Reports on HIV/AIDS: 1990

MAY 18, 1990, MMWR, Vol. 39, RR-8: [inclusive page numbers]
Persons with Other Medical Risk Factors
Health-care providers should tuberculin test all patients with medical risk factors
that substantially increase the risk of tuberculosis. These medical risk factors include:
* Silicosis
* Gastrectomy
* Jejunoileal bypass
* Weight of 10% or more below ideal body weight
* Chronic renal failure
* Diabetes mellitus
* Conditions requiring prolonged high-dose corticosteroid therapy and other
immunosuppressive therapy
* Some hematologic disorders (e.g., leukemia and lymphomas)
* Other malignancies
In addition, persons with an abnormal chest radiograph that shows fibrotic lesions
consistent with old healed tuberculosis should be skin tested.
Medically Underserved Low-Income Populations
The incidence of tuberculosis is closely related to socioeconomic status, with the
highest rates occurring among persons in low-income groups (5). Special control
strategies formulated in consultation with, and targeted toward, these low-income
groups and their service providers (e.g., health, welfare, and housing) are needed.
Tuberculosis prevention and control efforts among lower socioeconomic groups
present special problems because these groups usually have less access to care, have
less formal education, are more likely to have coexisting diseases, lack shelter or
transportation, have higher rates of substance abuse, and experience more obstacles
in complying with medical recommendations. Nevertheless, screening programs
have demonstrated success in reaching these groups. These programs have been
conducted among welfare recipients in New York City (6) and among the urban poor
in Vancouver, British Columbia (7).
Tuberculosis screening recommendations for the homeless have been published
(8). For these persons, screening consists of a chest radiograph (and possibly a
sputum smear) to determine current disease. Tuberculin skin testing programs that
identify infected persons without current disease should be undertaken only if the
group is stable (i.e., the diagnostic evaluation can be completed and a course of
prescribed therapy can be initiated). In most circumstances, the local government or
an agency funded by the government must assume responsibility for conducting
these screening programs.
Low-income groups may also be identified through occupational screening programs. These programs may be voluntary or mandated by law or regulation.
Unskilled laborers, migrant farm workers, and lower paid health-care workers are
occupational groups that include a large percentage of low-income persons.

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