Targeting High-Risk Neighborhoods May Eliminate Tuberculosis

Identifying specific neighborhoods that have a high incidence of tuberculosis followed by testing and treating the residents proved to eliminate those communities cases of tuberculosis, according to new research published in the American Journal of Public Health.

A latent tuberculosis infection, called LTBI, accounts for the development of most tuberculosis cases. By identifying geographic areas with persistent high incidence of both LTBI and active tuberculosis disease, researchers were able to locate two specific neighborhoods in Smith County, Texas, with a high risk of tuberculosis. In 1996, researchers performed community-based screenings of the infection among 2,258 eligible individuals. Results indicated that 1,291 individuals were tested, 229 tested positive for the LTBI infection and 147 received treatment.

Over the next 10 years, between 1996 and 2006, the two neighborhoods saw no cases of tuberculosis, compared to a period between 1985 and 1995 in which there were 15 cases. The study showed a positive result from geographically targeting specific high-risk clusters and predicts that an estimated seven to 14 tuberculosis cases were prevented as a result of the targeted screening and treatment.

The keys to active, community-based screening and preventive treatment would be to target high-risk populations with an efficient strategy, maximize participation and minimize losses to follow-up so that the entire process becomes cost-effective, according to the authors. In simple terms, the past location of tuberculosis in a community, epidemiologically speaking, may be the best predictor of the location of future tuberculosis cases, the authors suggest.

The American Journal of Public Health is the monthly journal of the American Public Health Association.