|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.