Tuberculosis control policies in major metropolitan health departments in the United States. IV. Standards in 1988.

Twenty-eight metropolitan health departments reporting greater than 250 cases annually in 1978 were surveyed to determine the standard of practice in the control of pulmonary tuberculosis and the factors affecting treatment policy. The results were compared to previous surveys in 1978, 1980, and 1984 to determine the impact of policies recommended by the Centers for Disease Control, state health departments, and other agencies. A high degree of uniformity again was demonstrated in chemoprophylaxis and hospitalization policies. However, screening, drug toxicity monitoring, and post-treatment follow-up varied widely among programs. A major trend toward short-course chemotherapy (mean duration of treatment, 20.8 +/- 2.34 months in 1980 versus 7.59 +/- 1.02 months in 1988) accompanied inclusion of pyrazinamide in first-line treatment of 59.4% of all patients in 1988 versus none in 1980. The prevalence of acquired immune deficiency syndrome (AIDS) in association with tuberculosis was estimated to be 7.72% in 1988 versus 2.52% in 1984; nine programs identified AIDS + tuberculosis in greater than 5% of all new cases in 1988 versus only two programs in 1984. Health departments identified the recommendations of the Centers for Disease Control and their respective state health departments as the major source of treatment policy; recommendations of the World Health Organization, American Academy of Pediatrics, and peer-reviewed literature had little effect upon treatment policies. This survey identifies substantial departures from prior treatment policies, some of which are attributed to reduction in available funding, development of shorter-course technology, and recognition of new groups of patients at risk to develop tuberculosis in the major cities in the major cities in the United States.(ABSTRACT TRUNCATED AT 250 WORDS)