# Presentation: 349887

## Stop TB in the African-American Community 

**Nickolas DeLuca, PhD**
**Communications, Education, and Behavioral Studies Branch**
**Division of Tuberculosis Elimination**

## Slide 2

## Slide 3

## Presentation Outline

- An overview of tuberculosis (TB)
- Epidemiology of TB in the African-American community
- TB/HIV co-infection
- Overview of Division of Tuberculosis Elimination sponsored activities to address TB in the African-American community

## Tuberculosis Transmission 

## Active TB Disease vs. Latent TB Infection

| Active TB | Latent TB Infection |
| --- | --- |
| TB germs in the body
May be infectious (before treatment)
Symptoms of TB (e.g., cough)
An active “case” of TB
Treatment needed to cure disease | TB germs in the body, but latent (dormant) state
NOT infectious
No symptoms
Not a “case” of TB
Treatment may be provided to prevent transition from TB infection to TB disease |

## Reported TB Cases* United States, 1982–2006

**Year**

**No. of Cases**

- *Provisional Data as of March 23, 2007

**13,767**

## TB in African Americans

- While overall rates continue to decline in the U.S., TB continues to disproportionately affect racial and ethnic minorities
- In 2005
- 82% of all reported TB cases occurred in racial and ethnic minorities
- 45% of TB cases reported in U.S.-born persons were among African Americans
- The TB case rate for U.S.-born blacks (8.9/100,000) is more than 8 times higher than the rate in U.S.-born whites (1.1/100,000)

## Characteristics Among Selected U.S.-born Persons with TB, 2004 

**Black***

**White***

| No. cases | 2,675 | 2,209 |
| --- | --- | --- |
| Male  | 70%
 | 67% |
| Median age  (years) | 46 | 57 |

***Non-Hispanic**

## TB Cases in U.S.-born Blacks United States, 2000–2004

_**<**_** 99**

**100–399**

_**>**_** 400**

**D.C.**

**TB Cases in U.S.-born Blacks ****United States, 2000****–****2004**

## Completion of TB Therapy < 1 year United States,* 1993–2003

- *Timely completion within 12 months
- **U.S.-born non-Hispanic** **

**Percentage**

## TB/HIV Co-infection

- HIV is the most significant risk factor for progression from TB infection to TB disease
- TB is an AIDS defining illness
- Knowledge of HIV/TB co-infection is important for optimal patient management patient management for contacts, and persons with LTBI or TB disease

## Percent of TB Cases by Race/Ethnic Population with TB/HIV Co-infection, 2000-2005

|  | Total TB/HIV
Cases | % HIV + of Total TB Cases  |
| --- | --- | --- |
| White, Non-Hispanic  | 706 | 4 |
| Black, Non-Hispanic | 4650 | 18 |
| Hispanic | 1455 | 9 |
| American I./ Alaska N. | 31 | 2 |
| Native H./Pacific I. | 115 | .5 |
| Asian | 162 | 1 |

## National TB surveillance system, unpublished data, accessed in April 2007

**18%**

## HIV Infection Among Reported TB Cases, 2005

- All TB cases
- Estimated 9% HIV/TB co-infection
- Estimated 31% with unknown HIV status
- TB Cases in blacks
- Estimated 18% HIV/TB co-infection
- Estimated 21% with unknown HIV status
- *Excludes California data

## TB and HIV Guidelines

- CDC has recommended HIV counseling and testing of all TB patients since 1989
- In September 2006, CDC released guidelines recommending routine HIV screening for patients in all health-care settings (*including TB clinics*) unless the patient declines (opt-out screening)

## Division of Tuberculosis EliminationActivities to Address TB in the African-American Community 

- Research
- Demonstration Projects
- Education and Training
- Communication
- Partnerships
- Community Mobilization

## Summit Goals 

**Summit Goals**** **

- Raise awareness of the problem
- Create links and build networks to lead to ongoing strategies to address the problem

## Summit Participants 

**	****Over 100 individuals from:**
**CDC  and TB prevention programs**
**Professional organizations**
**National Medical Association, National Black Nurses Association**** **
**Academic institutions**
**Representatives from Historically Black Colleges and Universities**
**Local and national advocacy organizations (civic, faith-based, community-based; fraternities)**
**NAACP, Rainbow-Push Coalition**** **
**HHS State and Regional Minority Health Consultants**

## Summit Breakout Sessions

**Summit Breakout Sessions**

- Convened groups based on organizational type to facilitate working with peers
- Groups devised   actions based upon group discussion
- Lists of options
- Restricted to items that could be implemented in the upcoming year

## Categorization of Summit Action Items

- Education and Awareness
- Networking
- Building Capacity
- System Change
- Publicity
- Political Will

## Education and AwarenessAction Items

- Distributed CDC educational materials
- Exhibits and health fairs
- Professional organization conference packets
- Community based organizations
- Increased distribution of *TB Challenge* Newsletter
- Established TB in African-American Community Website
- Established TB in African-American Community Electronic Mailing List

## TB Challenge Newsletter: Partnering to Eliminate TB in African Americans

## Stop TB in the African-American Community Website

- .
**http://www.cdc.gov/nchstp/tb/TBinAfricanAmericans/**

## Stop TB in the African-American Community Electronic Mailing ListSubscription Information 

**To subscribe:**
**http://www.cdcnpin.org/scripts/listserv/tb_aa.asp**

## 
“The Summit was very beneficial in putting TB on our radar screen and brought about new networking. Before the Summit, we were not doing anything in TB.”
		---National Advocacy Group participant

*“**The Summit was very beneficial in putting TB on our radar screen and brought about new networking. Before the Summit, we were not doing anything in TB*.”
- 		---National Advocacy Group participant

## Conclusions

- TB is a health disparity for the African-American community
- DTBE is undertaking activities to address this health disparity, but additional commitment, political will, partners, and resources are needed
- Blacks have the highest TB-HIV co-infection rate for all racial/ethnic groups
- Improvements in HIV testing of all TB patients are needed
- Knowledge of HIV/TB co-infection will improve patient management for HIV and TB patients

## Slide 29

## Acknowledgements

- Dr. Rachel Royce (RTI)
- Dr. Charles Wallace (Texas Department of State Health Services)
- Dr. Ana Lopez-Defede (University of South Carolina)
- Juani Muñoz Sanchez (RTI)
- Shelly Harris (RTI)
- Angela Greene (RTI)
- Tammeka Swinson (RTI)
- Brenda Stone-Wiggins (RTI)
- Dr. Cynthia Woodsong (RTI)
- RTI Office of Communications
- Dr. Kenneth Castro (CDC)
- Jeanne Courval
- Suzanne Marks
- Gail Burns Grant (CDC)
- Dr. Cornelia White (CDC)
- Elvin Magee (CDC)
- Dr. Wanda Walton (CDC)
- Patients and staff from the study sites
- NCHHSTP Office of Health Disparities

## Non-Hispanic Black TB Cases: Characteristics Associated with HIV infection, 2000-2005

| 
Risk Factor
 |  OR | 95% confidence interval |
| --- | --- | --- |
| IDU user |   4.9  | (4.3–5.7)     |
| Non-IDU user |   3.0 |        (2.8–3.3) |
| Homeless |   2.3 |        (2.1–2.6)     |
| Corrections |   1.5 |        (1.3–1.8) |
| Alcohol user  |   1.4 |        (1.3–1.5) |
|  |    |        |