Harborview clinic works to prevent spread of tuberculosis among refugee population

Tuberculosis is an old disease with a new resurgence, a comeback facilitated by various health and social factors — poverty, the AIDS virus, drug use, exposure through travel, and decreased public health surveillance.

“Tuberculosis among foreign-born persons is also a major contributor to the disease’s resurgence in the United States,” says Dr. Carey Jackson, director of the International Medicine Clinic at Harborview and assistant professor of medicine. “And compliance with preventive therapy is low priority among new refugees—they have so many adjustment issues.”

It is widely known that TB can be prevented in newly arriving immigrants through a six-month course of preventive treatment among those exposed to the bacteria. But compliance is also affected by the social stigma of the disease, misunderstandings about symptoms and the best treatment, and the tedium of daily long-term therapy. To counter these problems, Harborview, in partnership with the Seattle-King County Tuberculosis Clinic, has designed an outreach program to enhance acceptance of TB preventive therapy among Seattle area refugees, now mainly arriving from Russia, the Balkans and Somalia.

The goal of the two-year program, which began in May, is to educate the refugees soon after arrival about the importance of following the daily preventive regimen for the oral TB medication. (Those who already have the disease are usually treated with a combination therapy.)

Historically, certain immigrant groups don’t like taking this kind of medication for a variety of reasons, Jackson notes. “There are certain myths that persist—that the drug could damage their kidneys, or they overestimate the risk of hepatitis or nausea. They typically stop after two to three weeks instead of the six to nine months required.”

Last year, the federal refugee program increased funding to Seattle-King County Public Health to facilitate community-based TB prevention services with more active follow-up with patients. Through an intensive case management approach, focus groups are conducted to learn about how various ethnic groups view the disease, says Dr. Charles Nolan, director if the public health department’s TB clinic at Harborview. Nolan is a clinical professor of medicine and epidemiology at the UW.

The program now has nearly 60 patients receiving TB preventive therapy, with another 300 to 400 expected to join in the coming year. Three case workers deliver medicine to homes monthly and have personal contact with the refugees every two weeks. The federal funds have been matched by the Annie Casey Foundation and the Firland Foundation. “The TB service is also a hook to get at-risk people to get connected to systems they need to support their well-being,” says Nolan.

Tuberculosis is still the number-one killer among infectious diseases in the world, with about 3 million deaths a year. Disease rates are more than 100 per 100,000 in Somalia and about 70 per 100,000 in Eastern Europe, compared to 7 per 100,000 in the United States. The infection rate, defined as people with latent TB infection, varies from 30 to 50 percent in the worst-affected countries, compared with 5 percent in the United States. ¶

Ellen Liang, Harborview Medical Center