Mini-Grant Program

The TB Elimination Alliance (TEA) offers Mini-Grants to organizations serving Asian American (AA) and Native Hawaiian/Pacific Islander (NH/PI) communities. Mini-Grant proposals align with TEA priority areas and activities that reflect and enhance community engagement and education, provider education, and/or quality improvement. The population of focus is on AA and NH/PI communities, and supporting activities at the local level to advance the Centers for Disease Control and Prevention’s (CDC) LTBI and TB campaign

2023 Mini-Grant Recipients

Arkansas Coalition of Marshallese (Springdale, AR)

Title: TB Education and Testing in the Pacific Islander Community in Arkansas

The Arkansas Coalition of Marshallese (ACOM) serves the highest population of Compact of Free Association (COFA) citizens living in the United States. The United States and the Marshallese community have a unique relationship. Nuclear testing in the Marshall Islands created negative health conditions leaving the Marshallese community prone to cancer, chronic diseases, Hansen’s disease and a high incidence of TB. Marshallese migration to Arkansas can be attributed to attaining better opportunities for education and healthcare services. Asians and Native Hawaiians/Pacific Islanders are disproportionately impacted by TB at a greater rate compared to other racial and ethnic groups. Ethnic sub-groups such as the Marshall Islands within the Micronesia Region of the Pacific Islands reported an incidence rate of about 160 new cases of TB per 100,000 persons over a 5-year period (2014-2018).

For our third year in this mini-grant program, ACOM will partner with the John Bates Clinic under the Arkansas Health Department to provide virtual health education events on Facebook to raise awareness about tuberculosis (TB) and promote TB testing in the Pacific Islander community in Arkansas. Our goal is to increase the number of TB tests to 30-50 based on the number of tests that were conducted during our first year in this mini-grant program. ACOM will also offer a mini-conference for women and a conference for the community to address the intersectionalities of TB, COVID, and other diseases. Lastly, ACOM will translate TB education materials that are culturally and linguistically appropriate for the Pacific Islander community.

Asian Pacific Health Foundation (San Diego, CA)

Title: Implementing Direct Outreach through “Train-the-Trainers Strategy” to Raise Awareness of LTBI and TB in San Diego’s At-Risk Communities

The Direct Outreach through Train-the-Trainers Strategy is an interactive, educational initiative that targets the underserved communities in San Diego to raise awareness about latent tuberculosis/active tuberculosis disease (LTBI/TB). For context, about 20% of all TB cases in the United States were reported in California, with the majority of these reported among the foreign-born. Additionally, annual TB incidence rates were found at significantly greater levels in San Diego compared to other parts of California and the rest of the nation. APHF’s educational activities aim to promote active engagement concerning the links between LTBI and TB disease, to address misconceptions about tuberculosis, and to facilitate screening and treatment for LTBI and TB.

With our train-the-trainers strategy, APHF will utilize various forms of media, such as community-based presentations, educational LTBI/TB videos, and social media projects to educate groups of “trainers”, who will then educate and share information with their “trainees”. Our third round of the TB Elimination mini grant will continue to focus on training undergraduates and high school students, so as to encourage peer education through the students’ social and family networks. APHF will then combine its educational efforts with linkage-to-care through our San Diego county partners, with our goal of better informing the underserved and increasing their screening rates to maximize our collective TB control efforts in the county.

EthnoMed (Seattle, WA)

Title: Community Tuberculosis Profile Project to Reduce Barriers to Tuberculosis Diagnosis and Treatment

EthnoMed was started in 1994 and began publishing its work at www.ethnomed.org as an internet resource for clinicians and health care providers working with immigrant and refugee populations in the greater Seattle area. The EthnoMed team is based in the Interpreter Services Department at Harborview Medical Center and has worked closely with interpreters, cultural mediators, and community members to create educational resources for providers. Our website aims to be a source for social and cultural details relevant to clinical care with a focus on cross-cultural care. Our website provides information about immigration, cultural norms and values, experience with Western medicine, culture specific information and tools pertinent to the clinical encounter, as well as translated/culturally tailored information for patients. The mission of Ethnomed is to provide resources to facilitate the practice of cross-cultural medicine and has expanded to include patient-focused resources.

EthnoMed, in partnership with Public Health Seattle King County and HealthPoint in Seattle, is collaborating to create new tuberculosis-focused cultural profiles and other health communication tools aimed at providers serving patients most at risk for tuberculosis infection and disease. Cultural profiles reduce health disparities by giving providers context about patient communities which allows them to approach conversations with patients from an empathetic and culturally informed place. Our EthnoMed team will meet with community members and collect first-hand information about culturally specific practices and understanding regarding tuberculosis. These profiles will be hosted on the EthnoMed and King County Public Health websites. They will also be distributed to local clinics which treat many of the patients from these immigrant communities, such as the HealthPoint clinic system.

Jericho Road Community Health Center (Buffalo, NY)

Title: Community TB Testing to Assess Untreated Disease Prevalence

Jericho Road Community Health Center is a long-standing Federally Qualified Health Center (FQHC) in Buffalo, NY. They operate five safety net clinic locations in Buffalo’s most underserved communities. Jericho Road provides culturally sensitive medical care and supportive services, especially for refugee and low-income community members, facilitating wellness and self-sufficiency by addressing health, education, economic and spiritual barriers. They specialize in healthcare (including dental and behavioral health) and social service provision to immigrants and refugees of all faiths and backgrounds.

The long-term goal of this neighborhood testing initiative is to collect enough testing data to “prove” that widespread, targeted community testing is needed. Together, with the County Health Department, after assessing active and re-activated rates, coupled with the location of these cases, it is suspected that there are significant clusters of active, undiagnosed and untreated TB within these communities.

Midwest Asian Health Association (Chicago, IL)

Title: Chicago’s Greater Chinatown for TB Equity Initiative

Located in the heart of Chinatown, Midwest Asian Health Association (MAHA) primarily serves limited English-speaking, low-income, and low-literacy Asian immigrant populations living in greater Chinatown areas on the south side of Chicago including Armour Square and Bridgeport community areas, as well as metropolitan Chicago. The TB incidence rate for Armour Square at 28.8 per 100K residents is almost 29 times higher than Chicago’s overall TB rate of one per 100K residents, and the TB incidence rate for Bridgeport at 5.9 per 100K residents is almost six times higher than Chicago’s incidence rates. In collaboration with community partners, the Chicago Public Health Department, health care providers, and MAHA’s internal programs, the project will facilitate individual and group-level education sessions on TB education and prevention for a minimum of 120 individuals during the program period. Through these education sessions, 80% of the participants will improve their TB knowledge and behaviors to prevent further spread. MAHA will link high-risk TB residents to appropriate medical specialists. MAHA will conduct community outreach with culturally sensitive and linguistically appropriate TB educational brochures and incentives for clients and engage in targeted community outreach and social media campaigns to reach a broader population and link them to testing and treatment. Furthermore, MAHA will provide education sessions among healthcare professionals to educate them about TB prevalence among Asian and other immigrant populations in the target areas.

Mission Neighborhood Health Center (San Francisco, CA)

Title: Enhancing TB Awareness and Screening through Community Engagement

Mission Neighborhood Health Center (MNHC), a Federally Qualified Health Center (FQHC), has provided comprehensive healthcare services to the underserved Latinx population and other diverse minority communities in San Francisco for over 50 years. MNHC serves more than 15,000 patients at four locations in the Mission and Excelsior neighborhoods. With a strong commitment to improving community health, MNHC has become a trusted source of accessible and culturally sensitive care.

MNHC’s “Enhancing TB Awareness and Screening through Community Engagement” campaign aims to lessen the burden of tuberculosis (TB), improve health outcomes, and contribute to national and global TB elimination efforts. The project focuses on raising awareness and offering culturally appropriate TB education within the community. This includes dispelling misconceptions, reducing stigma, providing information about latent TB infection (LTBI) and active TB, encouraging testing, and ensuring timely treatment. The campaign involves a team of well-trained staff, including Community Health Workers, Health Educators, and physicians.

