velop better diagnostic tests and treatments for latent tuberculosis infection and active tuberculosis, a need identified in Chapter 2.7 Another recommendation is for research on nonadherence to treatment regimens that could be used to develop more effective strategies to promote acceptance and completion of treatment.8 A third recommendation proposes new approaches to identifying and treating latent tuberculosis infection among high-risk immigrants, who are well represented in the health care workforce.9 The report stresses that after treatment of active disease, “the second priority is targeted tuberculin skin testing and treatment of latent infection” (IOM, 2000, p. 8). In addition to immigrants from high-prevalence countries, the high-risk groups targeted include prison inmates, people with HIV infection, and homeless individuals. The report also calls for the United States to increase its support for global tuberculosis control. With more than 40 percent of tuberculosis cases in the United States and among health care workers involving people born in other countries, policymakers and public health authorities cannot ignore the international problem of tuberculosis.

In sum, just as tuberculosis risk in the workplace is linked to tuberculosis risk in the community, the risk in American communities is affected by the risk of tuberculosis elsewhere in the world and by migration within and across the nation’s borders. Effective tuberculosis control measures in the workplace are one element of a much larger strategy to prevent and eventually eliminate the disease.


Recommendation 5.2. To advance the development of diagnostic tests and new drugs for both latent infection and active disease, action plans should be developed and implemented. CDC should then exploit its expertise in population-based research to evaluate and define the role of promising products (IOM, 2000).


Recommendation 5.3. To promote better understanding of patient and provider nonadherence with tuberculosis treatment recommendations and guidelines, a plan for a behavioral and social science research agenda should be developed and implemented (IOM, 2000).


Recommendation 4.1 calls for preimmigration tuberculin skin testing of visa applicants from countries with high rates of tuberculosis. Once they have arrived in the United States, those with positive skin tests would, when indicated, be required to complete an approved course of treatment for latent tuberculosis infection before being issued a permanent residency card (“green card”). (Screening and treatment for active tuberculosis are already required.) The report also recommends that the federal government support the cost of such treatment rather than putting the burden on local communities.

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