The Tuberculosis Behavioral and Social Science Research Forum Proceedings
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Section II. Presentations and Panel Discussions
Keynote Session: Behavior, Society and Tuberculosis Control
Masae Kawamura, M.D.
Chairperson, Advisory Council for the Elimination of Tuberculosis; Director, Tuberculosis Control Section San Francisco Department of Public Health Tuberculosis Clinic, Ward 94 San Francisco General Hospital
Day 1, Morning Session
Dr. Kawamura noted the accomplishments of TB control efforts and offered pathways to further improving TB control programs. In particular, she identified several ways in which behavioral and social sciences can be applied to TB control, including:
- Validating what we are doing right and wrong;
- Introducing new behavioral strategies that have been proven in other fields;
- Refining currently successful behavioral strategies, such as DOT, to improve implementation and outcomes;
- Determining when strategies are appropriate or harmful; and
- Framing TB data in their full context with demographics, social determinants, health disparities, and incidence of other diseases so the data are useful for advocacy and policy making.
She also offered the following considerations to guide TB research and programs.
- Research interventions must be practical and well planned.
- If new resources will be needed to implement interventions, then the costs, savings, and benefits of such interventions should be documented.
- When choosing staff, remember that civil service front-line staff may prove to be different from dedicated research staff.
Dr. Kawamura identified specific populations and LTBI issues that still need to be addressed. Strategies are needed to engage minority and foreign-born communities, especially undocumented persons and new immigrants living on both sides of the U.S.-Mexico border. More work is needed to engage these patients and improve contact investigation methods and LTBI adherence strategies among them. Additionally, health promotion and prevention for LTBI could be improved by integrating targeted testing and LTBI treatment into primary care. Nontraditional approaches that go beyond education and incentives and enablers are needed to increase LTBI treatment adherence. Finally, the root causes of TB must be addressed. Communities and countries must mobilize to take action, and TB-related information must be provided in useful formats.
Dr. Kawamura recommended a “macro” approach to enhance TB control efforts while acknowledging the individual-level strategies that have contributed to previous TB control successes. During the discussion with Forum participants, she emphasized that the time has come to insist on ways to improve TB interventions. She concluded by reminding participants that patients’ perspectives are greatly needed to inform programs.