Recognizing the diverse communities it serves, MNHC tailors educational materials and engagement strategies to meet specific cultural and linguistic needs, particularly within the Latinx community. Through this personalized approach, MNHC aims to empower patients and community members to make informed decisions about their health, fostering greater understanding and contributing to the overall well-being of the community.

Regional Pacific Islander Task Force (San Francisco, CA)

Title: Veivakararamataki ni TB (TB Education, Testing, & Treatment Access with Fijian Community Members in Sonoma County)

The Regional Pacific Islander Taskforce (RPITF) advocates with and serves Pacific Islander communities across the Bay Area region. Native Hawaiian and Pacific Islander (NHPI)—RPITF prefers the term “Pacific Islander” (PI)—includes persons having origins in peoples of Polynesia, Micronesia, and Melanesia and includes a wide range of cultural traditions, languages, and nationalities. The diverse PI community have unique histories prior to Western contact and with colonial impact, and Pacific military expansion of the US has played a key role in PI community migration and access to health care and social programs domestically; which has negatively impacted economic mobility and health of many PI subpopulations. Different historical circumstances have resulted in a complex system of formal and informal relationships between Pacific Islander nations and the US. Furthermore, California’s proximity to these nations has made it a major US state destination for migrants and immigrants across multiple nations in the Pacific. The target population of our 2023 proposed TB/LTBI health education project will focus specifically on the Fijian community specifically in Sonoma County, a Northern California County in the Bay Area.

Compared to other PI nations, Fiji has the highest estimated number of TB cases in public health TB epidemiologic data from the past 20 years. This has been driven by various factors including the improvement of TB screening, implementation of active case finding public health activities, improved reporting, and increased TB transmission within the community. The RPITF recognizes that improving TB/LTBI screening and treatment access among Fijian community members traveling to and from Fiji in order to live and work in the US and SF Bay Area region would be a step towards moving the needle among LTBT/TB health disparities. The RPITF is jointly applying to this TB mini-grant opportunity with the Fijian Health Ministry, a coalition of 4 Fijian churches within Sonoma County of the Bay Area region known as the “Fijian Health Ministry team.” RPITF will be working with the Fijian Health Ministry, Radio Bula Duavata (Fijian radio station), local Bay Area community health partners (e.g., free clinic, FQHCs), and with Sonoma County Department of Public Health for this proposed project. The 4 Fijian churches are the Petaluma Wesley Church, Kenani Vou Methodist Church, Petaluma Fijian Ministry, and Metro Church Windsor. Our two overarching goals will be to 1) improve PI community awareness about TB/LTBI through health education workshops and health promotion/screening events as well as to 2) weave together access to screening, wellness, and TB treatment healthcare services through organizational partnerships and cross-sector collaborations.

Rural Women’s Health Project (Gainesville, FL)

Title: Aprender sobre la tuberculosis es ¡Vivir a todo Pulmón! [To learn about tuberculosis is to live life to its fullest]

The ¡VIVIR a todo Pulmón! project will be integrated into on-going work of our six Project SALUD Promotores and 15 Comunicadores who serve Latinx communities in 6 North Central Florida counties. We will combine a triad approach: one-on-one outreach education by Promotores de Salud; popular education formats for message dissemination (fotonovelas and radionovela); direct messaging via our texting and Comunicadora [Messenger] WhatsApp circles. The RWHP’s sustainable, grassroots work force of community-based educators who live and work in the communities they serve assures that information stays local. Beyond the campaign period of outreach on LTBI/TB, the Promotores will continue to be able to carry the message and materials within their ongoing direct response to communities’ members and within their outreach toolboxes. Work will be delivered in Spanish, with corresponding messaging in Q’anjob’al, a language common to area community members from Guatemala. We will work with our local health departments to assure that there is fluid linkage into infectious disease department care for needed testing or treatment of our limited English proficient community.

Project impact will include 360 direct education sessions delivered by promotores, distribution of posters and materials to churches, nurseries and work sites to benefit 400 workers/church goers, direct messaging delivered by Comunicadores to 400 in their WhatsApp circles, messaging to 1500 through our health education text services and distribution of translated audio messaging to at least 50 Q’anjob’al speakers in our region. The total impact is 2660 unique recipients of culturally and linguistically relevant health messaging.

San Diego County Medical Society Foundation, dba Champions for Health (San Diego, CA)

Title: Engaging San Diego: Enhancing Partnerships and Improving TB Messaging

Champions for Health (CFH) strives to be a pillar of reliability, strength and equity among health partners in San Diego. CFH’s mission is to improve community health and wellness, access to care for all, and support for physicians through engaged volunteerism. Since CFH’s founding, organizational efforts have provided a caring and efficient resource for patients in need, created a network of physician volunteers, reduced costs and stress on healthcare infrastructures, and established a healthier community and workforce through quality preventive care. CFH also identifies community wellness disparity and access areas using indicators including race, ethnicity, language, and other cultural barriers.

Building on county-wide partnerships of TB efforts, the one-day hybrid Summit intends to reach the San Diego Community in Practice which includes nearly 20 organizations comprising community clinics, health systems/hospitals, health plans and other community foundations (pharmacies and public health organizations). These organizations are led by and serve high priority A/AA, NH/PI, non-U.S. born Latino Americans and U.S. born African American communities.

This project will include Community in Practice working meetings and planning surveys that will lead up to the Summit. The anticipated outcome of the Summit is to improve and disseminate standardized TB prevention/elimination messages and materials that address all high-risk populations and age groups, benefitting at-risk individuals and the community agencies that serve them.

Todu Guam Foundation (Tamuning, Guam)

Title: A Community-Based Partnership in TB Elimination on Guam: Stakeholder-Led Initiative To Provide TB Education and Screening Amongst Hard-To-Reach Communities in Guam

In the 2022-2023 grant period, Todu Guam Foundation (TGF) became a first-time recipient of the TB Elimination Alliance’s mini grant and officially launched the TGF TB Program under the organization’s Mobile Care Clinic. The organization’s strong partnership with the Guam Department of Public Health and Social Service TB/Hansen’s Disease Program has been instrumental in TGF’s success in carrying out the objectives of this grant, and has been nationally awarded by the CDC (TB Champions) and NTCA (Joe Ware Partner Service Award) for this strong partnership.

Through the funding in the first year, TGF was able to deliver TB education to 685 individuals and their families, created partnerships with seven different local and national organizations, and presented informational material to local providers through TGF’s network of volunteer medical providers. In addition to carrying out the activities defined in the grant, TGF screened 494 individuals for TB and coordinated the medical evaluation of these individuals to rule out active TB disease diagnosis and treat those individuals that tested positive for TB infection. TGF focuses on the Non US-born citizens who are more at risk for TB. TGF programs use culturally appropriate information that address the needs of the community by utilizing translated information through print material or translations by TGF staff members or support from partner organizations. In addition, the mobile clinic model allows TGF to access individuals and at-risk communities that would otherwise not have access to this education or care because of their geographic location, language barriers, or cost of services.

We Are TB / Somos TB (National)

Title: SOMOS TB: Peer Support and Community for Spanish-Speaking People with TB and Their Families

We Are TB is a peer support and advocacy group composed of people in the United States personally affected by TB and their families. In addition to education and advocacy, our mission is to provide people with TB and their loved ones with support as they navigate their TB journey. We Are TB currently holds weekly virtual meetings, also known as “Support Space”, in order to facilitate a connection with those struggling with the physical, mental, and emotional symptoms (current or lingering) that accompany a TB diagnosis. As a Spanish-speaking arm of We Are TB, Somos TB began offering monthly meetings- solely in Spanish- in February 2022. As there is a high number of Spanish-speaking TB patients and survivors, monthly meetings do not offer enough flexibility to cater to those/everyone in need of support. As such, we would like to slowly expand our outreach and begin offering support on a biweekly basis. In order to achieve this, we will have two members of Somos TB in charge of leading and supervising these meetings. Like We Are TB Support Space, the focus of these meetings is to be able to connect/network with other TB patients who are currently undergoing TB treatment, those who have received treatment in the past, and/or those who are caring or have cared for a patient with a TB diagnosis.

