Researchers at Yale Schools of Medicine and Public Health focused on the difficulty of identifying high-risk individuals in urban settings—particularly foreign-born individuals—who may have latent TB infection (LTBI). According to CDC, foreign-born persons comprised 62.5 percent of all new active TB infections in the United States in 2011. However, screening policies and programs are different for refugees and naturalizing citizens and are not directed at high-risk undocumented individuals.
The researchers reviewed 2003–2011 data from a comprehensive mobile healthcare clinic in New Haven, Conn. They examined more than 2,500 TB skin tests and found 356 new cases of LTBI. Also, a mobile healthcare van reached many people who would not be reached by the usual methods. For example, undocumented immigrants and other foreign-born persons, whether documented or not, were among the highest number screened and treated. Many of these individuals were from a country ranked among those with the highest TB prevalence.
Frederick L. Altice, MD, senior author and professor of medicine in the section of infectious diseases at Yale School of Medicine, noted that although the Affordable Care Act would increase healthcare access and provide insurance for legal foreign-born persons, those without documentation would not interact with traditional healthcare systems and, therefore, would not be detected and treated unless innovative health systems were designed to focus on that population. Jamie Morano, MD, of the infectious disease section of Yale School of Medicine and first author of the study, commented that the situation provided an opportunity for local and national policymakers to pay attention to helping productive new immigrants remain healthy.
The full report, “Latent Tuberculosis Infection: Screening and Treatment in an Urban Setting,” was published online in the Journal of Community Health, (2013; doi 10.1007/s10900-013-9704-y).