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Task Order 11: Addressing TB among African Americans in the Southeast: Identifying and overcoming barriers to treatment adherence for LTBI and TB disease

Task Order 11 aims to investigate multi-level facilitators and barriers to TB control measures for African Americans in high-morbidity areas in the Southeastern United States to aid in devising effective interventions. Nationally, the tuberculosis (TB) rate among African Americans has been persistently eight to nine times the rate among whites. A large proportion of these cases are reported from eight Southeastern states where African Americans reside in relatively large numbers. Task Order 11 seeks to address this disparity by first seeking to understand the personal, institutional, and community-level barriers to TB control in African Americans in the Southeastern United States and the individual-level response to these barriers in Phase 1 of the project; and then in Phase 2 to assess an intervention of the project that will be developed based on the knowledge gained in the first phase. Also, we designed, conducted, and evaluated a national summit entitled Stop TB in the African-American Community to raise awareness and catalyze mobilization on a political level around this issue.


The RTI International site of the TBESC completed Phase 1 in Montgomery County, NC; Dekalb County, GA; and Davison County,TN. Selection of sites for Phase 2 is pending.

Study Objectives

  1. Understand institutional and community-level barriers to TB control in African Americans in the Southeastern United States and the individual-level response to these barriers.
  2. Develop, implement and evaluate interventions that ultimately: a) increase awareness about the excess of TB in African American communities and b) reduce the TB disparity
  3. Examine the TB knowledge, attitudes, beliefs, and practices of African Americans with TB, and those at risk for TB, in the Southeast United States.
  4. Examine the knowledge, attitudes, beliefs and practices of providers who serve these populations with respect to: a) TB diagnosis; b) screening; c) treatment (LTBI and TB disease); d) contact investigations; e) relationships with local TB programs; and f) cultural competence.
  5. Identify ways to overcome the identified barriers to increase health seeking behavior, as well as adherence to LTBI and TB disease treatment among the target populations.

Study Design

Phase 1 utilized a combination of qualitative individual and group interviews to gain information about the knowledge, attitudes, and beliefs of African American TB and latent TB infection patients, and those at-risk of TB as well as three sets of providers who serve them – TB control staff, health care providers, and community leaders. Surveillance data, administrative databases linked to census track, and other data were analyzed to help locate field sites within some of the highest TB morbidity among African Americans in the region. Qualitative methods were used summarize the data. The different perspectives of individuals in these six groups will help provide a comprehensive understanding that will suggest new avenues to help close the gap in TB elimination for African Americans. In Phase 2 one of these avenues will be developed into a specific intervention that will be formally evaluated. At all phases of Task 11 RTI has gathered input into the work from representatives of the eight Southeastern states and others.

Study Progress

Data collection is complete and analysis is underway.

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