title: Health care provider perspectives on tuberculosis care for foreign-born populations in New York City.
abstract: Tuberculosis (TB) in foreign-born patients is a key determinant of TB epidemiology in low-burden settings. In New York City (NYC), foreign-born TB populations are heterogeneous and face diverse challenges in accessing care.
  
  
  
  To characterize barriers and facilitators to health care services and identify potential mechanisms to improve TB care for foreign-born patients in NYC.
  
  
  
  Semi-structured interviews with health care providers identified through the NYC TB registry and snowball sampling. Transcripts were analyzed using a modified grounded theory approach.
  
  
  
  Fourteen providers from private practice (21%), community clinic (36%), and hospitals (43%) were interviewed. Barriers clustered into thematic areas: interrelated social and economic issues that impact TB care and treatment (documentation status, poverty, mental/behavioral health issues), challenges of fragmented health system (care continuity, costs), latent tuberculous infection, and relative lack of resources and significant barriers for clinic and private practice providers. Health care providers' deep commitment to foreign-born TB patients was evidenced by their attitudes and actions.
  
  
  
  Improving access to TB care for foreign-born patients in NYC requires strategies that address specific social, economic and structural barriers. Improving linkages between private providers and public health initiatives is a key challenge. Health care providers' commitment to foreign-born communities is a significant resource.
authors.affiliation: Touro College Graduate School of Social Work, New York.
authors.forename: J R
authors.initials: JR
authors.lastname: Zelnick
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York.
authors.forename: M R
authors.initials: MR
authors.lastname: O'Donnell
authors.affiliation: Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York.
authors.forename: S D
authors.initials: SD
authors.lastname: Ahuja
authors.affiliation: Division of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York, USA.
authors.forename: A
authors.initials: A
authors.lastname: Chua
authors.affiliation: Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York.
authors.forename: J
authors.initials: J
authors.lastname: Sullivan Meissner
mesh_terms: D000554:Ambulatory Care Facilities; D054242:Emigrants and Immigrants; D006282:Health Personnel; D006779:Hospitals, Public; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000208:ethnology* / Q000517:prevention & control; D009519:New York City / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011331:Private Practice; D011634:Public Health; D014376:Tuberculosis / Q000188:drug therapy / Q000208:ethnology* / Q000517:prevention & control