Tuberculosis surveillance in a therapeutic community.

Tuberculosis, a chronic communicable bacterial infection of epidemic proportions in the United States, is more common among debilitated and immunocompromised persons, for example, alcoholics, drug abusers, and HIV/AIDS patients, than among the general population. Daytop Village Inc., a drug free therapeutic community for chemical dependency treatment, initiated a program of tuberculosis (TB) surveillance and prevention education with grant support. Continuous educational sessions for staff and residents have raised awareness of the threat of TB. From March 1991 until September 1992, 2,932 clients screened for TB found 272 (9.2%) PPD positive. Of these 272, 125 also tested for HIV found 28 (22.4%) HIV positive. The TB screening program had no negative impact on the retention rate of Daytop residents. With sufficient fiscal and personnel support, tuberculosis education, screening, and treatment has been naturally integrated into the primary care agenda within the therapeutic community model of drug abuse rehabilitation.