Research

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BACKGROUND

The Tuberculosis Epidemiologic Studies Consortium (TBESC) was created by the Division of Tuberculosis Elimination (DTBE) of the U.S. Centers for Disease Control and Prevention (CDC) in order to strengthen, focus, and coordinate tuberculosis research. The Hawai`i Department of Health was one of 22 sites in the United States and Canada that successfully competed for membership in the TBESC I in 2001. Members of the TBESC are responsible for designing, conducting, and evaluating programmatically relevant epidemiologic, behavioral, economic, laboratory, and operations research concerning the identification, diagnosis, prevention, and control of active TB disease and latent TB infection in North America. To read the abstract of the TBESC profile presented at the American Thoracic Society 2003 Conference, click here.  Additional information on the TBESC research model and the design and implementation of the 22 site study can be found online.

Hawai’i is known to consistently have one of the highest case rates for active TB in the US. Therefore, the TBESC provides a unique opportunity for Hawai`i to participate in a national consortium of academic, state and metropolitan TB sites contributing to progressive research that addresses current questions to improve the diagnosis and treatment of latent and active TB in North America. Many of the topics identified in the recent Institute of Medicine’s (IOM) Report, Ending Neglect: The Elimination of Tuberculosis in the United States, are addressed by TBESC research projects to help accelerate the elimination of TB in the US and Canada. To read the CDC’s response to the IOM report, click here. Hawai’i continues to be involved in TB research through participation in the second phase of the program, TBESC II, which focuses on latent TB infection. A description of latent TB infection and more information on TBESC II can be found at the CDC’s TBESC website.

TBESC Sites

TBESC Map

CURRENT RESEARCH PROJECTS

The TB Control Branch of the Hawai’i Department of Health is currently involved in the TBESC II project, improving the diagnosis and treatment of latent tuberculosis, with first task order (TO 001) entitled, “Prospective Comparison of the Tuberculin Skin Test and Interferon-Gamma Release Assays in Diagnosing Infection with Mycobacterium tuberculosis and in Predicting Progression to Tuberculosis.” This prospective cohort study will compare three different tests for TB infection and determine their utility in predicting progression to active TB disease. Approximately 6,000 individuals at high risk for TB infection will be enrolled annually, with 500 of these from Hawai’i. For more information on this study, click here.

PAST RESEARCH PROJECTS

The TB Control Branch of the Hawai`i Department of Health was previously involved in four TBESC I research projects. Enhanced Surveillance to Identify Missed Opportunities for Prevention of Tuberculosis in the Foreign-Born, was the first large population-based epidemiological study of TB among the foreign-born in the United States and Canada. This cross-sectional study focused on in-person interviews with a random sample of 1,500 cases – 50 of whom lived in Hawai’i – who were diagnosed with TB in 2003-2004. Published results of this study can be found by following this link.

The second project, Factors Associated With Acceptance of, Adherence to, and Toxicity From Treatment for Latent Tuberculosis Infection, was a retrospective chart review intended to better understand the scope of treatment of latent tuberculosis infection (LTBI) in the United States and Canada, and to elucidate factors associated with acceptance and completion of such treatment. It provided a description of the population being offered and given treatment for LTBI in the United States and Canada. A prospective cohort study of selected patients who have been offered treatment for LTBI was conducted upon completion of the chart review. For further information regarding LTBI, click here. Click on the following links to access published results of this study: Colson et al (2013), Horsburgh et al (2010), Hirsch-Moverman et al (2015), Pettit et al (2013), and Sterling et al (2006).

The third project, Primary Care Management of Latent and Active Tuberculosis Among Immigrant Populations: a Study of Barriers and Facilitators, was intended to elicit and clarify the knowledge, attitudes, and practices of primary care providers who see foreign-born patients at risk for latent and active tuberculosis. Based on data provided during qualitative interviews, an intervention was designed to improve provider knowledge, attitudes, and practice. Pre-and post- intervention surveys were conducted to document the impact of the intervention.

The fourth project, Determining the programmatic costs and benefits of using a nucleic acid amplification (NAA) assay for TB diagnosis within the United States, was awarded to four sites including Hawaii. Retrospective chart abstractions were conducted for TB cases or suspects evaluated between 2008 and 2010, at the Department of Health TB Clinic and some local hospitals. Click here to access results published from this study.

SIGNIFICANCE

Given the high incidence of tuberculosis among Hawai`i’s foreign-born population, local TB control activities need to be tailored to the special circumstances of the foreign-born. These circumstances often involve complicating factors such as visa status, social and economic hardships, linguistic barriers, drug resistance TB and cultural beliefs that delay diagnosis and may interfere with adherence to therapy and cooperation with contact investigations. Our participation in TBESC research activities has and will continue to enable Hawai`i to contribute to research leading to the development of interventions that can improve basic TB control activities and provide the scientific foundation for public health efforts to eliminate TB. For further information, you may contact the TBESC research group at the Hawai`i TB Control Branch.


 Hawaii Tuberculosis Control Program
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Honolulu, HI 96817
Phone: (808) 832-5731
Fax: (808) 832-5846

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