{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:45:06Z","timestamp":1768571106480,"version":"3.49.0"},"posted":{"date-parts":[[2025,6,24]]},"group-title":"Primary Care Research","reference-count":38,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Treating asymptomatic tuberculosis (TB) infection prevents TB disease and is critical for TB elimination in the United States (U.S.). In the U.S., TB disease disproportionately affects those born outside of the U.S. The quality of TB preventive care in primary care settings for non-U.S.-born populations is poorly characterized. We aimed to measure gaps in TB preventive care among non-U.S.-born persons receiving primary care at community health clinics across the U.S.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective cohort study at 12 community health clinics in the U.S. Per clinic, individual-level demographic and TB clinical data were extracted for approximately 700 non-U.S.-born persons aged \u226518 years seeking care between June and December 2019. We constructed a care cascade describing gaps in TB infection testing and treatment and used multivariable mixed effects logistic models to evaluate associations between individual and clinic-level characteristics and observed gaps.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 8,460 non-U.S.-born individuals included, 68% were female, and the median age was 50 years (interquartile range 38-63). Of those included, 2,765 (33%) had a TB infection test ordered. Among 1,022 with a positive test, 787 (77%) were diagnosed with TB infection, of whom 377 (48%) were offered preventive treatment. Among 173 who were treated at study clinics, 141 (82%) completed treatment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Gaps in testing and treatment initiation for non-U.S.-born individuals were pervasive at the 12 community health clinics in this study. Research is needed to identify strategies that increase TB preventive care among populations who face the disproportionate burden of disease.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Article summary<\/jats:title>\n                  <jats:p>In this multi-site study of U.S. community health clinics, substantial gaps in tuberculosis infection testing and treatment initiation were identified for non-U.S.-born persons, a population that bears the disproportionate burden of TB disease in the U.S.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.06.24.25330215","type":"posted-content","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T03:05:29Z","timestamp":1750820729000},"source":"Crossref","is-referenced-by-count":0,"title":["Identifying gaps in tuberculosis preventive care for non-U.S.-born persons at community health clinics in the United States"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7567-7727","authenticated-orcid":false,"given":"Priya B.","family":"Shete","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew T.","family":"Murrill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharine M.","family":"Tatum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amina","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaylynn","family":"Aiona","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannette L.","family":"Aldous","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Flood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle K.","family":"Haas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Narita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April C.","family":"Pettit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie N.","family":"S\u00e9raphin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adithya","family":"Cattamanchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy L.","family":"Ayers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the Tuberculosis Epidemiologic Studies Consortium","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025062602000828000_2025.06.24.25330215v1.1","unstructured":"Advisory Council for the Elimination of Tuberculosis (ACET). Roadmap for Advancing TB Elimination in the United States through Scale up of Testing and Treatment of Latent TB Infection. In ACET Minutes of the Meeting June 16, 2020, Addendum 1, pages 40\u201351: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2021. https:\/\/www.cdc.gov\/faca\/committees\/pdfs\/acet\/acet-minutes-20200616-508.pdf."},{"key":"2025062602000828000_2025.06.24.25330215v1.2","doi-asserted-by":"publisher","DOI":"10.15585\/MMWR.MM7312A4"},{"key":"2025062602000828000_2025.06.24.25330215v1.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140881"},{"key":"2025062602000828000_2025.06.24.25330215v1.4","doi-asserted-by":"crossref","first-page":"172S","DOI":"10.1177\/0033354920927845","article-title":"Modeling the impact of recommendations for primary care-based screening for latent tuberculosis infection in California","volume":"135","year":"2020","journal-title":"Public Health Rep"},{"key":"2025062602000828000_2025.06.24.25330215v1.5","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1093\/aje\/kwy094","article-title":"Prospects for Tuberculosis elimination in the United States: results of a transmission dynamic model","volume":"187","year":"2018","journal-title":"Am J Epidemiol"},{"key":"2025062602000828000_2025.06.24.25330215v1.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153728"},{"key":"2025062602000828000_2025.06.24.25330215v1.7","doi-asserted-by":"crossref","first-page":"295","DOI":"10.15585\/mmwr.mm6611a3","article-title":"Tuberculosis among foreign-born persons diagnosed \u226510 years after arrival in the United States, 2010\u20132015","volume":"66","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025062602000828000_2025.06.24.25330215v1.8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw694"},{"key":"2025062602000828000_2025.06.24.25330215v1.9","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1001\/jama.2023.4899","article-title":"Screening for latent tuberculosis infection in adults: United States Preventive Services Task Force recommendation statement","volume":"329","author":"United States Preventive Services Task Force","year":"2023","journal-title":"JAMA"},{"key":"2025062602000828000_2025.06.24.25330215v1.10","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200510-1563OC"},{"key":"2025062602000828000_2025.06.24.25330215v1.11","doi-asserted-by":"publisher","DOI":"10.1177\/003335491513000413"},{"key":"2025062602000828000_2025.06.24.25330215v1.12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad246"},{"key":"2025062602000828000_2025.06.24.25330215v1.13","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1086\/520453","article-title":"Community-wide implementation of targeted testing for and treatment of latent tuberculosis infection","volume":"29","year":"1999","journal-title":"Clin Infect Dis"},{"key":"2025062602000828000_2025.06.24.25330215v1.14","doi-asserted-by":"crossref","first-page":"720","DOI":"10.5588\/ijtld.21.0454","article-title":"Successes and challenges of latent TB screening and treatment in a high-prevalence U","volume":"26","year":"2022","journal-title":"S. region. 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