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Migration-related Tuberculosis Among Asian Immigrants in San Francisco

其他書名	Treatment Outcomes, 1994-1998
出版	University of California, San Francisco, 2005
URL	http://books.google.com.hk/books?id=gSkrSvk_JM4C&hl=&source=gbs_api

註釋In California, the majority of new cases of tuberculosis (TB) have been detected among the state's newly arriving immigrants, yet there are few follow-up studies on the treatment outcomes of these foreign-born populations. A historical cohort study was conducted to evaluate the treatment outcomes of 4,943 Asian immigrants who were treated for active TB disease or latent TB infections at the San Francisco TB Clinic, from 1994 to 1998. The study sample consisted exclusively of Asian newcomers from China, the Philippines and the Southeast Asian countries of Vietnam, Laos and Cambodia. Their outcomes were followed using their electronic clinic record for ten years to the year 2004. In the active disease cohort, there were 359 Asians initiated on 4-drug first line chemotherapy for pulmonary and extrapulmonary disease. The 300 immigrants with active pulmonary TB achieved 100% treatment adherence. Among the 59 immigrants with extrapulmonary TB, one person (1.7%) failed to complete treatment resulting in a 98.2% adherence rate. These high adherence rates of the active TB cohort may have been result of the chemotherapy's mandated status. Among the 4,547 Asians treated for latent tuberculosis infections, 3,576 (82.5%) completed prophylaxis treatment and 755 (17.4%) were classified as non-adherent. Controlling for years in the United States, the logistic regression analysis indicated that two factors, the immigrants' countries of origin and speaking English, were statistically significant predictors for treatment completion. Chinese immigrants were 1.3 times (AOR 1.3, 95% CI, 1.06-1.67, p = .014) more likely to complete the voluntary prophylaxis treatment than immigrants from the Philippines. Immigrants who spoke English were 42% (AOR .417, 95% CI, .333-.524) less likely to complete treatment than the non-English speaking immigrants. This variation in treatment adherence suggests that clinicians' cultural assumptions about acculturation and adherence should be re-examined to identify the characteristics of the Asian population at risk for nonadherence. These findings indicate it is not the non-English speaking immigrant from China in need of drug monitoring, but in reality, it is the immigrant who speaks English and appears more acculturated who may require additional support to complete prophylaxis treatment.