摘要：Objectives . We used a community-based participatory research (CBPR) approach to plan and implement free TB skin testing at an adult education center to determine the efficacy of CBPR with voluntary tuberculosis (TB) screening and the prevalence of TB infection among immigrant and refugee populations. Methods . We formed a CBPR partnership to address TB screening at an adult education center that serves a large immigrant and refugee population in Rochester, Minnesota. We conducted focus groups involving educators, health providers, and students of the education center, and used this input to implement TB education and TB skin testing among the center's students. Results . A total of 259 adult learners volunteered to be skin-tested in April 2009; 48 (18.5%) had positive TB skin tests. Conclusions . Our results imply that TB skin testing at adult education centers that serve large foreign-born populations may be effective. Our findings also show that a participatory process may enhance the willingness of foreign-born persons to participate in TB skin-testing efforts. Incidence of tuberculosis (TB) infection in the United States has declined over the past decade, but a disparity has emerged wherein this decline has been much less pronounced among foreign-born Americans. More than half of active TB cases in the United States occur in foreign-born individuals, 1 and the majority of these cases are attributable to reactivation of latent TB infection (LTBI). 2 , 3 The Centers for Disease Control and Prevention (CDC) has recommended testing for and treating LTBI among foreign-born individuals from countries with a high incidence of TB who have lived in the United States for 5 years or less. 4 This strategy may be particularly effective for individuals from sub-Saharan Africa and Southeast Asia. 4 The risk of TB remains elevated even for foreign-born individuals who live in the United States for longer than 5 years. 3 In spite of the CDC's recommendation, LTBI screening of foreign-born individuals is not commonly practiced in the community setting because of a lack of funding and limited availability of local resources. 5 Previous studies have demonstrated that school-based targeted testing of asymptomatic foreign-born children is both effective and cost-effective for identifying and treating LTBI. 6 – 11 However, concerns have been raised that mandatory testing practices may be stigmatizing to these immigrant groups. 12a Community-based participatory research (CBPR) is a way to collaboratively investigate health topics within a community, whereby community members and academics work as partners in an equitable relationship. 12b – 14 CBPR has been particularly successful in identifying and addressing health disparities, because it empowers communities and promotes understanding of cultural issues pertinent to health. 15 , 16 The CDC recommends forging these types of partnerships to address TB in the United States. 17a Hawthorne Education Center (HEC), a constituent of the Rochester (MN) Public Schools district, provides education with an emphasis on literacy to Rochester adults. HEC serves a large foreign-born population through classes that teach English as a second language (ESL) and other programs. HEC has evolved into a community center, providing instruction for cultural adjustment, citizenship, and even training for driver's license exams. More than 70 different languages are spoken within HEC, which supports approximately 2500 students yearly from diverse backgrounds. An estimated 85% of HEC's students have incomes at or below the federal poverty level, and less than half (40%) have completed high school. The Hawthorne Health Service at HEC emerged as a collaborative free clinic and health-literacy campaign for adult learners and their families. Most Hawthorne learners have some of the strongest indicators of TB risk in the United States, including recent emigration from regions of the world where TB is endemic. The HEC community has experienced several cases of active TB among its students in recent years. In 2006, HEC leadership approached Mayo Clinic faculty who volunteered at HEC to suggest working together to address the problem of TB among the center's learners. Two years earlier, these 2 agencies had formed a CBPR partnership to broadly address health concerns at HEC. They established operating norms, held monthly meetings, and conducted a health needs assessment. This partnership grew to include 5 more community-based organizations, 2 more academic centers, and many more volunteers to form the Rochester Healthy Community Partnership, whose mission is to promote health and well-being among the Rochester population through CBPR, education, and civic engagement. Members of the Rochester Healthy Community Partnership conducted 10 focus groups with HEC adult learners and staff to elicit their perceptions of TB and their recommended solutions for addressing this issue. 17b In conducting the focus groups, we used principles of CBPR, including community involvement in every aspect of project design and analysis. One theme that emerged from the focus groups was a recommendation for free on-site TB testing. Therefore, to determine the efficacy of a CBPR approach to voluntary TB screening, and to determine the prevalence of LTBI at this adult education center, the partnership used a CBPR approach to plan and implement free TB skin testing at HEC. Every component of subsequent program planning and assessment was initiated and implemented under the supervision of the Rochester Healthy Community Partnership community–academic working group.
