Tuberculosis Cases In Baltimore On Decline Marc Kusinitz ------------------------------------ JHMI Office of Public Affairs A Hopkins study has shown that using a community-based public health strategy called Directly Observed Therapy, Baltimore has produced the greatest decline in tuberculosis rates among major cities in the United States at a time when rates were increasing dramatically in other cities. Baltimore's decline in TB cases, as reported in the Sept. 27 Journal of the American Medical Association, occurred despite the city's high rates of risk factors for the disease, including unemployment, poverty, injection drug use and AIDS, said Patrick Chaulk, assistant professor of medicine and an associate in the Department of Health Policy and Management at the School of Public Health and the study's lead author. AIDS cripples the immune system, making patients more vulnerable to infections by TB and other diseases. DOT is based on directly supervising patients as they take each dose of medication throughout their entire treatment, said Chaulk, who is also a senior associate for health at the Casey Foundation, a Baltimore-based philanthropy that supports projects addressing the needs of disadvantaged children and their families. A major factor in the increase in TB in other cities was failure of TB programs to monitor therapy adequately, he said. "Our program emphasized outreach to patients in homes, workplaces and schools, as well as high-risk patients in drug treatment facilities and prison. By adjusting DOT to patient schedules and life styles, we produced higher cure rates than other cities." The study shows that in the current climate of decreasing support for public programs, it is important that federally funded public health programs such as DOT not be cut back, he said. Without such programs, some infected people fail to take their medicine when they should, and continue to spread the disease. In addition, people who do not complete the entire treatment can develop a population of TB bacteria that are resistant to drug treatment. The study found that while TB rates increased 28.5 percent in the top 20 cities during the peak years of the AIDS epidemic (1985-92), the rate declined in Baltimore. The study also found that during the 11-year study period, TB rates increased 1.8 percent among the 20 cities that had the highest TB rates in 1981, but declined by 51.7% in Baltimore. In addition, Baltimore's rank among cities for the rate of TB infection dropped from sixth in 1981 to 28th in 1992. The DOT program was supported by the Centers for Disease Control and Prevention and state and local funds, and administered by the Baltimore City Health Department with Hopkins physicians.
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