SPECIAL ARTICLE
by Zachary Renfro, md 1 ; Leonard N. Mukasa, md 1,2 ; Joseph Bates, md 1,2 ; Virginia Maturino, md 1 ; Naveen Patil, md 1,2
Arkansas Department of Health, Little Rock 1 , UAMS 2
A Plan for Elimination of Tuberculosis in Arkansas:
It’s Past Time
Arkansas has developed a plan for elimination
of tuberculosis (TB) by 2040. The
physician is central in the implementation
strategy of this plan. The incidence
of TB in Arkansas has dramatically decreased
from 848 per million persons in 1953 to 26 per
million persons in 2018, largely due to the efforts
of the TB program at the Arkansas Department
of Health (ADH) and physicians across
the state (ADH, 2018). Despite this remarkable
decline, TB remains a major cause of suffering
and death in the state, and is a substantial
public health issue. The ADH is committed to
eliminating TB from Arkansas. Elimination
is defined as a case rate of 1 case per million
people. Most cases of active TB in Arkansas do
not arise from recent transmission, but rather
as a result of longstanding latent tuberculosis
infection (LTBI) which progresses to active disease
in 10-15% of those infected. (Lee, 2016)
There are an estimated 90,000-100,000 people
with LTBI in Arkansas, the majority of whom
are not tested and are unaware of their infection
status. Recent modeling suggests that at
the current rate of decline, TB won’t be eliminated
from the U.S. or Arkansas by the end of
the 21 st century. In order to change this, there
needs to be implementation of new and bold
strategies to attack TB disease by addressing
the large reservoir of people with LTBI who are
at the highest risk of progressing to TB disease.
To best use limited resources, limit the
number of false positives, and reduce unnecessary
follow-up and treatment; screening for LTBI
should be focused in epidemiologically determined
high-risk groups. These groups include:
Contacts to active TB cases
1. Non-U.S. born residents
2. People with diabetes mellitus
3. People who are HIV positive
4. Birth cohort prior to 1951 (pre-TB
antibiotic era)
5. People taking TNF-α antagonists
6. People on chemotherapy
7. People in high congregate settings
such as prison, homeless shelters, and
long-term care facilities.
This strategy will only work when the clinician
at the frontline becomes a champion for TB
screening. How can physicians join this noble
cause and contribute to the fight against TB?
Physicians can help by ensuring that patients
at high risk for TB receive at least a baseline
screening for TB and by documenting screening
results in patients' medical records. Then, report
all positive TB tests to your county’s local
health unit in a timely manner so that further
evaluation can begin as soon as possible.
Today we have the ability to rapidly diagnose
LTBI and TB. When identified, we have
highly efficacious medication regimens for
both LTBI and TB, including a short course,
three-month regimen for LTBI. In short, we
have the capability to eliminate TB and with it
the associated pain, suffering, and loss. Physicians,
nurses, and public health officials all
have a role to play in achieving this goal. It’s
our job to Think TB. Clinicians’ roles are integral
to the elimination of TB from our state. The
Arkansas Department of Health thanks you for
your dedication to this cause and the people
we serve.
References
Lee, S. (2016). Tuberculosis Infection and
Latent Tuberculosis. Tuberculosis and Respiratory
Diseases, 79, 201–206. http://dx.doi.
org/10.4046/trd.2016.79.4.201
Mukasa, L. (2018). 2018 Annual Tuberculosis
Statistical Report. Tuberculosis Program: Arkansas
Department of Health.
20 • The Journal of the Arkansas Medical Society www.ArkMed.org