In order to expand our outreach, Somos TB intends to take greater advantage of our social media platforms. With this grant and the compensation provided, we are committing to uploading posts on our social media at least twice per month. These posts may include but are not limited to meeting reminders, outreach activities and events, as well as gratitude posts to fellow TB-focused organizations. Currently, these social media platforms include Instagram and X (formerly Twitter) however, we are committed to creating a Facebook page and other relevant platforms that we believe will expand our impact/visibility in the TB community and other closely related groups/organizations.

2022 Mini-Grant Recipients

Arkansas Coalition of Marshallese (Springdale, AR)

Title: TB Education and Testing in the Pacific Islander Community in Arkansas

The Arkansas Coalition of Marshallese (ACOM) serves the highest population of Compact of Free Association (COFA) citizens living in the United States. The United States and the Marshallese community have a unique relationship. Nuclear testing in the Marshall Islands created negative health conditions leaving the Marshallese community prone to cancer, chronic diseases, Hansen’s disease and a high incidence of TB. Marshallese migration to Arkansas can be attributed to attaining better opportunities for education and healthcare services. Asians and Native Hawaiians/Pacific Islanders are disproportionately impacted by TB at a greater rate compared to other racial and ethnic groups. Ethnic sub-groups such as the Marshall Islands within the Micronesia Region of the Pacific Islands reported an incidence rate of about 160 new cases of TB per 100,000 persons over a 5-year period (2014-2018).

For our third year in this mini-grant program, ACOM will partner with the John Bates Clinic under the Arkansas Health Department to provide virtual health education events on Facebook to raise awareness about tuberculosis (TB) and promote TB testing in the Pacific Islander community in Arkansas. Our goal is to increase the number of TB tests to 30-50 based on the number of tests that were conducted during our first year in this mini-grant program. ACOM will also offer a mini-conference for women and a conference for the community to address the intersectionalities of TB, COVID, and other diseases. Lastly, ACOM will translate TB education materials that are culturally and linguistically appropriate for the Pacific Islander community.

Asian Pacific Health Foundation (San Diego, CA)

Title: Implementing D.O.T.S. to Raise Awareness of LTBI and TB in San Diego’s Vietnamese Population through Training Undergraduates and High School Students

The Direct Outreach through Train-the-Trainers Strategy (D.O.T.S.) is an educational program about latent tuberculosis/tuberculosis (LTBI/TB) which targets the underserved communities in San Diego, with a focus on its Vietnamese population. In the U.S., about 20% of TB cases were in California, with most cases among the foreign-born. Furthermore, annual TB incidence rates were found at significantly higher levels in San Diego than in other parts of California and the nation. APHF’s educational activities aim to raise awareness about the links between LTBI and TB disease, address misconceptions, decrease stigma, and facilitate screening and treatment for LTBI and TB.

In the train-the-trainers strategy, APHF will utilize various forms of media, such as educational LTBI/TB videos and accompanying handouts in English and Vietnamese to educate groups of “trainers”, who will then educate and share information with their “trainees”. Round 2 of the TB Elimination mini grant will additionally focus on training undergraduates and high school students, in an effort to expand outreach by encouraging peer education through students’ social and family networks. By coupling our educational efforts with linkage-to-care through our San Diego county partners, our goal is to better inform our underserved and to increase their screening rates to maximize our collective TB control efforts.

Colorado Alliance for Health Equity and Practice (Denver, CO)

Title: Culturally Appropriate Community Engagement for Risk-Assessment and Quality Improvement for Treating and Managing Tuberculosis Patients

Our previous work with TEA has allowed us to create a sustainable system that enabled increased screening, testing, and treatment for those with one or more risk factors in the Asian-Pacific Islander (AANHPI) population. This year we will expand this work to include the Latinx and African American (Black) population. Over 20% of all our patients are either Latinx or the African American.As culture and language influence health, healing, wellness-beliefs, perception of disease and illness; health-seeking behaviors of patients, and attitudes toward preventative care, the role of patient navigators and community health workers is extremely important. Fifteen patient navigators from fourteen different cultures are employed or contracted to assist in providing culturally and linguistically appropriate care.

CAHEP and the Denver Metro TB Clinic (DMTBC) at Denver Health have been partnering to increase screening, testing, and treatment of tuberculosis infection (TBI) among the at-risk populations in Denver, Colorado. CAHEP clinical staff has been trained in 2021-22 and understands the modified clinical workflow, IGRA testing and interpretation of results, TBI treatment, when to suspect TBD and steps to refer to public health, and common misconceptions about TB. In addition, the DMTBC has been available for consultation, to test and treat uninsured individuals, and as a referral network for individuals who are suspected of having active TB disease. Thus, CAHEP has conducted such services, in some form, for over fifteen years and patient-engagement, treatment, education, and awareness services have successfully supported patients while addressing health disparities.

Healthy Asians & Pacific Islanders (HAPI) Medical Center (Las Vegas, NV)

Title: HAPI Medical Center STOP TB program: TB Education and Awareness in the Las Vegas, NV community

HAPI Medical Center, in partnership with the Asian Community Development Council (ACDC) in Las Vegas, Nevada aim to bring TB awareness and Education to the Las Vegas community. In 2021, 80 patients per Las Vegas Public Health Department were diagnosed with TB and approximately 51% of that number was in the AAPI community. Tuberculosis continues to be a taboo topic in the Asian and Pacific Islanders communities, heavily stigmatized and under-diagnosed. TB education, awareness, screening and treatment remains difficult in this population as 81% of the AAPI community in Las Vegas remains uninsured and without medical care.

HAPI Medical Center was started in August of this year to target the uninsured and under-represented AAPI community here in Las Vegas, NV. In our very first year of TB education and awareness we started the STOP TP program to educate the population on Tuberculosis, the difference between Active and LTBI, the de-stigmatization of TB, addressing misinformation, and the necessity of screening.

The STOP-TB program involves conducting Questionnaires at every vaccination clinic to bring forth the educational knowledge individuals have of TB. Multilingual volunteers will distribute educational materials translated into multiple languages on paper, and a Nurse Practitioner will be on-site for community outreach and education. Tuberculosis education and resources will be featured on our website with different language capabilities. Infectious disease providers will be providing TB seminars and educational courses for local providers and for the community. World TB day will feature a health fair to further educate the population on TB.

To assess the program’s impact and community response, pre/post questionnaires will be distributed in all events, as well as metrics on web visits, health fair attendees, and demand for translated materials.

Home of Helping Hand (Lawrenceville, GA)

Title: Reaching out to the Refugee community : Education, Raise Awareness for Latent Tuberculosis Infection ( LTBI)

This project goal is to promote our Refugee community health knowledge. Especially to those uneducated Seniors, young and middle age Refugees. This project will utilize our community workers and leaders for outcomes of awareness, education for latent tuberculosis.

La Maestra Family Clinic, Inc. (San Diego, CA)

Title: TB Education and Testing in San Diego’s Vulnerable Communities

La Maestra Family Clinic, Inc. is a Federally Qualified Health Center (FQHC) with over 30 years of experience serving low-income, uninsured and underinsured communities in the central, south, and east regions of San Diego County, California. The organization currently operates 18 primary care and behavioral health sites, ten dental suites, three school-based sites, two mobile medical and dental units, and a state-of-the-art mobile mammography coach. According to clinic data, La Maestra has grown from serving 15,870 patients in 2003 to 39,943 patients in 2021.

La Maestra’s TB Education and Testing in San Diego’s Vulnerable Communities project aims to raise awareness about the link between LTBI and TB disease, address misperceptions, decrease stigma, and encourage and facilitate testing and treatment for LTBI and TB; increase awareness of the recommended shorter treatment regimen for LTBI; encourage providers to test and treat LTBI among at-risk populations. The organization will achieve this through a multidisciplinary team of health education staff, physicians, and a hepatologist. The team will utilize its existing culturally and linguistically appropriate LTBI and TB education, training and community engagement resources and activities that resonate with high priority AA, NH, PI, non-U.S. born Hispanic/Latino, and U.S. born African American communities.

