Tuberculosis Cases In Baltimore On Decline


Marc Kusinitz
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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.