title: Utilization of a latent tuberculosis infection referral system by newly resettled refugees in central Ohio.
abstract: METHODS
  A resettlement medical screening program that refers refugees with a positive tuberculin skin test (TST) to a public health tuberculosis (TB) clinic for evaluation for latent tuberculosis infection (LTBI).
  
  
  OBJECTIVE
  To identify the proportion of refugees that were TST-positive,  how many attended after referral for medical evaluation, what characteristics influenced follow-up, and whether programmatic changes would increase follow-up rates.
  
  
  METHODS
  Refugee characteristics and follow-up information were extracted from the resettlement medical records of 224 adult  refugees screened in Columbus, Franklin County, Ohio, in 2008. Programmatic modifications in the referral system were implemented in December 2010.
  
  
  RESULTS
  Of 224 refugees screened, 115 (51%) had a TST induration ≥ 5 mm, 113 (98.3%) were referred and 60 (53.1%) attended the Columbus  Public Health (CPH) TB clinic for evaluation. Resettling from East Asia (Myanmar, Viet Nam; OR 12.48, 95%CI 2.32-67.06) and TST induration size ≥ 10 mm (OR 9.38, 95%CI 1.41-62.26) were significantly associated with follow-up at the CPH. Implementation of scheduled appointments,  telephone reminders and transportation arrangements increased follow-up to 93.5%.
  
  
  CONCLUSIONS
  Collaborative strategies can improve follow-up rates of TST-positive refugees during resettlement medical screening, facilitate LTBI treatment and prevent the development of active TB.
authors: The Ohio State University College of Public Health, Columbus, Ohio 43210, USA.
authors: K
authors: K
authors: Kowatsch-Beyer
authors: A
authors: A
authors: Norris-Turner
authors: R
authors: R
authors: Love
authors: P
authors: P
authors: Denkowski
authors: S-H
authors: SH
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D001208:Asia / Q000208:ethnology; D044466:Asian People; D016009:Chi-Square Distribution; D004641:Emigration and Immigration; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012036:Refugees; D017010:Reminder Systems; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013689:Telephone; D014187:Transportation of Patients; D014374:Tuberculin Test; D055815:Young Adult