Joseph S Johnson, MPH, Refugee Health Section, California Department of Health Services, 1501 Capitol Ave, Suite 71-5195, PO Box 997413, MS5204, Sacramento, CA 95899-7413, 916-552-8262, jjohnso3@dhs.ca.gov

Counties in California that receive refugees face issues surrounding treatment compliance for latent tuberculosis infection (LTBI). Within California, there is a high rate of LTBI with a low rate of voluntary treatment among refugees. Refugee populations have set beliefs, both personal and religious, against the use of medications, particularly to treat LTBI. Refugees have cultural differences along with knowledge, value and belief systems that vary significantly from Western health practices and religious convictions. The concept of prevention services remains difficult for many new refugees to understand and to accept. These beliefs may interfere with health care treatment, medications and testing for LTBI. Counties that receive funding for refugee health assessment services for newly arriving refugees have implemented strategies to improve the initiation and completion rates for LTBI treatment among refugees. These include outreach activities into the refugee communities that include networking with the refugee religious organizations, culturally appropriate classes taught in the refugee clinics and community settings by culturally and linguistically appropriate staff, increased accessibility, home visits and incentives. Tracking systems have been implemented to strengthen refugee case management, in order to better identify other necessary services for refugees, such as interpreter and transportation services. These activities have led to a markedly increased completion rate in one LTBI focused program where educational interventions were employed. Twelve other programs have implemented similar outreach and educational activities are in the process of evaluating the effects. The evaluation results will be available for the 2004 APHA Annual meeting.

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