title: Sustained reduction in tuberculosis incidence following a community-based participatory intervention.
abstract: BACKGROUND
  Rates of latent tuberculosis infection (LTBI) and tuberculosis (TB) disease are elevated in the rural southeastern United States and among US- and foreign-born Black residents. To prevent TB and reduce TB transmission, community-based strategies are essential.
  
  
  OBJECTIVE
  To describe a community-based participatory intervention for improving the detection and treatment of LTBI and TB and reducing TB incidence.
  
  
  METHODS
  In rural Florida, we carried out a community educational TB campaign from 1997 to 2000, including presentations at community events, a media campaign and working with local community groups to develop culturally appropriate prevention messages. The campaign was implemented concurrently with a population-based LTBI survey.
  
  
  RESULTS
  The annual TB incidence rate in the intervention area decreased from 81 per 100 000 in 1994-1997, to 42/ 100 000 in 1998-2001, and to 25/100 000 in 2002-2005 (P = 0.001). This decrease was not observed in communities where the intervention was not implemented. There was no decrease in the TB incidence rate ratio between Blacks and non-Blacks in either region during the study period.
  
  
  CONCLUSIONS
  We conclude that community participation in LTBI screening and TB education was associated with a substantial reduction in TB rates. Although the TB incidence rate ratio did not decrease between Blacks and non-Blacks, TB incidence fell in all racial groups.
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: O'Donnell
authors.affiliation: Glades Health Initiative Inc, Belle Glade, Florida, USA.
authors.forename: S
authors.initials: S
authors.lastname: Chamblee
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: von Reyn
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Marsh
authors.affiliation: C L Brumback Health Center, Belle Glade, Florida, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Moreland
authors.affiliation: Tuberculosis Control Program, Public Health, Seattle and King County, Seattle, Washington, USA ; University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: M
authors.initials: M
authors.lastname: Narita
authors.affiliation: 2020 Company LLC, Atlanta, Georgia, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Johnson
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Horsburgh
keywords: HIV/AIDS; racial disparities; rural health; southeastern United States; tuberculosis