Screening for infection and disease as a tuberculosis control measure among indigents in New York City, 1994-1997

SETTING: Several social service agencies in New York City, and the Chest Cl inic of Bellevue Hospital, a large public hospital. OBJECTIVE: TO determine the utility of screening as a preventive and contro l measure among persons at risk for tuberculosis. DESIGN: Persons seeking social services at several private agencies in New York City were screened, and those with a positive skin test or symptoms su ggestive of active tuberculosis were referred to the Chest Clinic for evalu ation. RESULTS: Of 3828 persons evaluated, 20 had active tuberculosis, and 33% of the screened cohort were tuberculin skin test positive, Of 466 persons with tuberculosis infection who were evaluated, only 55 persons were given ison iazid (INH), and only 20 completed preventive therapy. Most patients who we re not given INH had taken it previously, were older than 35 years, or had continuing alcohol use which made physicians reluctant to prescribe isoniaz id, CONCLUSION: Screening for tuberculosis may detect a significant number of c ases of active disease when the background prevalence of the disease is ver y high. However, screening for infection as a means to prevent future cases is unlikely to be effective unless rates of administration and completion of isoniazid preventive therapy are increased.