Micronesian Islander Community (Salem, OR)

Title: Increasing TB Education and Awareness in the Micronesian Community in Oregon

The Micronesian Islander Community (MIC) serves the Micronesian community in Oregon and back home on the islands of the Republic of Marshall Islands, Republic of Palau, and the Federated States of Micronesia. In addition to Micronesians, MIC serves our Micronesian families from the Compact of Free Association (COFA) citizens living in the U.S. Micronesians are disproportionately impacted by TB, with large TB breakouts in the Marshall Islands and Chuuk.

For this mini-grant, MIC will work with the TB Alliance and the local public health agencies in Oregon (specifically, Marion and Union counties) to provide health education events in person and virtually (on Facebook and via Zoom) to raise awareness about TB and to encourage TB testing by our community. MIC’s goal is to provide TB education and awareness to 40-50 community members and connect people to appropriate testing and resources. MIC will also develop a mini health resource fair to provide information on TB, COVID-19, MPX, and other infectious diseases that are affecting the community.

Polynesian Association of Alaska (Anchorage, AK)

Title: Pacific Island Awareness Program for LTBI/TB Community in Anchorage Alaska

Alaska is close to 30,000 Pacific Island communities that made Alaska their home. 80% of them live in Anchorage, about 50% reside in the low income area of Anchorage. These areas are but not limited to Fairview, Mt. View, Muldoon, Midtown. Pacific Island Community in Alaska was hit hard with Covid from 2019 to 2022, the community have lost loved ones during Covid. Pacific Islanders living in the United States are more than three times as likely to contract tuberculosis than the overall population. 

During the COVID-19 pandemic, reported TB disease diagnoses fell 20% in 2020 and remained 13% lower in 2021 than per-pandemic levels. These declines may represent true reduction in TB disease, as well as missed or delayed TB disease diagnoses due to multiple factors associated with the COVID-19 pandemic. Socio economic factors such as access to health care, poverty, language barriers, lack of knowledge, and stigma may affect disparities in infection among Pacific Island. Therefore, the goal of this proposed project is to create a culturally and linguistic LTBI/TB education, training, and community engagement resources and activities that resonate with Pacific Island high priority living in Alaska. 

Through this program, short videos will be produced and created in native Pacific Island Language and will be accessible and available to the community through media, newsletters, fliers and many other sources of communication. Kids coloring books will translate in Pacific Island Languages and will be accessible for kids to use and learn about TB infection. PAOA focuses on the power of education and community empowerment to address the disproportionate impact of Tuberculosis (TB) among Pacific Island and work to prevent certain inequities from manifesting further. If we are to work towards ending TB in the world, that work must involve addressing latent TB infection (LTBI) and cultivating the awareness and engagement of communities necessary to meaningfully create this change. 

The objectives of the project are twofold: to raise awareness about the link between LTBI and TB disease, address misconceptions, and reduce stigma and to create culturally and linguistically appropriate LTBI and TB education and community engagement resources to cultivate agency and informed decision making when it comes to testing and treating LTBI in Anchorage Alaska. The goals of the project will be achieved through a compilation of education and community building programming facilitated for and primarily by the members of the Polynesian Association of Alaska and particularly for those affected by TB and LTBI. This project will thoughtfully and creatively work with Pacific Island communities impacted to address TB and LTBI and provide community members the tools and access to improve their health outcomes.

Saint Paul – Ramsey County Public Health (Saint Paul, MN)

Title: TB/LTBI Community Engagement and Education in Hmong Communities in Minnesota

Saint Paul – Ramsey County Public Health (SPRCPH) Tuberculosis Control Program & Clinic plans to re-engage Hmong stakeholders who partnered with the TB clinic in response to the 2016-2019 MDR-TB outbreak. These partners supported the development of culturally and linguistically appropriate community engagement, education, and provider training in response to the MDR-TB outbreak in those communities. Relationships built during the outbreak were essential to an effective and culturally appropriate response. Re-engaging these partners will ensure effective response to future MDR-TB outbreaks impacting Hmong communities in Ramsey County and surrounding communities, a population disproportionately impacted by LTBI and TB in Minnesota.

Project goals include: 1.) Raising awareness, addressing misconceptions, decreasing stigma, and encouraging testing and treatment of LTBI/TB in the Hmong communities in Ramsey County. 2.) Encouraging providers serving Hmong communities in Ramsey County to include TB as part of the differential diagnosis when assessing clients, and refer to TB clinics for further testing and treatment of LTBI/TB. Through this project, SPRCPH TB Clinic plans to engage partners in planning and implementation to enhance community education and awareness of LTBI and TB in Hmong communities and facilitate provider training aimed at clinical staff serving those communities. SPRCPH TB Clinic will partner with community-based organizations to facilitate community engagement and education including interviewing Hmong healthcare providers on local Hmong TV and radio. TB clinic staff will facilitate provider training to community-based clinical service staff. The CDC’s Think. Test. Treat. TB Campaign will be used in outreach and educational materials.

San Diego County Medical Society Foundation, dba Champions for Health (San Diego, CA)

Title: Collaboration for Action to achieve Results toward the Elimination of TB (CARE-TB)

CARE TB’s goal is to expand an established foundation through program enhancement and collaboration. CFH will achieve this goal by implementing three screening, testing, and treatment events during this funding cycle. Event one will take place in late October at Kearny High School in the Linda Vista neighborhood in central San Diego. Linda Vista has a population of 31,000 with 32% identifying as Hispanic, 19% Asian, and 5% Black. Last year, with our second round of TEA funding, CFH selected Bayside Community Center in Linda Vista as a screening, testing, and treatment pilot site due to its smaller size and limitations in staffing and lab services due to COVID-19. Even with a small testing cohort of 13 individuals, six tested positive. While all participants had subsequent negative chest x-ray results, in response to this experience, the CARE TB team would like to continue working with this community, using new, additional resources at a larger community event. October’s event will link with the TB Peer Educator Project (TBPEP), a 7-week project-based program for high school seniors. Students at Kearny High will learn about TB and its impact on San Diego County. As a program outcome, students will be encouraged to come up with TB prevention messages and promote them to their peers and community members. Since the event is close to Halloween, the messages and activities will be incorporated into a haunted health fair on campus and open to community members. CARE TB will be part of this health fair, providing TB risk assessments and blood tests, then offering chest x-rays and treatment for those that are positive through County TBCRHB. Another health fair highlight will be having Asian Pacific Health Foundation (APHF) as an additional partner. They will have a TB educational booth at the health fair and assist with the TB risk assessments. This partnership will continue with CARE TB’s second event, supporting APHF educational outreach at Mesa College’s English as a Second Language (ESL) classes. Mesa College is also located in the Linda Vista area, close to Kearny High School. At APHF’s event, CARE TB will offer ESL students screening, testing with chest x-ray, and treatment for those that test positive. CARE TB’s third outreach event will be in the San Diego County community of San Ysidro. San Ysidro is a neighborhood located in South County on the United States – Mexico international border. Its population is 28,000 with 93% identifying as Hispanic, 2% Asian, and 1% Black. In San Ysidro, CARE TB proposes to do a screening, testing, and treatment event in conjunction with a CFH COVID-19/flu clinic. Starting small, the CARE TB team will select a site that is associated with a low-income residential complex or community center where social services are embedded. Since CFH and the County TBCRHB are already a part of San Ysidro’s community network of schools, healthcare systems, and nonprofit organizations, they will be able to select a location that meets the CARE TB program’s needs and capacity.

Southeast Asian Coalition of Central Massachusetts, Inc. (Worcester, MA)

Title: Southeast Asian Coalition of Central Massachusetts, Inc. LTBI/TB Elimination Education Campaign, 2022

Southeast Asian Coalition of Central Massachusetts, Inc. (SEACMA) will increase awareness of LTBI and TB in Asian community members in Central and Western Massachusetts. SEACMA will distribute translated information to community members via community gathering places (e.g., faith-based institutions, community centers, markets, etc.), direct contact, a social media campaign, and annual cultural events (e.g., the Moon Festival, Annual Asian Festival, etc.). Further, SEACMA will hold a minimum of six (6) training sessions for community members to increase participant knowledge of LBTI and TB. Topics covered will include the link between LBTI and TB disease, address misconceptions, decrease stigma, and encourage and facilitate treatment for LTBI and TB.

