ORGANIZATIONAL ISSUES IN CONDUCTING TUBERCULOSIS SCREENING AT A SYRINGE EXCHANGE PROGRAM

There has been a rise in tuberculosis (TB) cases in the United States and there is a potent link between human immunodeficiency virus (HIV) and tuberculosis. In New York City it is estimated that 40% of the 200 ,000 injecting drug users are infected with HIV. In addition, the tube rculosis case rate is approximately four rimes the national average, a nd one third of these cases occurred in those persons infected with HI V Drug users have a high prevalence of latent tuberculous infection an d are at high risk for progression to active tuberculosis. Drug users are at high risk for both HIV and TB. Although studies have shown the value of incorporating TB services into drug treatment programs, the m ajority of drug users in the United States are not in drug treatment. We have been evaluating the feasibility of conducting TB screening and directly observed TB preventive therapy for active injecting drug use rs at a syringe exchange program in New York City. This paper describe s issues relating to the implementation of the TB screening program an d discusses general and operational issues relevant to integrating med ical and public health programs into existing programs serving drug us ing individuals. (C) 1998 Elsevier Science Inc.