Screening for TB infection among a high risk inner-city population: Is it efficacious?

H. M. Blumbero, B. Metzger, M. Sotir, J. Tapia, S. Murdock, N. N. Bock

Research output: Contribution to journalArticlepeer-review


The majority of cases of tuberculosis (TB) in the U.S. are due to reactivation of latent infection. We prospectively evaluated the efficacy of TB screening and preventive therapy (PT) among a high risk inner-city population in Atlanta. Patients accessing care at a variety of sites in Atlanta including GMH ER and selected clinics, Mercy Mobile Health Care clinics for the homeless, as well as the Atlanta City Jail were offered a tuberculin skin test (TST) and if positive were evaluated for PT and started on INH if indicated. All services were free. Over a 2 year period, 7246 inner-city residents had a TST placed and 65% returned to have the TST read at 48-72 hours. Demographics of the population screened were as follows: 82.7% were black, 12.8% were white, and 4.5% were of other race/ethnicity. Median age was 35 years, 94.9% were bom in the USA, and 62.5% were male. 809 (17.2%) of the 4701 that returned to have the TST read had a positive test. No cases of active TB were diagnosed. 409 (50.5%) of the 809 with a positive TST had an indication for PT per ATS/CDC guidelines. 310 started PT and 84 (27.1% of those that started PT, 10.4% of those with an indication for PT, 1.2% of the total screened) completed at least 6 mo of INH. In multivariate analysis factors associated with a higher completion rate included: foreign birth (OR=4.1, 95%CI 1.8-9.3) and age >65 (OR=6.0, 95%CI 1.4-24.5); those screened in jail were less likely to complete PT (OR=0.3, 95%CI 0.1-0.6). In summary, we were able to screen a large number of inner-city residents for TB, have most return to have the TST read and noted a significant proportion had TB infection. However, only a fraction of those screened completed PT. Large scale screening of a high risk population does not appear to be efficacious given limited resources and competing priorities of TB control programs; a more targeted approach is indicated.

Original languageEnglish (US)
Pages (from-to)414
Number of pages1
JournalClinical Infectious Diseases
Issue number2
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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