Prevention and control of tuberculosis in U.S. communities with at-risk minority populations. Recommendations of the Advisory Council for the Elimination of Tuberculosis.

Tuberculosis (TB) is an increasing public health problem in the United States, particularly among racial/ethnic minorities. In 1990, the number of reported TB cases increased 9.4% compared with 1989 and 15.5% compared with 1984. In 1990, almost 70% of all TB cases and 86% of those among children ages less than 15 years occurred among racial/ethnic minorities. Compared with non-Hispanic whites, the 1990 TB case rate was notably higher for racial/ethnic minorities. Adverse social and economic factors, the human immunodeficiency virus epidemic, and immigration of persons with tuberculous infection are contributing factors to the increase in TB cases. Other contributing factors include physician nonadherence in prescribing recommended treatment regimens and patient nonadherence in following prescribed recommended treatment regimens. To eliminate TB in U.S. communities with at-risk racial/ethnic minorities, the Advisory Council for the Elimination of Tuberculosis recommends a) initiating public awareness campaigns to alert these communities about the increasing TB problems; b) training and educating public and private health-care providers in the skills needed to relate effectively to the at-risk communities being served, and empowering at-risk populations with knowledge and other resources needed to influence the TB programs directed toward their communities; c) building coalitions to help design and implement intensified community TB prevention and control efforts; d) intensifying the screening of at-risk populations for TB and tuberculous infection and providing appropriate treatment and preventive therapy; e) increasing the speed and completeness with which all health-care providers report confirmed and suspected TB cases to appropriate health departments; and f) improving the availability and quality of TB health-care services in socioeconomically disadvantaged areas.