONS Funded by the California Tides Foundation Community Clinic Initiatives Relationship to Family with TB (n=328) BACKGROUND: Despite declining rates of tuberculosis (TB) nationwide, TB infection and disease remains prevalent among immigrants. In Alameda County, the majority of new cases were from Asian and Pacific Islanders from high endemic countries. TB cases among Filipinos in this county “hotspot” were among the highest. OBJECTIVE: To characterize TB screening rates, positivity rate, latent infection versus actual TB cases, treatment of latent infection and personal awareness of TB cases in a community sample of Filipino- Americans. METHODS: A TB screening questionnaire was administered to 328 Filipino- American participants in a community health survey. RESULTS: 73% of respondents (n=240) were TB skin tested, but 27% were not, including some who “did not know.” Of those skin tested, 78% (n=187) self-reported a negative result and 22% (n=53) a positive results. Based on self-reported skin tests, chest x-rays, symptom histories and other labs, 15% of the sample had latent TB infection and 2% had old treated TB. Of those with latent TB, only half completed the recommended 6 to 9 months of TB prophylaxis. Those that did not, perceived themselves to be “OK” or were not encouraged to do so by their doctors. Finally, only 10% were aware of TB disease among family and acquaintances and 90% claimed not to know anyone with TB. During follow up interviews, respondents were very reticent to discuss the TB cases they were aware of. CONCLUSIONS: TB infection was under screened and undertreated, despite the known high prevalence rate among Filipino-Americans, and in spite of the high health insurance rate of the sample. TB remains highly stigmatized. (%) Age (>=45 years) 44% Female 56% Philippine born 76% Lived >=10 years in the US* 70% US citizen 70% Permanent resident 25% College graduate 59% Medically insured 81% *non-US born only A descriptive, cross sectional survey was conducted among Filipinos, aged >= 18 years who live or work in Union City, CA in 2009. A convenience sample was recruited to create a representative sample of the Union City Filipino community; the cohort was aged and sex matched based on the 2000 Census. A self-administered, a 110-item confidential questionnaire in English and Tagalog elicited information including health history, screening, access, diagnosis, and behaviors. Informed consent was obtained prior the interview. The TB questionnaire was designed as an algorithm to further determine TB classifications. Those with an affirmative history of TB testing for example, were asked about chest x-ray results, sputum testing, symptoms, diagnosis and treatment regimen. This enabled the classification of those who had latent TB infection, those who had treated TB disease, and those who had probable old TB disease. To identify issues related to health access, behaviors, cultural beliefs, barriers to care, and common health conditions, including TB in a community sample of Filipino-Americans To determine self-reported: 1. TB screening rates, 2. positivity rate (by protein purified derivative (PPD) skin test), 3. the percentage of latent infection versus active TB 4. rates of treatment of latent infection and 5. personal awareness of TB cases Latent TB treatment One-fourth were PPD +; of those three-fourths had latent TB PPD screening and positivity rates Despite the high prevalence of TB cases, over 90% of respondents denied personal knowledge of anyone with TB. RESULTS Ifyes,w hatw as the result? 77% 23% Positive N egative H ave you everbeen tested forTB ? 20% 6% 74% Yes No D on'tknow PPD results 5 7 2 56 42 189 Negative LatentTB Active TB Unknow n O ld TB TB infection by classification Received treatment 45% N o treatm ent 55% Among those with latent TB, over half (55%) did not receive treatment The results of the study were subject to the limitations of self-reported data and the author unable to independently ascertain results based on a review of respondents’ medical records. Furthermore the stigma attached to TB and the differences in how TB infection is screened and managed in the U.S. compared to the Philippines, could all lead to underreporting of inciden LIMITATIONS In 2006, Filipinos accounted for 11% of total TB cases in the U.S. and 20% of TB cases in California. This translates to a case rate of 52/100,000 persons. In contrast the U.S. national case rate is 5/100,000 persons. The high prevalence of TB infection in the Philippines – the 9 th highest in the world – is the substrate for the high incidence of TB in Filipino immigrants. Alameda County Health Dept. TB Control Unit, 2010
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Transcript of Tuberculosis Prevalence, Screening and Treatment among Filipinos in Union City, California Christine...
Tuberculosis Prevalence, Screening and Treatment among Filipinos in Union City, CaliforniaChristine Araneta PA-C, Stephanie Sario BA, Jennifer Lee MPH
Asian Health Services, Oakland, California
RESULTS
Screening for TB infection: For a high endemic community, in a known TB “hotspot”, the rates for TB screening were below the expected standard. Given that the sample was highly insured at 81%, one-fourth were not tested or did not know their status.
Treatment of latent TB infection: Latent TB infections were those who tested positive, had negative chest x-rays, and no symptoms and signs of TB. A little over half were treated preventively with anti-TB drugs anywhere from six to nine months. The other half, were not, perceiving that anti-TB prophylaxis was unnecessary or not highly recommended by their physicians. Latent infection is the reservoir of future TB infections and disease, and its eradication depends greatly on physician practices and the public’s TB-risk awareness.