For Asian immigrants, refugees, and asylees in Central and Western Massachusetts, the barriers to health information and access to care are high. Members of the community often lack basic health information delivered in a linguistically and culturally relevant way. A culturally and linguistically appropriate health campaign for LBTI/TB would be beneficial to community members to raise awareness of the disease and give concrete interventions.

SouthLand Integrated Services, Inc. (Garden Grove, CA)

Title: Improving LTBI Testing and Treatment Among Vietnamese Immigrants Through Culturally Sensitive Education and the Use of Patient Health Navigators

The foreign-born Vietnamese population in Orange County, California, has remained at the highest risk for tuberculosis reactivation and infection over the last decade. In 2022, the Orange County TB report identified 44.9% of TB cases were from persons originating from Vietnam, up from 33.5 % in 2019. The health disparity related to TB infection for this population needs immediate attention from the public health sector to improve the lives of foreign-born Vietnamese immigrants. To encourage awareness of testing and completing treatment for LTBI, increased access to culturally and linguistically appropriate TB/LTBI education should be available and easily accessible for this population. Primary care facilities are ideal locations for TB education and screening services to prevent patients from advancing to TB infection. SouthLand Integrated clinic has successfully screened patients for TB/LTBI in recent years, but the current challenge is to increase the number of patients that will test, accept, and complete LTBI treatment. This project has three objectives. First, Southland is teaming up with the local and state TB division to provide culturally and linguistically appropriate TB/LTBI education in Vietnamese through pamphlets, flyers, and posters for their Vietnamese population. Second, the clinic will also pilot a short TB educational video in Vietnamese during patient visits to help educate those with positive TB risk factors. Lastly, SouthLand Integrated clinic will designate a part-time TB/LTBI patient navigator to answer TB-related questions and work one on one with patients at high-risk for TB reactivation to ensure testing and treatment is completed.

Todu Guam Foundation (Tamuning, Guam)

Title: Todu Guam Foundation

The Todu Guam Foundation TB Elimination Program aims to promote community engagement through education to community providers and the most at-risk populations. The TB Elimination Program will use components of TGF’s existing Mobile Clinic Program community outreaches, which brings medical access to hard-to-reach individuals and families, to provide community engagement and education about LTBI and TB disease. A comprehensive training curriculum about LTBI and TB will be developed and delivered to both clinical and non-clinical staff of medical clinics. Expanding on the partnership with the Guam Department of Public Health TB Program, TGF will develop a program evaluation incorporating standardized data collection for LTBI/TB testing and treatment as well as standardized policies and procedures for community outreaches, and implement a quality improvement methodology. The anticipated outcome of the program will result in better coordination and efforts to eliminate TB on Guam through effective interventions to reach marginalized, at-risk and remote populations and affect local clinic’s skills, knowledge, attitudes and behavior regarding LTBI/TB diagnosis and treatment.

Vietnamese American Cancer Foundation (Fountain Valley, CA)

Title: TB-Free OC Initiative

The CDC estimates that over 200,000 people in OC have latent tuberculosis infection (LTBI). For years, the number of TB cases in Orange County, California remained high, with Asian population being disproportionately affected by the disease. According to Orange County Health Care Agency, in 2021, the TB case rate among Asians was five times higher than the rate for Hispanics and Whites, at 16.0 versus 3.1 and 0.5 per 100,000 population. Moreover, 87.0% of TB cases were non-U.S. born and 44.9% were born in Vietnam. Orange County is also known as the home to the largest Vietnamese population outside of Vietnam. As one of the recipients for the TB Elimination Alliance Mini-Grant Program this cycle, through the TB-Free OC Initiative, VACF aims to continue increasing awareness about the link between LTBI and TB disease, addressing misperceptions, decreasing stigma, and encouraging testing for LTBI and TB. Additionally, VACF aims to create a culturally and linguistically appropriate LTBI and TB education, training, community engagement resources and activities that resonate with the Vietnamese community. To achieve these goals, VACF will conduct four (4) half-hour educational radio shows to raise awareness and provide information about LTBI/TB; three (3) to six (6) educational workshops and/or one-on-one education to educate at least 200 community members about LTBI/TB; and recruit and provide training on LTBI/TB to 40 Vietnamese Community Health Ambassadors (CHAs). The ambassadors will serve as advocates to promote awareness, empower the community, especially their social groups, and provide linkage to LTBI/TB resources.

2021 Mini-Grant Recipients

Learn more about the recipients here: 2021 TB Elimination Alliance Mini-Grant Recipients

Arkansas Coalition of Marshallese (Springdale, AR)

Title: TB Education and Testing in the Pacific Islander Community in Arkansas

The Arkansas Coalition of Marshallese (ACOM) serves the highest population of Compact of Free Association (COFA) citizens living in the United States. The United States and the Marshallese community have a unique relationship. Nuclear testing in the Marshall Islands created negative health conditions leaving the Marshallese community prone to cancer, chronic diseases, Hansen’s disease and a high incidence of TB. Marshallese migration to Arkansas can be attributed to attaining better opportunities for education and healthcare services. Asians and Native Hawaiians/Pacific Islanders are disproportionately impacted by TB at a greater rate compared to other racial and ethnic groups. Ethnic sub-groups such as the Marshall Islands within the Micronesia Region of the Pacific Islands reported an incidence rate of about 160 new cases of TB per 100,000 persons over a 5-year period (2014-2018). 

For our second year in this mini-grant program, ACOM will partner with the John Bates Clinic under the Arkansas Health Department to provide virtual health education events on Facebook to raise awareness about tuberculosis (TB) and promote TB testing in the Pacific Islander community in Arkansas. Our goal is to increase the number of TB tests to 30-50 based on the number of tests that were conducted during our first year in this mini-grant program. ACOM will also offer a mini-conference for women and a conference for the community to address the intersectionalities of TB, COVID, and other diseases. Lastly, ACOM will translate TB education materials that are culturally and linguistically appropriate for the Pacific Islander community. 

Asian American Community Services (Columbus, OH)

Title: Reaching the hard to reach: Awareness, education, screening, and linkage to care for Latent Tuberculosis Infection (LTBI)

This project goal is to promote culturally relevant tuberculosis education and to raise awareness for better treatment, control and prevention of tuberculosis among Asian Americans and Asian immigrant families in Central Ohio. This project will utilize community health workers and train-the-trainer for outcomes of awareness, education, screening, and linkage to care for latent tuberculosis.  

Asian Pacific Health Foundation (San Diego, CA)

Title: Implementing D.O.T.S. to Raise Awareness of LTBI and TB in the Vietnamese Community in San Diego 

The Direct Outreach through Train-the-Trainers Strategy (D.O.T.S.) is a pilot educational program about latent tuberculosis/tuberculosis (LTBI/TB) targeting the Vietnamese community in San Diego. In the U.S., about 20% of TB cases were in California, with most cases among the foreign-born. San Diego County has the third largest Vietnamese population in California, with also the lowest English proficiency compared to other Asian groups. Due to these factors, APHF will focus on the Vietnamese community in San Diego to maximize the impact of TB control efforts. Reaching out to Vietnamese to educate them is crucial since Vietnam has one of the highest TB burdens in the world. Additionally, more than 80% of TB cases are people with untreated LTBI. In the train-the-trainers strategy, APHF will create LTBI/TB videos and accompanying handouts in English and Vietnamese to educate a group of “trainers” quarterly, who will then educate and share information with their “trainees”. APHF will also conduct an online seminar on LTBI/TB for health professionals. These educational activities aim to raise awareness about the link between LTBI and TB disease, address misperceptions, decrease stigma, and encourage and facilitate testing and treatment for LTBI and TB.

