Utilization of a latent tuberculosis infection referral system by newly resettled refugees in central Ohio

A resettlement medical screening program that refers refugees with a positive tuberculin skin test (TST) to a public health tuberculosis (TB) clinic for evaluation for latent tuberculosis infection (LTBI).

To identify the proportion of refugees that were TST-positive, how many attended after referral for medical evaluation, what characteristics influenced follow-up, and whether programmatic changes would increase follow-up rates.

Refugee characteristics and follow-up information were extracted from the resettlement medical records of 224 adult refugees screened in Columbus, Franklin County, Ohio, in 2008. Programmatic modifications in the referral system were implemented in December 2010.

Of 224 refugees screened, 115 (51%) had a TST induration ≥ 5 mm, 113 (98.3%) were referred and 60 (53.1%) attended the Columbus Public Health (CPH) TB clinic for evaluation. Resettling from East Asia (Myanmar, Viet Nam; OR 12.48, 95%CI 2.32-67.06) and TST induration size ≥ 10 mm (OR 9.38, 95%CI 1.41-62.26) were significantly associated with follow-up at the CPH. Implementation of scheduled appointments, telephone reminders and transportation arrangements increased follow-up to 93.5%.

Collaborative strategies can improve follow-up rates of TST-positive refugees during resettlement medical screening, facilitate LTBI treatment and prevent the development of active TB.