Impact of Port of Entry Referrals on Initiation of Follow-Up Evaluations for Immigrants with Suspected Tuberculosis: Illinois
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US-bound immigrants with suspected non-infectious TB are encouraged to be medically re-evaluated after arrival in the United States. We evaluated the Centers for Disease Control and Prevention’s immigrant referral process, designed to facilitate timely post-arrival evaluations. Over 1,200 immigrants with suspected TB arriving during October 1, 2008–September 30, 2010 were identified. In 2011, differences in days to evaluation initiation were assessed by referral type using survival analysis and Cox proportional hazard models. Among those receiving any referral, median time to post-arrival evaluation was significantly lower compared with immigrants receiving no referral (16 vs. 69 days, respectively; p < 0.0001). After adjusting for the covariates, immigrants receiving any referral initiated follow-up at 4 times the rate (adjusted hazard ratio = 4.0; p < 0.0001) of those receiving no referral. Implementing a referral system at US ports of entry will improve timeliness and increase the proportion of immigrants initiating domestic evaluation.
KeywordsEvaluation Tuberculosis Referral Immigrants
We thank the Illinois Department of Public Health TB Control Program Regional Nurse Consultants Elaine Darnell, Debra Stephens and Carrie Storrs, and Peter Ward, Illinois Department of Public Health TB Control Program Surveillance Manager, for coordinating data collection efforts with Illinois county health departments; Ashley Dyer, University of Illinois Chicago student, for data collection and entry; and Chicago Quarantine Public Health Officers Shannon Bachar and Lisa Poray for providing immigrant referrals. This study was supported by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention Cooperative Agreement Number 5U38HM000414. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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