CDC History of Tuberculosis Control - Medical and Public Health ...

tially case-managed all known HIV/TB cases
and helped to facilitate their care throughout
the healthcare system. To date, there have
been no known outbreaks of TB in any of the
health care facilities within the County.
Today the HIV/TB liaison program continues
to work closely with the many early intervention
clinics where TB testing is a standard of
care for all patients.
The 1990s have been a time of rapid influx of
both federal and state funding for the elimination
of TB. This allowed the implementation
of a number of new programs. Directly observed
therapy (DOT) is now the standard of
care and in 1998 more than 75% of public
health clinic patients were on DOT. The TB
Control Program has contracted with a number
of community-based organizations (CBOs)
to screen high-risk persons for TB and provide
preventive therapy. This has resulted in thousands
of persons being screened and given
preventive therapy who otherwise would not
have been reached by the health department.
A project to screen homeless persons for TB
by using a mobile radiology unit detected
dozens of cases of TB that were treated earlier
than otherwise, preventing further transmission
of infection to this vulnerable population.
This helped to accelerate the decline of TB
disease in the homeless. An MDR unit was
established to monitor and consult on every
MDR patient in the county whether under
private or public care. The percentage of such
cases has been kept below 2% of the total cases
for many years. Most of the cases that do
occur come into the county from other locations
already with MDR. Most of them are
successfully treated while remaining in Los
Notable Events in TB Control
21
Angeles County. The Public Health Laboratory
for the county was given personnel
resources and the latest technical equipment to
better serve the needs of the TB control programs.
The State of California has been very active in
addressing many of the problems that have
hindered TB control. For example, a law is
now in place that requires health care facilities
to obtain permission from the local health
officer or TB controller before any person
suspected or diagnosed with TB is discharged.
The health officer can refuse discharge if the
follow-up plan is inadequate or the patient
continues to be a threat to the public health of
the community. Another law establishes a
process for the legal detention of patients with
TB who represent a threat to the public
health. The State has also appropriated money
to pay for the detention of TB patients and
also to pay for housing of the homeless. Los
Angeles County has taken full benefit of these
actions. The Surveillance Unit at the TB
Control Program and the Liaison nurses at the
county hospitals have been given the responsibility
for approving hospital discharges under
the Director’s supervision. The County, with
the help of State funding, has recently opened
a Southern California regional center for the
detention of TB patients at one of our county
facilities. This facility can also provide longterm
skilled nursing care for any TB patient
needing it and the services of a drug and
alcohol treatment center.
An earthquake of another nature occurred in
1995. The Los Angeles County Department
of Health Services faced the possibility of
bankruptcy. A huge, complicated reorganization
of the department resulted. TB services as
well as all public health services were condensed
into 11 locations throughout the
county where previously there had been more
than 30. This created trying times, but fortunately
TB cases were not lost. On the other
hand there was a significant drop-off in the
number of patients being screened and placed