title: Moving toward tuberculosis elimination: implementation of statewide targeted tuberculin testing in Tennessee.
abstract: BACKGROUND
  From 1993 to 2010, annual U.S. tuberculosis (TB) rates declined by 58%. However, this decline has slowed and disproportionately occurred among U.S.-born (78%) versus foreign-born persons (47%). Addressing the high burden of latent TB infection (LTBI) must be prioritized.
  
  
  OBJECTIVE
  Only Tennessee has implemented a statewide program for finding and treating people with LTBI. The program was designed to address high statewide TB rates and growing burden among the foreign-born. We sought to assess the feasibility and yield of Tennessee's program.
  
  
  METHODS
  Analyzing data from the 4.8-year period from program inception in March 2002 through December 2006, we quantified patients screened using a TB risk assessment tool, tuberculin skin tests (TST) placed and read, TST results, and patients initiating and completing LTBI treatment. We then estimated the number needed to screen to find and treat one person with LTBI and to prevent one case of TB.
  
  
  RESULTS
  Of 168,517 persons screened, 102,709 had a TST placed and read. Among 9,090 (9%) with a positive TST result, 53% initiated treatment, 54% of whom completed treatment. An estimated 195 TB cases were prevented over the 4.8 years analyzed, and program performance measures improved annually. The number of TSTs placed to prevent one TB case ranged from 150 for foreign-born persons to 9,834 for persons without TB risk.
  
  
  CONCLUSIONS
  Targeted tuberculin testing and LTBI treatment is feasible and likely to reduce TB rates over time. Yield and cost-effectiveness are maximized by prioritizing foreign-born persons, a large population with high TB risk.
authors.affiliation: Division of Tuberculosis Elimination, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta,Georgia, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Cain
authors.forename: Katie N
authors.initials: KN
authors.lastname: Garman
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Odile P
authors.initials: OP
authors.lastname: Ferrousier-Davis
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Miranda
authors.forename: Charles D
authors.initials: CD
authors.lastname: Wells
authors.forename: Connie A
authors.initials: CA
authors.lastname: Haley
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data; D004641:Emigration and Immigration; D005240:Feasibility Studies; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D014374:Tuberculin Test / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*