- The Washington Times - Monday, March 27, 2000

World TB Day 2000 118 years after Robert Koch announced his discovery of the TB bacillus brought good news for our national TB efforts. For the sixth year in a row the total number of TB cases and deaths has declined, with more than 40 U.S. counties reporting no cases. Globally however TB continues to present a devastating burden, with estimates of 2 billion people infected with the TB bacillus.
Washington, as an international city, shows the effect of this global TB crisis. 1999 District statistics report 31 percent of new D.C. cases occurring among the foreign born, of which 15 percent are students at local colleges and universities. Overall, the District's case rate remains over twice the national rate of 6.8 per 100,000 despite approximately $1.4 million in federal and District funds allotted to the control effort.
TB patients in the District are overwhelmingly African-American males. A large percentage report homelessness and chronic unemployment (18 months or longer). HIV co-infection occurs in 20-25 percent. These represent the most difficult cases for successful completion of therapy and efforts to address these needs in the past have not always succeeded. A single-room occupancy facility opened in 1997 has closed because of problems with maintenance and vandalism; efforts at public-private partnerships begun in 1993 with local churches to provide meals and directly observed treatment (DOTS) have fizzled; collaborations between the Division of TB Elimination (DTBE) and the correctional system to track inmates with TB upon release or transfer remain difficult.
The 1999 report released by the Medical Society of the District of Columbia's Task Force on Tuberculosis comprising representatives from agencies including government, the private sector and academia, detailed many of the areas of need for the program. The report highlighted basic problems such as lack of transportation and reliable laboratory services. Since then important changes have occurred. There is both a capable director of TB services and an energetic head of the Department of Health newly appointed. Many of the uncertainties in drug and X-ray supplies have been stabilized, and efforts are again underway to rebuild the District's laboratory services. What more can be done?
We must renew our commitment to solve the problems of lack of housing, food and vital support service that face these patients. The DTBE must establish new relationships and involve new partners in the education and fight against TB transmission. The recent appointment of Ron Lewis, formerly with HIV services, to head the Preventive Division is an encouraging step.
The Advisory Council for the Elimination of TB recently reaffirmed the national commitment to elimination. Towards this goal it advises strategies targeted to local epidemiology conditions, enhanced application of existing tools, and establishment of new partnerships and new stakeholders.
Washington can provide leadership in developing approaches to target these most difficult of TB patients. The mayor's recent State of the District Address emphasized health as a core priority and placed it in the context of the theme of safety for the citizens. This is a commendable framework for hope, but the District must make good on this promise by ensuring that more of its citizens feel safe from age-old infectious threats such as TB.

Michael S.A. Richardson, M.D., is a member of the MSDC Task Force on Tuberculosis.

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