title: Missed opportunities for tuberculosis prevention in New York City, 2003.
abstract: BACKGROUND
  Proper management and prevention can radically decrease the incidence of tuberculosis (TB). To further decrease TB cases in New York City, every opportunity for prevention must be utilized. This study sought to identify patients whose disease could have been prevented and describe missed opportunities for TB prevention.
  
  
  METHODS
  Patients diagnosed with TB from April to July, 2003 were identified using the New York City TB registry. Surveillance data, medical records, and patient interviews were used to determine whether patients missed a prevention opportunity or potential for screening. Preventable TB was defined as inappropriate screening of contacts and immigrants, inappropriate treatment of persons with prior TB diagnoses, or those who tested positive for latent TB infection (LTBI) as contacts, immigration, or in community settings. Potentially preventable TB was defined as occurring when those eligible for LTBI screening in community settings were not screened more than 1 year before TB diagnosis. Patients classified as having preventable or potentially preventable TB were grouped as patients with missed opportunities. We calculated the odds of missing a prevention opportunity using logistic regression.
  
  
  RESULTS
  Among the 218 study patients, 22% had preventable TB and 35% had potentially preventable TB. The most common missed opportunity among patients with preventable TB was the failure to initiate LTBI treatment. Birth outside of the United States was not associated with missing a prevention opportunity (odds ratio [OR] = 1.31, confidence interval [CI] = 0.71-2.39); however, extended travel outside of the United States increased the odds (OR = 2.51, CI = 1.19-5.69), particularly among non-US-born patients (OR = 3.01, CI = 1.21-8.59). Missed screening opportunities related to pregnancy, employment, or school attendance were encountered by over half of the study patients.
  
  
  CONCLUSIONS
  The majority of New York City TB patients in our cohort experienced at least 1 missed opportunity for prevention. Further study is warranted to determine whether LTBI treatment eligibility should be extended to those who travel for extended periods, particularly among the non-US-born patients.
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of TB Control, Long Island City, NY 11101, USA. mslopen1@health.nyc.gov
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Slopen
authors.forename: Fabienne
authors.initials: F
authors.lastname: Laraque
authors.forename: Amy S
authors.initials: AS
authors.lastname: Piatek
authors.forename: Shama D
authors.initials: SD
authors.lastname: Ahuja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D003140:Communicable Disease Control / Q000379:methods / Q000706:statistics & numerical data*; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011322:Primary Prevention / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents