title: [Eliminating tuberculosis one neighborhood at a time].
abstract: OBJECTIVE
  We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it.
  
  
  METHODS
  In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project.
  
  
  RESULTS
  Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County.
  
  
  CONCLUSIONS
  Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.
authors.affiliation: Centros para el Control y la Prevención de Enfermedades, Atlanta, Georgia, Estados Unidos de América, pcegielski@cdc.gov.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Cegielski
authors.forename: David E
authors.initials: DE
authors.lastname: Griffith
authors.forename: Paul K
authors.initials: PK
authors.lastname: McGaha
authors.forename: Melanie
authors.initials: M
authors.lastname: Wolfgang
authors.forename: Celia B
authors.initials: CB
authors.lastname: Robinson
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Clark
authors.forename: Willis L
authors.initials: WL
authors.lastname: Hassell
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Robison
authors.forename: Kerfoot P
authors.initials: KP
authors.lastname: Walker
authors.forename: Charles
authors.initials: C
authors.lastname: Wallace