Implementation and Effectiveness of CDC Guidelines for Green Card Applicants with Latent Tuberculosis Infection

CDC 针对潜伏性结核感染绿卡申请人的指南的实施和有效性

• 批准号: 10017706
• 负责人: Valerie Anne Pham
• 金额: $ 3.75万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017706
• 关键词: 2 year old; Address; Adherence; Affect; Awareness; BCG Live; Biological Assay; Blood Tests; California; Case Study; Centers for Disease Control and Prevention (U.S.); Comprehension; County; Data; Data Collection; Diagnosis; Disease; Effectiveness; Ensure; Epidemiology; Evaluation; Evidence based treatment; Fellowship; Foundations; Goals; Green Card; Guideline Adherence; Guidelines; Health; Health Resources; Hybrids; Immigration; Incidence; Instruction; Interferon Type II; Intervention; Interview; Knowledge; Mandatory Reporting; Medical; Migrant; Modeling; Molecular; Morbidity - disease rate; Notification; Oranges; Patient Education; Patients; Persons; Population; Prevalence; Prevention Guidelines; Process; Public Health; Public Health Practice; Qualitative Research; Reporting; Research; Research Design; Residencies; Services; Statistical Data Interpretation; Surgeon; Survey Methodology; Surveys; Techniques; Test Result; Testing; Training; Tuberculin Test; Tuberculosis; Universities; Vaccinated; Writing; community based participatory research; disparity reduction; health disparity; implementation science; implementation strategy; improved; knowledge base; medical examination; mortality; outreach program; prevent; screening; screening guidelines; skills; theories; treatment services; uptake

Project Summary/Abstract An estimated 13 million people in the US have latent tuberculosis (TB) infection (LTBI) and act as reservoirs from which deadly active TB disease can develop. Of the total number of TB cases reported nationally in 2017, non-US-born persons accounted for approximately of 70.1%; however, the disproportion is even greater in Orange County, California, where non-US-born persons accounted for approximately 89.2%. A recent study of TB among non-US-born residents found 58.6% of TB cases were from permanent residents, indicating a significant missed opportunity for LTBI intervention in the immigration process. A population that can be screened and treated to reduce the incidence of LTBI is “green” card applicants (GCAs) seeking a change in status from temporary to permanent US residency. GCAs are already procedurally screened for LTBI through medical examination made mandatory by U.S. Citizenship and Immigration Services. The Centers for Disease Control and Prevention (CDC) released new guidelines that may provide favorable opportunities to ensure LTBI-positive GCAs are provided with evidence-based treatment. With the release of the new guidelines, there are many gaps in knowledge, particularly the effect these guidelines will have on GCAs and civil surgeons. It is crucial to screen and treat LTBI in non-US-born persons to reduce disparities in TB morbidity and mortality and, consequently, to achieve TB elimination in the US. This study will contribute to the current knowledge base about the reach and implementation fidelity of the new guidelines through the following aims: 1) to determine civil surgeons’ adherence to new CDC guidelines, specifically the percentage of civil surgeons who screen using a blood test, report LTBI-positive GCAs to the health department, and inform GCAs of their LTBI diagnosis; 2) to determine the effect of the implementation of new CDC guidelines on LTBI treatment rates among GCAs; and 3) to explore facilitators and potentially modifiable barriers to guideline adherence among civil surgeons. We will generate critical preliminary data for developing public health outreach programs to maximize the uptake of the new guidelines and, ultimately, prevent TB among GCAs. As TB screening is already routinely done in this population, focusing on extending LTBI treatment services to GCAs may be a sustainable strategy that substantially contributes to TB elimination in the US. This fellowship training will take place at the University of California-Irvine and will enable the applicant to achieve the following goals: 1) mastery of skills for quantitative research, specifically in research design, statistical analysis, and survey building; 2) mastery of skills for qualitative research, specifically in qualitative study design, fieldwork analysis, data collection, interview techniques, content analysis, and write-up of qualitative data; 3) expand knowledge of theories, models, and frameworks of implementation science; and 4) engagement in health disparities, migrant health, and community-based research.

项目总结/摘要 据估计，美国有1300万人患有潜伏性结核病（TB）感染（LTBI）， 致命的活动性结核病可能发展的水库。在报告的结核病病例总数中， 2017年，非美国出生的人约占70.1%;然而，这种比例失调 在加州的橙子县，这一比例更高，非美国出生的人约占89.2%。一 最近对非美国出生居民结核病的研究发现，58.6%的结核病病例来自永久居民， 这表明LTBI在移民过程中错过了一个重要的干预机会。的中国人 可以进行筛查和治疗，以减少LTBI的发病率是“绿色”卡申请人（GCA）寻求 从美国临时居民身份变更为永久居民身份。GCA已经在程序上进行了筛查， LTBI通过美国公民和移民服务局强制进行的体检。的 疾病控制和预防中心（CDC）发布了新的指南， 确保为LTBI阳性GCA提供循证治疗的机会。与释放 新的指导方针，在知识方面存在许多差距，特别是这些指导方针将对 GCA和民间外科医生。在非美国出生的人中筛查和治疗LTBI以减少 结核病发病率和死亡率，从而实现在美国消除结核病。这项研究将有助于 目前关于新准则的覆盖范围和实施保真度的知识基础， 以下目标：1）确定民间外科医生遵守新的CDC指南，特别是 使用血液测试进行筛查的民间外科医生，向卫生部门报告LTBI阳性GCA，并告知 他们LTBI诊断的GCA; 2）确定实施新CDC指南对LTBI的影响 GCA之间的治疗率; 3）探索指南的促进因素和潜在的可修改障碍 民间外科医生之间的依从性。我们将为发展公共卫生提供关键的初步数据， 推广计划，以最大限度地吸收新的指导方针，并最终在GCA中预防结核病。作为 结核病筛查已经在这一人群中进行，重点是将LTBI治疗服务扩展到 GCA可能是一种可持续的战略，大大有助于在美国消除结核病。该研究金基金 培训将在加州大学欧文分校进行，并使申请人能够实现 以下目标：1）掌握定量研究的技能，特别是在研究设计，统计分析， 2）掌握定性研究的技巧，特别是定性研究的设计， 实地调查分析、数据收集、访谈技巧、内容分析和定性数据的撰写; 3） 扩展实施科学的理论，模型和框架的知识;以及4）参与 健康差距、移民健康和基于社区的研究。