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sons who, because of epidemiological circumstances, are at high risk of having latent tuberculosis infection. This is done by:

  • Analysis of local epidemiological data and targeting of high-incidence groups for specific screening projects.

  • Ensuring that patients, once identified via screening programs, have access to appropriate and adequate tuberculosis services. This again is dependent on the high-risk group being targeted and may require services being provided outside of the “traditional tuberculosis clinic” system.

  • Ensuring that patients are evaluated and placed on treatment for latent tuberculosis infection (as appropriate).

  • Ensuring their completion of therapy. Screening without followup does not serve the needs of the patients or public health.

Health departments attain these goals by structuring their tuberculosis services within the framework of essential functions as described in the Institute of Medicine report, The Future of Public Health (Institute of Medicine 1988). This framework includes assessment (epidemiology and surveillance), policy development, and assurance (patient and contact management and education and training). The methods by which these goals are addressed vary according to morbidity rates, public health infrastructure capacity, and resources.

REFERENCES

    American Lung Association of South Carolina and the Division of Tuberculosis Control, South Carolina Department of Health and Environmental Control . 1989 . Tuberculosis Control Enablers and Incentives . Columbia : Author .

    American Thoracic Society and Centers for Disease Control and Prevention . 2000 . Targeted tuberculosis testing and treatment of latent infection . Am J Respir Crit Care Med 161 : 5221–5247 .

    Arriaza BT , Salo W , Aufderheide AC , and Holcomb TA . 1995 . Pre-columbian tuberculosis in northern Chile: Molecular and skeletal evidence . Am J Phys Anthropol 98(1) : 37–45 .

    Behr MA , Warren SA , Salamon H , Hopewell PC , Ponce de Leon A , Daley CL , Small PM. 1999 . Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli Lancet 353(9151) : 444–449 .

    Canetti, G . 1962 . L' eradication de la tuberculose dans les differents pays, compte-tenudes donditions existantes (problemes theoretiques et solutions pratiques) . Bull Int Union Tuberc Lung Dis 32 : 608–642 .

    Centers for Disease Control and Prevention . 1989 . A strategic plan for the elimination of tuberculosis in the United States . MMWR . 38 : 269–272 .

    Centers for Disease Control and Prevention . 1995 . Essential components of a tuberculosis prevention and control program . MMWR 44(RR-11) : 1–16 .

    Chaulk CP. 1999 . Tuberculosis elimination and the challenge of the long-term completer . Int J Tuberc Lung Dis 3(4) : 269 .



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