What You Need to Know about Latent Tuberculosis Infection (LTBI) and Tuberculosis (TB) and its Impact on A/AA and NH/PI Communities: A Note from the Tuberculosis Elimination Alliance
By Tiffany Hirokawa
For Asian, Asian Americans (A/AAs), Native Hawaiians, and Pacific Islanders (NH/PIs), tuberculosis (TB) and latent TB infection (LTBI) disproportionately impacts these communities. A/AAs accounted for nearly 36% and NH/PIs accounted for nearly 2% of all U.S. TB cases in 2021. To address the disproportionate impact of LTBI/TB, community health centers (CHCs) play a pivotal role as essential safety net providers serving the frontlines of prevention and treatment for at-risk communities. However, CHCs face substantial barriers in implementing and conducting LTBI/TB screening, testing, and treatment for their patient populations often as a result of limited funding and staffing, unclear/non-applicable TB guidelines, provider and patient educational barriers, and sociocultural patient barriers.
The Tuberculosis Elimination Alliance’s limited blog series, “Addressing LTBI and TB at Community Health Centers Serving Asian, Asian Americans, Native Hawaiians, and Pacific Islanders,” aims to shed a light on the impact of LTBI and TB on A/AA and NH/PI communities and the community health center providers that serve them. Learn about TB/LTBI basics, the critical role CHCs play in community care, and the importance of providing resources and support to TB/LTBI providers.
Community health centers (CHCs) are critical safety net providers on the frontlines of prevention and treatment for at-risk communities. CHCs provide care to the most vulnerable communities including those who are uninsured or underinsured, have limited English proficiency (LEP), and face additional sociocultural barriers. According to the Kaiser Family Foundation’s (KFF) article “Community Health Centers: Growing Importance in a Changing Health Care System,” in 2016 nearly 92% of health center patients had income at or below 200% of the federal poverty level. Although qualified community health centers receive federal funding to serve underserved communities, CHCs continue to face substantial barriers in implementing and conducting tuberculosis (TB)/latent TB infection screening, testing, and treatment for their patient populations often as a result of limited funding and staffing, unclear/non-applicable TB guidelines, provider and patient educational barriers, and sociocultural patient barriers.
While TB and LTBI are often seen as ancient and nearly eradicated diseases in the U.S., LTBI/TB disease continues to impact those living in the U.S. and its territories. In 2021, alone, there were 7,860 reported TB cases and an estimated 13 million individuals living with asymptomatic LTBI. Asian, Asian American (A/AA), Native Hawaiian, and Pacific Islander (NH/PI) populations continue to be disproportionately impacted by TB at a greater rate compared to other racial and ethnic groups. A/AAs accounted for nearly 36% and NH/PIs accounted for nearly 2% of all U.S. TB cases in 2021. Furthermore, among non–U.S.-born individuals, A/AAs and NH/PIs face further TB disparities. In 2021, 71% of non–U.S.-born persons reported having TB disease, and among this demographic, 48% identified as Asian and 1% as NH/PI. However, patients are not the only populations experiencing substantial barriers to their care. Providers and health systems providing this care are also disproportionately impacted.
The TB Elimination Alliance (TEA) was created to support and address the needs of community health centers and the at-risk populations they serve. As a national partnership of community leaders, TEA is dedicated to eliminating LTBI/TB inequities among A/AA and NH/PI populations through education, awareness-building, and innovation.
To further understand the impact of LTBI/TB in A/AA- and NH/PI-serving community health centers, TEA conducted a national LTBI/TB needs assessment survey between March to May 2022 to collect data on the challenges and best practices of A/AA and NH/PI-serving community health centers in the U.S. and its territories. As a continuation of the 2017 AAPCHO-led LTBI/TB needs assessment, these updated findings and recommendations informed the need for comprehensible LTBI/TB resources and guidelines that are culturally-relevant and conscious of patients’ and health centers’ barriers to LTBI/TB screening, testing, treatment, and education.
The findings will be released this late July 2022 in the “Assessing Latent Tuberculosis Infection and Tuberculosis Screening, Testing, and Treatment Needs Among Community Health Center Serving Asian Americans, Native Hawaiians, and Pacific Islanders’’ report.
In the meantime, TEA aims to provide foundational LTBI and TB background information to engage readers of all levels of LTBI/TB knowledge. In our limited blog series, learn about the following:
- The basics of LTBI and TB presentation, transmission, and treatment;
- TB risk factors for at-risk communities;
- Screening and testing barriers; and
- Treatment barriers.
Stay tuned for the next blog post and additional updates regarding the release of TEA’s needs assessment findings!
Want to get involved? Become a local TEA partner today! We invite state and local TB control programs, community-based organizations, and community health centers to consider becoming a TEA partner today.
We also encourage you to apply to our upcoming mini-grant cycle. For the 2022–2023 TEA Mini-Grant Program, TEA will be offering up to fifteen (15) Mini-Grants to organizations serving A/AA- and NH/PI-communities to enhance LTBI/TB community engagement and education, provider education, and quality improvement. Deadline to apply is Friday, August 5 by 5:00pm local time. Learn more from the RFP: https://bit.ly/TEA22RFP