A tuberculin screening and isoniazid preventive therapy program in an inner-city population

As tuberculosis transmission decreases, case rates decline and an increasin g proportion of cases arises from the pool of persons with latent infection . Elimination of tuberculosis will require preventing disease from developi ng in infected persons. From 1994 to 1996 the Atlanta TB Prevention Coaliti on conducted a community-based tuberculin screening and isoniazid preventiv e therapy project among high-risk inner-city residents of Atlanta, Georgia. We established screening centers in outpatient waiting areas of the public hospital serving inner-city residents, the city jail, clinics serving the homeless, and with outreach teams in neighborhoods frequented by drug users . All services were provided free. A total of 7,246 persons participated in tuberculin testing; 4,701 (65%) adhered with skin test reading, 809 (17%) had a positive test, 409 (50%) fit current guidelines for isoniazid prevent ive therapy, 84 (20%) we intended to treat completed therapy. The major lim itations of this community-based tuberculin screening and preventive therap y project were the low proportion of infected individuals who were eligible for isoniazid preventive therapy and the poor adherence with a complete re gimen among those we intended to treat. For community-based programs to be efficacious, preventive therapy regimens that are of shorter duration and s afe for older persons will need to be implemented.