California: TB Fight Is Complicated Task

The best weapons health care workers have against the spread of TB are education, outreach and monitoring, particularly in immigrant communities where the problem is worsening. There is much misinformation among those populations, according to Linh Bui, a social worker who launched Orange County's TB program two years ago.

"People don't understand what TB is. They think they can get it from smoking too much or working outside, breathing dust," he said.

A state report shows TB cases increasing in California after an eight-year decline. Some health care officials worry about how cuts in state and county TB funds might weaken programs and led to a rise in infection. After the rise in TB rates, the county's net TB budget rose to $9.6 million in 2001-2002 from $8.9 million the previous fiscal year. But that budget will likely drop to $9.4 million next year, county health officials say.

It costs, on average, $16,000 to treat an active TB case, so the budget cut is the equivalent of medication delivery, monitoring and treatment for 12 active TB patients. "In the face of cutbacks, we might have a resurgence," said Dr. Julie Low of the Orange County Health Care Agency. "One case can lead to the infections of many other people." In 2001, 85.3 percent of the county's TB patients were foreign-born.

To ensure that TB patients adhere to their full treatment regimen -- which may last more than six months and involve as many as four antibiotics -- 20 health care workers across the state make 55,000 to 60,000 patient visits a year. Only seven of Orange County's 246 TB patients took their medicine without a worker watching in 1999. To avoid possibly stigmatizing home visits, workers sometimes meet patients at work or in public places.

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