Center for Pan Asian Community Services Inc. (Atlanta, GA)

Title: CPACS Tuberculosis Prevention and Screening Project

As of 2020, there were a total of 7,163 cases reported; however non-U.S.-born Asians comprised of 48% of all people reported with TB nationally. In the state of Georgia, non-Hispanic Asians had the highest TB case rate among other race/ethnic groups, accounting for 43.6% of cases. CPACS has worked and maintained a strong relationship with local county health districts mostly affected with TB. CPACS aims to improve awareness of TB among AAPIs in the state of Georgia by, encouraging preventive screening, coordinating intake process and case management for clients that are screened, creating culturally and linguistically appropriate LTBI and TB educational and informational activities that resonate with AAPI communities, improve access to TB screening, encourage and educate providers to screen and treat LTBI among at-risk populations with support from local county health department, and collect qualitative data to analyze community and provider knowledge. CPACS projects to provide 100 vouchers for free LTBI blood screening tests. Our goal is to also provide virtual educational/training sessions to the providers, community leaders, volunteers, and at-risk populations. At the end of our project, our results and findings will confirm if we were able to meet our baseline measurements: that 60% of community members will show an increase in TB/LTBI knowledge and awareness, 70% of healthcare providers will increase in TB/LTBI knowledge and awareness, and 100 vouchers will be distributed to the target population for free LTBI blood screening tests and given their results.

Colorado Alliance for Health Equity and Practice (Denver, CO)

Title: CAHEP’s AAPCHO Grant Application Abstract 2021-2022

CAHEP is a non-profit organization serving the most vulnerable populations through culturally and linguistically sensitive means. CAHEP provides medical, dental, and behavioral health services. There are three CAHEP providers working in one clinic. The population served is approximately 70% Asian American and Pacific Islanders (AAPI), equating to about 3,200 individuals per year. CAHEP has been serving these populations for 20 years and has gained trust and respect through working in the clinical setting and at sites within the community (churches, temples, and cultural-enclaves). The key to improving the health of vulnerable immigrant families, with culture-specific health beliefs, is providing culturally and linguistically appropriate care in partnership with the community. As culture and language influence health, healing, and wellness-beliefs, perception of disease and illness; health-seeking behaviors of patients, and attitudes toward preventative care, the role of patient navigators and community health workers is extremely important. Fifteen patient navigators from fourteen different cultures are employed to assist in providing culturally and linguistically appropriate care.  Moreover, certain diseases such as HIV and TB raise significant taboo and trust issues.  CAHEP has conducted such services with AAPI families of various races and ethnicities, for over ten years. Therefore patient-engagement, treatment, education, and awareness services have successfully supported patients. Best practices require community-supported clinics to work with Public Health agencies, as proposed in this grant.

DeKalb County Board of Health (Decatur, GA)

Title: Community Alliance for Resilience and Engagement (CARE) to Enhance LTBI/TB Testing and Treatment Project

Goal: Enhance community engagement and education, as well as provider education to increase and facilitate access to LTBI/TB testing and treatment in DeKalb County’s Asian American (AA), Native Hawaiian (NH) and Pacific Islander (PI) Communities.

Methods: The CARE Project will (1) identify trusted communities to serve as “influential network agents” (INAs) to communicate the LTBI/TB’s burden and the importance of testing and treatment and (2) develop an educational webinar for providers. Anticipated outcomes: (1) INAs demonstrate increased knowledge of the burden of LTBI/TB in AA, NH, and PI communities as a result of completing training, as measured by pre- and post-tests; (2) INAs demonstrate increased capacity to identify and correct myths and misconceptions about LTBI/TB as a result of completing training, as measured by pre- and post-tests; and (3) Increased uptake of LBTI/TB testing services by members of AA, NH, and PI communities in months 3, 6, 9, and 12 of the project period compared to baseline, as recorded in the electronic medical record system; (4) Increased TB testing from baseline at months 3, 6, 9, and 12, as measured by pre- and post-training surveys from providers viewing the webinar; and (5) Increased uptake of shorter LTBI treatment regimen from baseline at months 6 and 12, as measured through pre- and post-training surveys from providers viewing the webinar.

Drexel University School of Medicine – Dr. Ehrlich Lab (Philadelphia, PA)

Title: Educational Outreach to Tuberculosis in Burmese Refugees & Children in Philadelphia

Tuberculosis (TB) disease was reported in 3,190 Asians in the United States, accounting for 35% of all people reported with TB disease nationally. Moreover, 56% of TB cases in the United States occur in foreign-born persons, with refugee populations particularly vulnerable to both TB and drug-resistant TB. There have been reported studies that migration seems to trigger a latent to active form of the disease. At Drexel University Dr. Garth Ehrlich’s lab, we are working towards research on latent TB and its human susceptibility genes that lead to active TB as opposed to latent TB. Our lab will be collaborating with the Nationalities Service Center (NSC) and Hansjörg Wyss Wellness Center to do educational outreach programs on the types of TB, drug-resistant TB, and its treatments to incoming Refugees and Asian communities in Philadelphia. We will also be working closely with St. Christopher Children Hospital on finding diagnosed TB children and promoting TB awareness. To those who are diagnosed, we will be helping them to get appropriate treatment and follow up with them to check whether the patients follow their medication and help enroll in case management services provided by the Philadelphia Health Department.

Ministry of Health and Human Services (Ebeye, Kwajelein)

Title: Addressing misperceptions about the link between LTBI and TB disease could lead to greater benefits for the Ebeye TB Program and RMI community in the future

In 2017, organizations from the US and WHO led the TB-Free Ebeye with their main goals as follows: 1. Detect early active TB cases, 2. Reduce poor treatment outcomes (long term health problems, and adverse social and economic consequences of TB), and 3. Reduce TB transmission by shortening the duration of infectiousness. The outcomes for the screening activities showed a positive impact. We diagnosed 175 LTBI cases and 83 TB cases. The number of LTBI cases identified increased, and the active TB cases fluctuated. However, the main problem for both LTBI and TB disease is that the treatment outcome is not 100% effective. The treatment outcomes for LTBI ranges from 85-93%, and for TB disease is from 75-88%. By looking at these outcomes, we believe that treatment is one of the most important steps in eliminating TB for the Ebeye community in the Republic of the Marshall Islands.

In this project, our goal is to educate, test and treat 300 people in three different zones. We will raise awareness about the link between LTBI and TB disease, address misconceptions, decrease stigma, and encourage and facilitate testing and treatment for LTBI and TB disease. In this one-year project funded by the TB Elimination Alliance, I trust and hope that we will come to improve our community and develop a better understanding of LTBI and TB disease, so they do not believe in myths and misperceptions in the future.

Philippine Nurses Association (Canton, Michigan)

Title: Raising Awareness about Latent Tuberculosis Infection and Tuberculosis (LTBI/TB) among Asian-Americans living in Michigan

Michigan (MI) is home to the second largest Asian population in the Midwest. Asians are heterogeneous groups and Asian immigrants make up a majority of the total foreign-born and immigrant population in MI at 52.3%. Data showed that most of the cases of TB were among the foreign-born individuals. There is evidence in the literature on the disparities of Asian Americans, particularly Filipinos to TB. Asians were among the non-US born persons with the highest TB rate of 25.7per 100,000 individuals. In 2019, although the overall TB incidence in the US had decreased by 1.6% compared to 2018, the TB rate among non-US born persons was 15.5x more compared to those US born. Socioeconomic factors such as access to health care, poverty, language barriers, lack of knowledge, and stigma may affect disparities in infection amongst Asian Americans. Therefore, the goal of this proposed project is to create a culturally and linguistic LTBI/TB education, training, and community engagement resources and activities that resonate with Filipino high priority Asian Americans living in MI. To achieve this goal, we aim to 1) train clinical and non-clinical staffs on testing and treating LTBI/TB and the shorter courses of LTBI treatments in MI and 2) raise awareness of LTBI/TB among local Asian American communities. The intended outcomes of this project are to train 25 clinical and nonclinical staff on testing and treating LTBI/TB and shorter courses of LTBI/TB treatments, and to raise awareness of LTBI/TB among local Asian Americans.

Philippine Nurses Association (New York City, New York)

Title: Optimizing TB Care Outcomes Through the Implementation of Patient Navigators

In August 2017, the Bureau of Tuberculosis Control (BTBC) tested a total of 68 people at community-based tuberculosis (TB) testing events in West Queens, the neighborhood with the highest number of TB cases in New York City. Twenty-one people tested positive on blood based-TB test for latent TB infection (LTBI) and of those, 17 were foreign-born Filipinos. The BTBC recognized that Filipinos are high-risk population and treatment for LTBI is essential to reduce cases of TB among this population. Of the 17 Filipino that tested positive, only 5 clients have visited the BTBC Chest Center for TB valuation and only 3 have initiated LTBI treatment. Language barriers and cultural differences are major challenges when working with foreign-born populations. The task of following up with these patients and scheduling Chest Center appointments relies on a trusted member of the community that serves as a link between health services and the community. Our objective is to implement two Filipino patient navigators (PN) to facilitate access to TB services and improve the quality and cultural competence of service delivery. It is hoped that pairing culturally and linguistically competent PNs with Filipino clients will encourage visit to BTBC Chest Centers for TB evaluation and increase initiation of LTBI treatment thus reducing the incidence of TB among this population.

