Tuberculosis Challenges and Stigma

Major challenges in TB treatment and control in the US:

  • Getting patients to take their medicine and take it properly
  • Recognizing that a great amount of TB in the United States occurs in immigrants
  • Educating physicians in the proper treatment of TB
  • Recognizing the difference between a TB infection and active TB
  • Being knowledgeable of the PPD tuberculin skin test, a latent TB infection (LTBI), and the management of LTBI
  • Proper follow-up and long-term care of patients who have or have had TB

Address stigma and fear related to TB:
Education:

  • The public must be made aware that myths about TB exist in the United States and are often more prevalent in the third world.

Provision of culturally competent, patient-centered TB care:

  • Physicians must understand what the disease TB means to people of all cultures and walks of life and they must in a kind, considerate way attempt to dispel the myths about TB.
  • Patients from immigrant and refugee communities must be treated properly and with dignity
    • Professional interpreters are needed for many patients
    • Patients who suffer from illiteracy must be cared for in a kind and benevolent manner.
    • Patients should be made to feel that they are participating in the management of their disease.
    • Possible components of a multifaceted, patient-centered treatment strategy:
      • Enablers: Interventions to assist the patient in completing therapy include:
        • Transportation vouchers
        • Childcare
        • Convenient clinic hours and locations
        • Clinic personnel that speak the languages of the populations served.
        • Reminder systems and follow-up of missed appointments
        • Social services assistance (referrals for substance abuse treatment and counseling, housing, and other services)
          • Outreach workers (bilingual/bicultural as needed) can provide many services related to maintaining patient adherence, including
            • provision of directly observed treatment (DOT)
            • follow-up on missed appointments
            • monthly monitoring
            • transportation
            • sputum collection
            • social service assistance
            • educational reinforcement
          • Integration of care of TB with care for other conditions
          • Incentives: Interventions to motivate that patient, tailored to individual patient’s wishes and needs, and thus meaningful to the patient, including:
            • Food stamps and snacks or meals
            • Restaurant coupons
            • Assistance in finding and provision of housing
            • Clothing or other personal products
            • Books
            • Stipends
            • Patient contract


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