Human Immunodeficiency Virus Infection in a Rural Community in the United States

Ellerbrock, Tedd V.; Chamblee, Sandra; Bush, Timothy J.; Johnson, Johnny; Marsh, Bryan J.; Lowell, Pam; Trenschel, Robert J.; Reyn, C. Fordham von; Johnson, Linda S.; Horsburgh, C. Robert

doi:10.1093/aje/kwh262

Cited by 25 publications

(35 citation statements)

References 22 publications

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“…Detailed descriptions of the survey methods have been previously reported (21)(22)(23). Between January 1998 and October 2000, a randomized population-based tuberculin skin test survey was performed in a rural area of western Palm Beach County, Florida.…”

Section: Community Surveymentioning

confidence: 99%

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Revisiting Rates of Reactivation Tuberculosis

Horsburgh¹,

O’Donnell²,

Chamblee³

et al. 2010

Am J Respir Crit Care Med

131

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Rationale: Reactivation tuberculosis (TB) occurs as a result of reactivation of latent TB infection (LTBI), and was reported to occur in the United States at a rate of 0.10 to 0.16 cases per 100 person-years in the 1950s; it has not been measured since. Objectives: To calculate the rate of reactivation TB in a U.S. community. Methods: A population-based tuberculin skin test survey for LTBI was performed in western Palm Beach County, Florida, from 1998 to 2000 along with a cluster analysis of TB case isolates in the same area from 1997 to 2001. Reactivation (unclustered) TB was presumed to have arisen from the population with LTBI. Measurements and Main Results: The rate of reactivation TB among persons with LTBI without HIV infection was 0.040 cases per 100 person-years (95% confidence interval ½CI, 0.024-0.067) using the n method and 0.058 cases per 100 person-years (95% CI, 0.038-0.089) using the n-1 method. HIV infection was the strongest risk factor for reactivation (rate ratio ½RR, 57; 95% CI, 27-120; P , 0.001). Among persons without HIV infection, reactivation was increased among those older than 50 years (RR, 3.8; 95% CI, 1.3-11) and among those born in the United States (RR, 3.2; 95% CI, 1.1-9.3). Conclusions: Rates of reactivation TB in this area have declined substantially since the 1950s. The greatest part of this decline may be attributed to the disappearance of old, healed TB in the population. If similar declines are seen in other areas of the United States, the cost-effectiveness of screening and treatment of LTBI may be substantially less than previously estimated.

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Section: Community Surveymentioning

confidence: 99%

“…LTBI was defined as a positive TST according to standard definitions, namely induration of greater than 10 mm when read at 48 to 72 hours, except for HIV-infected persons, for whom induration of greater than 5 mm was used. Subjects were tested for antibody to HIV using ELISA and confirmed by Western blot (22).…”

Section: Community Surveymentioning

confidence: 99%

Revisiting Rates of Reactivation Tuberculosis

Horsburgh¹,

O’Donnell²,

Chamblee³

et al. 2010

Am J Respir Crit Care Med

131

View full text Add to dashboard Cite

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“…It has a population of nearly 35 000, of whom 15% are White, 50% are African American, 25% are Hispanic and 10% are Haitian. 16 …”

Section: Study Area and Populationmentioning

confidence: 99%

“…Annual prevalence data on HIV infection are not available for the intervention or control areas; however, between 1986 and 2000, HIV prevalence in WPB changed more slowly than the decrease in TB rates reported here. 16 Third, it is possible that lower TB incidence is, in part, due to better control of HIV with ART; however, despite the availability of ART after 1998, not all eligible persons with HIV infection in the community were receiving it. Fourth, it is possible that TB incidence decreased among persons who did not receive the intervention (e.g., ecological fallacy).…”

Section: Public Health Action Tb Reduction By Community-based Intervementioning

confidence: 99%

Sustained reduction in tuberculosis incidence following a community-based participatory intervention

O’Donnell

Chamblee²,

Reyn

et al. 2012

public health action

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dents in the design and implementation of the intervention, a strategy known as 'community-based participatory research' (CBPR). 14 To improve participation in TB and LTBI screening and ultimately reduce TB incidence rates in the community, we designed and implemented a communitybased participatory intervention campaign to promote knowledge about and participation in TB prevention activities. One focus of the campaign was a community survey of LTBI prevalence (results reported elsewhere 15 ).The objectives of the present study were to assess the effect of our campaign on the incidence of TB disease and to assess if the intervention reduced the disparity in TB incidence between Blacks and non-Blacks. To do this, we examined surveillance data from before and after the campaign and compared western Palm Beach County, a predominantly agricultural area, with the more urban eastern section of the county, where the campaign did not take place. METHODS Study area and populationWestern Palm Beach County (WPB) Florida, defi ned as the area including postal zip codes 33430, 33438, 33476 and 33493, is a predominantly agricultural area in the southern part of Florida. It has a population of nearly 35 000, of whom 15% are White, 50% are African American, 25% are Hispanic and 10% are Haitian. 16 Community interventionThe Glades Health Survey, a survey to examine the prevalence of TB and human immunodefi ciency virus (HIV) in WPB, was initially proposed in October 1994. A subsequent pilot study indicated a likely 50% participation rate, which would not be high enough to yield valid results. Community interviews identifi ed a lack of trust that health offi cials would maintain patient confi dentiality as a substantial roadblock to participation. At a subsequent meeting of a local umbrella organization of representatives from political, public and private health-related enterprises, a TB study group was formed. This study group decided that the survey should be performed by a local non-governmental organization, and they formed the Glades Health Survey Board (GHSB) to undertake the task.The creation of the GHSB, an ethnically, racially and geographically representative group including social service workers and three pastors, spurred active community engagement in the survey and community Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor There was no decrease in the TB incidence rate ratio between Blacks and non-Blacks in either region during the study period. Conclusions:We conclude that community participation in LTBI screening and TB education was associated with a substantial reduction in TB rates. Although the TB incidence rate ratio did not decrease between Blacks and non-Blacks, TB incidence fell in all racial groups.

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“…are less likely to have health insurance; must become considerably ill before obtaining access to care because of longer distance to travel for care and disproportionate distribution of federal funding of primary health care and supportive services for PLWHA; have less HIV-experienced practitioners and less opportunity to participate in AIDS treatment clinical trials; and have less access to affordable housing (Berry, 1993;Crosby, Yarber, DiClemente, Wingood, & Meyerson, 2002;Ellerbrock et al, 2004;Hall, Li, & McKenna, 2005;Rhodes, Hergenrather, Wilkin, Alegria-Ortega, & Montano, 2006;Ricketts, 1999;Sowell, Moneyham, & Aranda-Naranjo, 1999;St Lawrence, 1999).…”

mentioning

confidence: 99%