Stigma of TB: Because of the high TB burden among Filipinos, one would expect a greater personal awareness of the problem. For the sample however, 90% denied knowing anyone with TB. On follow-up phone-calls, interviewers noted a great reticence on the part of participants to discuss experiences. This underscores the stigma still attached to TB.
Demographic characteristics (n=328)
ABSTRACT
BACKGROUND
OBJECTIVES
METHODS
In 2009, the Centers for Disease Control and Prevention reported a decline in TB cases in California and the United States.
However, in Alameda County, California, there was a 16% increase from 2008 to 2009
Three-fourths of the new TB cases were from immigrants from high endemic countries including the Philippines, Vietnam, China, India and Mexico. Of these, 14% were from the Philippines, the highest source country of TB infections in Alameda County.
CONCLUSIONS
CONCLUSIONS
Funded by the California Tides Foundation Community Clinic Initiatives
Relationship to Family with TB (n=328)
BACKGROUND: Despite declining rates of tuberculosis (TB) nationwide, TB infection and disease remains prevalent among immigrants. In Alameda County, the majority of new cases were from Asian and Pacific Islanders from high endemic countries. TB cases among Filipinos in this county “hotspot” were among the highest.
OBJECTIVE: To characterize TB screening rates, positivity rate, latent infection versus actual TB cases, treatment of latent infection and personal awareness of TB cases in a community sample of Filipino-Americans.
METHODS: A TB screening questionnaire was administered to 328 Filipino-American participants in a community health survey.
RESULTS: 73% of respondents (n=240) were TB skin tested, but 27% were not, including some who “did not know.” Of those skin tested, 78% (n=187) self-reported a negative result and 22% (n=53) a positive results. Based on self-reported skin tests, chest x-rays, symptom histories and other labs, 15% of the sample had latent TB infection and 2% had old treated TB. Of those with latent TB, only half completed the recommended 6 to 9 months of TB prophylaxis. Those that did not, perceived themselves to be “OK” or were not encouraged to do so by their doctors. Finally, only 10% were aware of TB disease among family and acquaintances and 90% claimed not to know anyone with TB. During follow up interviews, respondents were very reticent to discuss the TB cases they were aware of. CONCLUSIONS: TB infection was under screened and undertreated, despite the known high prevalence rate among Filipino-Americans, and in spite of the high health insurance rate of the sample. TB remains highly stigmatized.
(%) Age (>=45 years) 44%
Female 56%Philippine born 76%Lived >=10 years in the US* 70%US citizen 70%Permanent resident 25%College graduate 59%Medically insured 81%
*non-US born only
A descriptive, cross sectional survey was conducted among Filipinos, aged >= 18 years who live or work in Union City, CA in 2009.
A convenience sample was recruited to create a representative sample of the Union City Filipino community; the cohort was aged and sex matched based on the 2000 Census.
A self-administered, a 110-item confidential questionnaire in English and Tagalog elicited information including health history, screening, access, diagnosis, and behaviors. Informed consent was obtained prior the interview.
The TB questionnaire was designed as an algorithm to further determine TB classifications. Those with an affirmative history of TB testing for example, were asked about chest x-ray results, sputum testing, symptoms, diagnosis and treatment regimen. This enabled the classification of those who had latent TB infection, those who had treated TB disease, and those who had probable old TB disease.
To identify issues related to health access, behaviors, cultural beliefs, barriers to care, and common health conditions, including TB in a community sample of Filipino-Americans
To determine self-reported: 1. TB screening rates, 2. positivity rate (by protein purified derivative (PPD) skin test), 3. the percentage of latent infection versus active TB
4. rates of treatment of latent infection and 5. personal awareness of TB cases
Latent TB treatment
One-fourth were PPD +; of those three-fourths had latent TB
PPD screening and positivity rates
Despite the high prevalence of TB cases, over 90% of respondents denied personal knowledge of anyone with TB.
RESULTS
If yes, what was the result?
77%
23%
Positive Negative
Have you ever been tested for TB?
20%
6%
74%
Yes No Don't know
PPD results
5
7
2
5642
189
Negative Latent TB Active TB Unknown Old TB
TB infection by classification
Received treatment
45% No treatment55%
Among those with latent TB, over half (55%) did not receive treatment
The results of the study were subject to the limitations of self-reported data and the authors were unable to independently ascertain results based on a review of respondents’ medical records.
Furthermore the stigma attached to TB and the differences in how TB infection is screened and managed in the U.S. compared to the Philippines, could all lead to underreporting of incidence.
LIMITATIONS LIMITATIONS
In 2006, Filipinos accounted for 11% of total TB cases in the U.S. and 20% of TB cases in California. This translates to a case rate of 52/100,000 persons. In contrast the U.S. national case rate is 5/100,000 persons.
The high prevalence of TB infection in the Philippines – the 9th highest in the world – is the substrate for the high incidence of TB in Filipino immigrants.
Alameda County Health Dept. TB Control Unit, 2010