San Diego County Medical Society Foundation, dba Champions for Health (San Diego, CA)

Title: Collaboration for Action to achieve Results toward the Elimination of TB: CARE TB in the San Diego County Asian-Pacific Islander (API) Communities

CARE TB is a private-public partnership consisting of two San Diego-based agencies, Champions for Health (CFH) and the San Diego County TB and Refugee Health Branch (TBCRHB), supported by the work of TB Free California (CA), a partnership among the California Department of Public Health (CDPH), community clinics and health departments throughout California to eliminate TB. Our agencies each have a well-documented history of outreach and education to high-burden communities challenged by health disparities. Round 2 of the TB Elimination mini grant expands on the development of TB prevention messaging materials developed directly to San Diego County Filipino and Vietnamese communities during the initial round of funding. With this new round of funding, CARE TB’s goal is to provide immediate and convenient opportunities for individuals to receive TB education and materials at CFH vaccine/flu clinics in high-risk TB areas with low access to healthcare. Once these areas are selected, CARE TB proposes to conduct TB risk assessments, using the five-question San Diego County TB Risk Assessment, translated in Tagalog and Vietnamese, and implemented by Filipino and Vietnamese community members and distribute the TB prevention materials created per the evaluations done in the first round and provide individual education. A demonstration project will also be implemented to provide the option of appropriate TB testing for those deemed at-risk via the risk assessment, following up with test results, and offering an exam and treatment to those testing positive and are uninsured and coordinate treatment transition with their provider.

Southeast Asian Coalition of Central Massachusetts, Inc. (Worchester, MA)

Title: Southeast Asian Coalition of Central Massachusetts, Inc. LTBI/TB Elimination Education Campaign, 2021

Southeast Asian Coalition of Central Massachusetts, Inc. (SEACMA) will increase awareness of LTBI and TB in Asian community members in Central and Western Massachusetts. SEACMA will distribute translated information to community members via community gathering places (e.g., faith-based institutions, community centers, markets, etc.), direct contact, a social media campaign, and annual cultural events (e.g., the Moon Festival, Annual Asian Festival, etc.). Further, SEACMA will hold a minimum of six (6) training sessions for community members to increase participant knowledge of LBTI and TB. Topics covered will include the link between LBTI and TB disease, address misconceptions, decrease stigma, and encourage and facilitate treatment for LTBI and TB. 

For Asian immigrants, refugees, and asylees in Central and Western Massachusetts, the barriers to health information and access to care are high. Members of the community often lack basic health information delivered in a linguistically and culturally relevant way. A culturally and linguistically appropriate health campaign for LBTI/TB would be beneficial to community members to raise awareness of the disease and give concrete interventions.

The Regents of the University of California, San Francisco (San Francisco, CA)

Title: Digital health for Community Health: Utilizing the electronic medical record to engage families in LTBI Care in the Asian-American, Native Hawaiian and Pacific Islander Community

Electronic medical record (EMR)-based tools can help providers evaluate and manage patients with latent TB infection (LTBI). However, greater efforts are needed to utilize the EMR to improve engagement with patients and the community, and guide future activities to increase the quality of LTBI care. Our overall goal is to leverage EMR tools and data to improve completion of latent TB infection (LTBI) testing and initiation of LTBI treatment for children in the Asian-American, Native Hawaiian, and Pacific Islander (AA/NHPI) community. To achieve this goal, we have developed a set of EMR tools to improve data collection and monitoring of LTBI screening, diagnosis, and treatment in a pediatric-specific federally qualified health center (FQHC) in Oakland, CA. With these tools, we will 1) generate monthly LTBI Care Cascade Reports to contact families and increase completion of LTBI testing and initiation of treatment by at least 25% over 1 year; and 2) lead two dissemination meetings to share data generated from the EMR to AA/NHPI community partners to receive feedback and increase community AA/NHPI acceptance of LTBI testing and treatment by at least 15% over 1 year. If successful, we hope to expand these efforts to other clinics to improve patient and family engagement in LTBI care in the AA/NHPI community.

Vietnamese American Cancer Foundation (Fountain Valley, CA)

Title: TB Free OC

According to the Orange County Health Care Agency – Pulmonary Disease Services, in 2020, four in five TB cases in Orange County, California occurred among Asians, and top country of birth of those cases was Vietnam (47.5%). Orange County (OC) is the home of the largest Vietnamese population outside of Vietnam. In addition, CDC estimates that over 200,000 people in OC have latent tuberculosis infection (LTBI), and one in six non-U.S. born persons in Orange County have LTBI. Without early detection and timely treatment for LTBI, persons with LTBI are at risk for developing TB disease. Thus, VACF’s TB-FREE OC Initiative’s goal is to increase LTBI/TB awareness, knowledge, testing, and treatment for the Vietnamese population in OC through culturally and linguistically appropriate interventions. To achieve this goal, VACF will conduct four (4) half-hour educational radio shows to raise awareness and provide information about LTBI/TB; three (3) to six (6) educational workshops and/or one-on-one education to educate at least 200 community members about LTBI/TB; and organize 2-4 free TB screening events and individualized testing service to at least 60 community members in total.

We Are TB (National)

Title: Storytelling and Community Empowerment to End TB

The We Are TB in collaboration with Wisconsin Tibetan Association (WTA) and Public of Madison and Dane County aims to harness the power of storytelling and community empowerment to address the disproportionate impact of Tuberculosis (TB) among Tibetans and work to prevent certain inequities from manifesting further. If we are to work towards ending TB in the world, that work must involve addressing latent TB infection (LTBI) and cultivating the awareness and engagement of communities necessary to meaningfully create this change. The objectives of the project are twofold: to raise awareness about the link between LTBI and TB disease, address misconceptions, and reduce stigma and to create culturally and linguistically appropriate LTBI and TB education and community engagement resources to cultivate agency and informed decision making when it comes to testing and treating LTBI Tibetans in Madison, Wisconsin. The goals of the project will be achieved through a compilation of educational and community building programming facilitated for and primarily by the members of the Tibetan American community of Wisconsin and particularly those affected by TB and LTBI. Through hybrid and virtual offerings, this project has the capability to reach beyond the primarily audience impacting Tibetan communities worldwide. This project will thoughtfully and creatively work with communities impacted to address TB and LTBI and provide community members the tools and access to improve their health outcomes.

2020 Mini-Grant Recipients (Inaugural)

Arkansas Coalition of Marshallese (Springdale, AR)

Title: TB Education and Testing in the Pacific Islander Community in Arkansas 

The Arkansas Coalition of Marshallese (ACOM) serves the highest population of Compact of Free Association (COFA) citizens living in the United States. For this one-year project, ACOM will partner with the John Bates Clinic under the Arkansas Health Department to provide virtual health education events to raise awareness about tuberculosis (TB) and promote TB testing. ACOM will also translate TB education materials that are culturally and linguistically appropriate for the Pacific Islander community in Arkansas.

Asian American Community Services (Columbus, OH)

Title: Reaching the hard to reach: A Community-based photovoice to increase tuberculosis education and awareness

Asian American Community Services will implement a one-year project to utilize Photovoice among members of the Asian American Community in Central Ohio, to share their perspectives and experiences on tuberculosis through photographs, narratives and reflections. The goal is to empower the community and raise awareness for tuberculosis (TB) prevention and care, and to promote culturally relevant TB education and screening.

