The Role of Social and Behavioral Sciences in Combating Tuberculosis

With a long history, tuberculosis (TB) remains one of the major infectious diseases in the world, killing millions of people every year. After decades of decline, the US saw a resurgence in TB rates from the late 1980s through the early 2000s. Although TB rates have been declining since then, approximately 10,000 people begin treatment for TB disease each year. Higher rates persist in persons born in other countries.

TB can be seen as a “medical model” disease which is largely controlled by physicians, nurses, and epidemiologists.  This is in contrast to HIV/AIDS where a variety of social and behavioral science disciplines are represented.  Current treatment of TB disease utilizes Directly Observed Therapy, a largely effective treatment model which does not depend on an understanding of patient motivation – public health law allows providers to force treatment on non-compliant patients. As a result, people providing TB services have given little attention to patients’ knowledge, attitudes, and beliefs (KAB).

As the incidence of TB disease continues to decline in the US, the focus of TB services is increasingly on treating latent TB infection (LTBI) to prevent the development of active disease. Unlike treatment for active TB but similar to treatment for many other diseases (HIV/AIDS, hypertension, asthma, etc.), LTBI treatment is voluntary. People with LTBI are not required to begin treatment and suffer no consequences for non-completion. Thus, to convince people to start and complete LTBI therapy, providers will need to understand what people know and think about TB.  This is especially critical when working with people who come from other countries, where TB incidence may be high, different beliefs in TB transmission and treatment abound, and LTBI treatment is not provided.

This roundtable session will review the relatively few studies which have been conducted on TB KAB in the US.  These studies have largely focused on such high-risk groups as drug users, immigrants, and the homeless. However, recent studies conducted by the presenters have incorporated more heterogeneous samples.  The presentation will provide a descriptive summary of findings, followed by a discussion of how KAB variables may be used in multivariable models examining such outcomes as treatment acceptance and adherence.  Additionally, their presentation will examine the use of multivariable techniques in exploring the components of KAB. 

Through their understanding of human behavior, social workers and other social/behavioral scientists clearly have an important role to play in the on-going fight against TB.  Their expertise will be essential in improving such health behaviors as help-seeking, treatment acceptance, and treatment adherence.