Study finds large gaps in TB preventive care for non-U.S.-born patients

Tuberculosis (TB) remains a preventable disease when asymptomatic infection is identified and treated, and preventing progression to active TB is a key part of eliminating TB in the United States. TB disease in the U.S. disproportionately affects people born outside the country, yet the quality and reach of preventive care in primary care clinics where many non-U.S.-born patients receive services are not well described. To address this, a team led by corresponding author Priya B. Shete reviewed medical records from 12 community health clinics across the U.S. The researchers performed a retrospective cohort study, extracting individual-level demographic and TB clinical data for roughly 700 non-U.S.-born adults per clinic who sought care between June and December 2019. They used those records to build a care cascade — a step-by-step picture of where people are tested, diagnosed, offered treatment, and complete therapy — and to look for gaps in the system that prevent people from receiving full preventive care.

The study included 8,460 non-U.S.-born individuals: 68% were female, and the median age was 50 years (interquartile range 38–63). The researchers found that testing was uncommon; only 2,765 people (33%) had a TB infection test ordered. Of those who tested positive (1,022 people), 787 (77%) were recorded as diagnosed with TB infection, and only 377 of those diagnosed (48%) were offered preventive treatment. A much smaller number, 173 people, actually began treatment at the study clinics, though among those who started, 141 (82%) completed their treatment. To explore patterns associated with these gaps, the investigators constructed a care cascade describing where losses occurred and used multivariable mixed effects logistic models to evaluate associations between individual and clinic-level characteristics and the observed gaps.

The findings point to widespread shortcomings in both testing and initiating preventive treatment for non-U.S.-born patients at the community health clinics studied. While completion rates were high among the relatively few people who began treatment at these clinics, most people never reached that stage because many were not tested or — if diagnosed — were not offered preventive therapy. These gaps are important because treating asymptomatic TB infection prevents progression to active disease and supports national elimination goals. The authors conclude that more research is needed to identify practical strategies that raise testing rates and ensure people diagnosed with TB infection are offered and can access preventive treatment, particularly in settings that serve populations facing a disproportionate burden of disease.