The WHO reports that the incidence of TB is approximately 9.0 million new cases globally each year and approximately 3.3 million cases are missed by health systems as either undiagnosed or not reported. A single index case can infect up to 10 to 15 contacts over the course of a year. Thus, complete and timely evaluation of all contacts exposed to TB is crucial for decreasing the transmission and incidence of TB. Several barriers to testing of contacts have been identified, however, no studies specifically address contacts’ non-acceptance to TB testing and evaluation. Both nurses and non-nurse managers conduct contact investigations (CI), but it is not known if there are differences in adherence to TB testing and evaluation based on type of provider. The study will seek to determine factors associated with non-acceptance of TB testing and evaluations as well as compare testing adherence rates among household contacts manage by nurses versus non-nurse managers.
Pender’s Health Promotion Model (HPM) will guide the examination of factors that prevent contacts from accepting TB testing and evaluation. The HMP stresses that an understanding of the major determinants of health informs the counseling of healthy behaviors. Uncovering the factors that determine a contact’s behavior will likely lead to effective counseling of contacts exposed to TB.
A retrospective study of four years of data extracted from the New York City Department of Health and Mental Hygiene TB registry will be used to assess factors associated with household contact’s non-acceptance of TB testing and evaluation. Data elements include demographics, contact information, reporting and assignment, clinical disposition, and case management provider type. Logistic regression will be used to assess the probability of not accepting TB testing and evaluation based on independent variables, and to assess differences between two independent variables: a nurse manager and a non-nurse manager with non-acceptance of TB testing and evaluation.
Study findings will provide data to facilitate health departments to develop appropriate strategies to increase household contacts’ acceptance of TB testing and evaluation.