Asian American Health Coalition of the Greater Houston Area dba HOPE Clinic (Houston, TX)

Title: Bridging the Tuberculosis Education Gap in AA/NHPI Communities    

Background: HOPE Clinic currently takes referrals from Harris County Public Health’s Refugee Screening program for persons identified as tuberculosis (TB) positive and provides treatment for those who meet program criteria. HOPE Clinic also collaborates with the Houston Health Department to provide latent TB infection (LTBI) treatment in high-risk communities, especially to bridge accessible care to low income and the uninsured. As a community safety net, HOPE Clinic is dedicated to educating and delivering the 12-dose regimen to treat LTBI. Through this collaboration, HOPE Clinic offers affordable therapy to patients onsite resulting in a completion rate above 80% improving TB treatment outcomes for vulnerable populations.

Activities: For this one-year project, HOPE Clinic will expand this model of care to all sites, training HOPE Clinic providers and clinical staff. Education on TB will be provided to resident physicians and other new hires, many of whom speak Asian American Pacific Islander (AAPI) languages. HOPE Clinic will also provide education for local independent practitioners and the local health authority, who also serve AAPIs.  To support linguistic needs for provider and community education, HOPE Clinic will create a variety of in-language educational materials for both providers and patients.

Asian Services in Action, Inc. (Akron, OH)

Title: TB Education and Screening in AAPI communities in NE Ohio

For this one-year project, Asian Services In Action, Inc. (ASIA) will increase the number of community based tuberculosis (TB)-focused outreach and education events held within local Asian American Pacific Islander (AAPI) communities. Over the project period, ASIA will provide linguistically-appropriate outreach and education about TB and Latent TB Infection (LTBI) to 200 individuals, with a focus on Chinese, Bhutanese, Burmese/Karen, Congolese, Indian and Afghani communities, resulting in 40 TB screenings. These efforts will occur in-person or virtually, as dictated by public health guidelines to achieve the following goals:

    1. Increase knowledge, within the refugee population, about TB/LTBI  risk factors and help patients with TB/LTBI understand their diagnosis and proper follow-up.
    2. Connect refugees at risk for TB/LTBI infection to the International Community Health Center (ICHC) for screenings and primary medical care.

This project will be guided by a Certified Nurse Practitioner (CNP) and will utilize in-language Community Health Workers (CHWs) to staff awareness and education events.

Center for Pan Asian Community Services Inc. (Atlanta, GA)

Title: Health Equity Through Testing and Education (HETTE)

For this one-year project, Center for Pan Asian Community Services Inc. (CPACS) will implement projects targeted at Asian American Pacific Islander (AAPI) populations to:

    1. Create culturally and linguistically appropriate latent TB infection (LTBI) and tuberculosis (TB) education and training activities that resonate with AAPI communities
    2. Encourage and educate providers to test and treat LTBI among at-risk and AAPI populations
      • Activities will be accomplished through the completion of up to three virtual educational/training sessions for providers and/or community members
    3. Provide up to eighty (80) drive-thru TB health screenings with the support of COSMO Health Center and the Georgia Department of Public Health
Colorado Department of Public Health and Environment (Denver, CO)

Title: Building a Sustainable System for the Provision of TB Infection Services in the Primary Care Setting

For this one-year project, Colorado Department of Public Health and Environment will partner with the Colorado Alliance for Health Equity and Practice (CAHEP), a non-profit organization with approximately 70% of their patient population being Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI).  Currently, screening, testing, and treatment for latent tuberculosis infection (LTBI) are only performed when a patient has had direct contact with an individual with tuberculosis (TB) disease (TBD) or has other significant risk factors for progression to TBD. Under this project, Colorado Department of Public Health and Environment will create a sustainable system that will enable CAHEP to provide ongoing screening, testing, and treatment for those with one or more risk factors, including those with compromised immune systems and persons immigrating from areas with high rates of TB. The Colorado State TB program will provide training and technical support for CAHEP providers and patient navigators. Topics for training and support include, but are not limited to, modification of the clinical workflow, IGRA testing and interpretation of results, TBI treatment options, when to suspect TBD and refer to public health, and common misconceptions about TB. As an additional partner, the Denver Metro TB Clinic will be available for consultation, to test and treat persons who are not insured, and as a referral network for individuals suspected of having active TB disease.

Fort Bend County Clinical Health Services (Rosenberg, TX)

Title: Fort Bend County Asian American TB Awareness Project 

For this one-year project, Fort Bend County will raise awareness and provide culturally relevant education of tuberculosis (TB) to the residents of Fort Bend County from India/of Indian descent. Decreasing the stigma by dispelling the misinformation related to TB through partnerships with community organizations, healthcare providers and religious leaders will lead to increased acceptance of screening and treatment of TB infection and disease. The Fort Bend County Asian American TB Awareness project will engage in outreach activities quarterly by providing education to the community. Furthermore, based on the identified needs, screening, testing and treatment offered at outreach activity.  The Fort Bend County Clinical Services Department TB program seeks to decrease the burden of current infection and future disease through these ongoing efforts by increasing screening, treatment and completion of treatment in Fort Bend County residents from India/of Indian descent.

North East Medical Services (Daly City, CA)

Title: North East Medical Services’ (NEMS) TB Elimination Program

For this one-year project, North East Medical Services (NEMS) will improve tuberculosis (TB) testing and treatment of at-risk patients through provider education and quality improvement of its electronic health record (EHR) and clinical workflows. NEMS will simplify its TB risk assessment form in the EHR to reflect California Department of Public Health’s simplified risk assessment, integrate travel history into routine clinic intake procedures, work with its onsite pharmacy to ensure that preferred shorter treatment regimens are easy to order and readily available to patients, and work with the San Francisco Department of Public Health to educate providers on the preferred shorter treatment regimens recommended by the Centers for Disease Control and Prevention.

San Diego County Medical Society Foundation, dba Champions for Health (San Diego, CA)

Title: Collaboration for Action to achieve Results toward the Elimination of TB, CARE TB in the San Diego County Asian-Pacific Islander (API) Communities. 

CARE TB is a private-public partnership consisting of two San Diego-based agencies, Champions for Health (CFH) and the San Diego County TB and Refugee Health Branch (TBCRHB), supported by the work of TB Free California (CA), a partnership among the California Department of Public Health (CDPH), community clinics and health departments throughout California to eliminate TB. Our agencies each have a well-documented history of outreach and education to high-burden communities challenged by health disparities. Together, we are a comprehensive, engaged response committed to reducing TB’s burden in local API communities, specifically Filipino and Vietnamese. The core of CARE TB will be its advisory committee, consisting of API community members representing diverse organizations, including healthcare systems, service agencies, schools, LTBI/TB patients, and business organizations. The advisory committee is responsible for forming the LTBI/TB outreach agenda and reviewing and approving all educational resource recommendations, activities, and, eventually, the CARE TB Plan. Supporting the development of this plan is the County of San Diego TB Elimination Initiative (TBEI.) TBEI is responsible for developing San Diego County’s overall TB elimination plan. TBEI has more than 45 participants at its current development stage, representing 27 agencies, with 35 of its members outside the SD County government. With the development of the plan, the CARE TB advisory committee members and its program will become part of TBEI to facilitate its sustainability and expansion.

UCSF Benioff Children’s Hospital Oakland (Oakland, CA)

Title: Pediatric Latent TB Infection in Alameda County: Increasing Screening, Diagnosis and Treatment through Education and Enhancing the Electronic Medical Record

For this one-year project, UCSF Benioff Children’s Hospital Oakland (BCHO) will:

    1. Develop and pilot an latent tuberculosis infection (LTBI)-specific workflow in the Electronic Medical Record (EMR) to expand LTBI screening, diagnosis, and treatment among children of Asian-American, Native Hawaiian, and Pacific Islander (AA/NHPI) background. 
    2. Provide educational sessions to providers, patients and families to raise awareness about the risk of LTBI in children and the AA/NHPI community, to promote provider use of the EMR workflow, and to increase acceptance of LTBI care among patients and families. 

To achieve these goals, expertise will be leveraged across BCHO, general pediatricians, pediatric infectious diseases specialists, local and state public health partners, and community representatives. BCHO will develop the EMR LTBI workflow at the BCHO Primary Care Clinic, and pilot the workflow and information sessions over 9 months with the goal to achieve at least a 25% increase in screening, diagnosis and treatment of pediatric LTBI.