Tuberculosis among participants in an academic global health medical exchange program.

ABSTRACT

BACKGROUND: Although individuals from low tuberculosis (TB) burden countries experience an increased risk of TB infection when traveling to high burden countries for medical training or service, the degree of risk has not been well quantified. OBJECTIVE: Improved knowledge will aid development of guidelines for TB screening, pre/post-travel education, and risk reduction. DESIGN: Retrospective survey including questions on demographic characteristics, pre-travel TB counseling, in-country activities, and post-travel TB testing. PARTICIPANTS: Six hundred eight individuals who traveled to Eldoret, Kenya with the Academic Model Providing Access to Healthcare (AMPATH) medical exchange program between July 2004 and June 2009 were invited to complete an online survey in January 2010. MAIN MEASURES: The percentage of participants with a tuberculin skin test (TST) conversion and percentage reporting pre-travel and post-travel counseling and testing for TB were examined. KEY RESULTS: Four hundred thirteen out of 608 (68%) responded with sufficient information to be included in the analysis. Two hundred thirty-nine individuals (58%) reported that TB prevention was discussed in pre-travel preparations. One hundred thirteen (27%) of the survey participants reported "ideal" care [definition pre-travel TST (within 1 year of travel), pre-travel counseling, and a post-travel TST specifically related to their travel]. Out of 267 participants at risk for TST conversion, 11 (4.1%; 95% CI 2.2-7.3) had a conversion. TST conversion was not associated with longer duration of stay or participation in direct medical care. CONCLUSIONS: Travelers to TB-endemic areas with international medical exchange programs are at risk for TB infection, regardless of their length of stay or whether or not they participate in direct medical care. Many receive inadequate pre- and post-travel TB counseling and testing. Efforts should be made to improve TB education for program participants.