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Free Content Health care provider perspectives on tuberculosis care for foreign-born populations in New York City

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BACKGROUND: Tuberculosis (TB) in foreign-born patients is a key determinant of TB epidemiology in low-burden settings. In New York City (NYC), foreign-born TB populations are heterogeneous and face diverse challenges in accessing care.

OBJECTIVE: To characterize barriers and facilitators to health care services and identify potential mechanisms to improve TB care for foreign-born patients in NYC.

DESIGN: Semi-structured interviews with health care providers identified through the NYC TB registry and snowball sampling. Transcripts were analyzed using a modified grounded theory approach.

RESULTS: Fourteen providers from private practice (21%), community clinic (36%), and hospitals (43%) were interviewed. Barriers clustered into thematic areas: interrelated social and economic issues that impact TB care and treatment (documentation status, poverty, mental/behavioral health issues), challenges of fragmented health system (care continuity, costs), latent tuberculous infection, and relative lack of resources and significant barriers for clinic and private practice providers. Health care providers' deep commitment to foreign-born TB patients was evidenced by their attitudes and actions.

CONCLUSION: Improving access to TB care for foreign-born patients in NYC requires strategies that address specific social, economic and structural barriers. Improving linkages between private providers and public health initiatives is a key challenge. Health care providers' commitment to foreign-born communities is a significant resource.
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Keywords: barriers; foreign-born; health care; tuberculosis

Document Type: Research Article

Affiliations: 1: Touro College Graduate School of Social Work, New York, USA 2: Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA 3: Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York, USA 4: Division of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York, USA

Publication date: December 1, 2016

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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