Impact of An Internal Medicine-Pediatrics Residency Quality Improvement Project to Increase Latent Tuberculosis Screening

Approximately a quarter of the world's population has latent tuberculosis infection (LTBI) and is at risk of developing active tuberculosis (TB) during their lifetime. 1 World Health OrganizationLicence: CC BY-NC-SA 3.0 IGO. WHO, 2018 Google Scholar In 2019, approximately 70% of active TB cases occur among non-U.S. born persons. 2 Schwartz NG Price SF Pratt RH et al. Tuberculosis - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020; 69: 286-289 Crossref PubMed Google Scholar , 3 Salinas JL Mindra G Haddad MB et al. Leveling of tuberculosis incidence - United States, 2013-2015. MMWR Morb Mortal Wkly Rep. 2016; 65: 273-278 Crossref PubMed Scopus (86) Google Scholar , 4 Yuen CM Kammerer JS Marks K et al. Recent transmission of tuberculosis - United States, 2011-2014. PLoS One. 2016; 11e0153728 Crossref PubMed Scopus (72) Google Scholar Over 90% of all TB cases in persons born or who have lived outside of the United States are due to reactivation of LTBI 4 Yuen CM Kammerer JS Marks K et al. Recent transmission of tuberculosis - United States, 2011-2014. PLoS One. 2016; 11e0153728 Crossref PubMed Scopus (72) Google Scholar ,5 Tsang CA Langer AJ Navin TR et al. Tuberculosis among foreign-born persons diagnosed >/=10 Years After Arrival in the United States, 2010-2015. Am J Transpl. 2017; 17: 1414-1417 Crossref Scopus (6) Google Scholar Patients with active TB can delay seeking care from fear of immigration authorities and this delay can expose more people to active TB. 6 Asch S Leake B Anderson R et al. Why do symptomatic patients delay obtaining care for tuberculosis?. Am J Respir Crit Care Med. 1998; 157: 1244-1248 Crossref PubMed Scopus (140) Google Scholar Individuals born outside of the United States may experience racial or ethnic biases when engaging healthcare and thus, may express hesitation to report birth country, past medical history, or TB disease.