Setting: Grady Memorial Hospital, a public hospital in Atlanta, Georgia, a city with high rates of tuberculosis.
Objective: To identify specific points of contact with the public health system where high risk individuals could receive tuberculin testing and isoniazid preventive therapy.
Design: Patient interviews and medical chart reviews of tuberculosis patients diagnosed in hospital between October 1993 and December 1994.
Results: In total 151 tuberculosis patients participated: 80% were male, 89% African American, the mean age was 40; 50% were HIV co-infected. Three fourths reported no regular source of medical care. The only potential public health sites at least one third of the patients had encountered in the five years prior to tuberculosis diagnosis were correctional institutions (44%) and public hospital in-patient wards (37%). Duration of incarceration was six months or more in only 13% of patients. Of 108 (71%) patients who had identified substance abuse problems, only 25% had been in treatment programs.
Conclusion: We conclude that most tuberculosis cases in this community occurred in persons with poor access to health care and few opportunities for public health intervention. Tuberculosis prevention for this high risk population can best be accomplished by focusing efforts on early case identification, completion of therapy and contact investigations.