Study Highlights U.S. Gaps in TB Preventive Care for Immigrants
25 September 2025
A study led by researchers at the University of California, San Francisco identified pervasive gaps in tuberculosis (TB) testing and treatment for non–U.S.-born adults at U.S. community health centers.
The retrospective cohort study, published in Open Forum Infectious Diseases, analyzed individual-level demographic and TB clinical data on non–U.S.-born adults who sought care at 12 community clinics from June to December 2019. Over 70% of people with TB in the United States were born or lived outside of the country in settings with a high incidence of TB, with over 90% of these diagnoses attributed to reactivation of asymptomatic or latent TB infection (LTBI) acquired before immigration. The aim of the study was to characterize the LTBI “care cascade” (screening, testing, and treatment) in the community healthcare clinics where immigrants typically receive primary care.
“Systematic reviews have highlighted large gaps in TB infection testing and treatment for persons migrating from high to low-TB incidence settings with a wide range of barriers to guideline-directed care,” the study authors wrote. “However, there are limited data on the gaps in care for non-U.S.-born persons from geographically diverse primary care clinics in the U.S.”
Only 1 in 3 tested for TB
A total of 8,460 non–U.S.-born adults were included in the analysis, with a median of 702 per site. Of those included, 2,765 (33%) had at least one TB infection test ordered, 2,572 had valid results for at least one test, and 1,022 had at least one positive result.
Among the 1,022 with a positive test, 787 (77%) were diagnosed as having a TB infection, of whom 377 (48%) were offered preventive treatment at the seven clinics that provided on-site LTBI treatment. Of the 173 patients who were treated at those clinics, 141 (82%) completed treatment. Another 190 patients were referred to an outside clinic, with no follow-up recorded.
The authors say research is needed to identify strategies that could increase TB preventive care in populations who face a disproportionate burden of disease.
“Integrated and person-centered approaches to addressing access, implementation and quality barriers along the entire cascade have the greatest potential to improve outcomes,” they wrote.
By Chris Dall, MA
Source: CIDRAP
