TEACH PROGRAM RAISES TB AWARENESS.

A Louisiana State University program, titled "Tuberculosis Education Aimed at Community Health" (TEACH), achieves its dual objectives of educating medical students and providing community outreach

Introduction

Despite the availability of effective anti-tuberculosis treatment, cure rates for tuberculosis (TB) remain unacceptable, and adherence to treatment is a challenging problem throughout the world.

After several decades of decline, the incidence of TB in the United States increased 20% between 1985 and 1992, according to the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga. Among the reasons for the increase are the epidemic of human immunodeficiency virus (HIV); immigration from countries where TB is more prevalent; transmission of TB in high-risk environments, such as correctional facilities, homeless shelters, hospitals, and nursing homes; and deterioration of the public health care infrastructure.

After the surge from 1985 to 1992, the incidence resumed its decline. The 21 337 TB cases reported in the United States in 1996 represent the fourth consecutive year of decline. Even so, there are areas in which TB continues to flourish, especially among foreign-born persons. In 1997, nearly 40% of TB cases were in foreign-born persons. Additionally, outbreaks of drug-resistant TB continue in many areas. An estimated 10 to 15 million persons in the United States are infected with Mycobacterium tuberculosis. Without intervention, about 10% will develop TB at some point.

Minority populations are disproportionately affected with TB. According to a 1997 breakdown by race and ethnicity by the CDC, 33% of reported TB cases were in African Americans, 21% were in Hispanics, 19% were in Asian/Pacific Islanders, and 24% were in whites.

The national TB case average is 7.4 per 100 000 population. The number of TB cases in Louisiana exceeds that, at 9.3 per 100 000 population, ranking in the top 10 states in the nation. The case rate in the Orleans Parish is twice the national average. In 1999, 30% of all TB cases in Louisiana were from the New Orleans area. More than 50% of these New Orleans cases occurred in African Americans. Fifty-one percent of cases were in unemployed/homeless persons, a majority of whom had a history of substance abuse. [1]