# Implementation and Effectiveness of CDC Guidelines for Green Card Applicants with Latent Tuberculosis Infection

> **NIH NIH F31** · UNIVERSITY OF CALIFORNIA-IRVINE · 2020 · $37,529

## Abstract

Project Summary/Abstract
 An estimated 13 million people in the US have latent tuberculosis (TB) infection (LTBI) and act as
reservoirs from which deadly active TB disease can develop. Of the total number of TB cases reported
nationally in 2017, non-US-born persons accounted for approximately of 70.1%; however, the disproportion is
even greater in Orange County, California, where non-US-born persons accounted for approximately 89.2%. A
recent study of TB among non-US-born residents found 58.6% of TB cases were from permanent residents,
indicating a significant missed opportunity for LTBI intervention in the immigration process. A population that
can be screened and treated to reduce the incidence of LTBI is “green” card applicants (GCAs) seeking a
change in status from temporary to permanent US residency. GCAs are already procedurally screened for
LTBI through medical examination made mandatory by U.S. Citizenship and Immigration Services. The
Centers for Disease Control and Prevention (CDC) released new guidelines that may provide favorable
opportunities to ensure LTBI-positive GCAs are provided with evidence-based treatment. With the release of
the new guidelines, there are many gaps in knowledge, particularly the effect these guidelines will have on
GCAs and civil surgeons. It is crucial to screen and treat LTBI in non-US-born persons to reduce disparities in
TB morbidity and mortality and, consequently, to achieve TB elimination in the US. This study will contribute to
the current knowledge base about the reach and implementation fidelity of the new guidelines through the
following aims: 1) to determine civil surgeons’ adherence to new CDC guidelines, specifically the percentage of
civil surgeons who screen using a blood test, report LTBI-positive GCAs to the health department, and inform
GCAs of their LTBI diagnosis; 2) to determine the effect of the implementation of new CDC guidelines on LTBI
treatment rates among GCAs; and 3) to explore facilitators and potentially modifiable barriers to guideline
adherence among civil surgeons. We will generate critical preliminary data for developing public health
outreach programs to maximize the uptake of the new guidelines and, ultimately, prevent TB among GCAs. As
TB screening is already routinely done in this population, focusing on extending LTBI treatment services to
GCAs may be a sustainable strategy that substantially contributes to TB elimination in the US. This fellowship
training will take place at the University of California-Irvine and will enable the applicant to achieve the
following goals: 1) mastery of skills for quantitative research, specifically in research design, statistical analysis,
and survey building; 2) mastery of skills for qualitative research, specifically in qualitative study design,
fieldwork analysis, data collection, interview techniques, content analysis, and write-up of qualitative data; 3)
expand knowledge of theories, models, and frameworks of implementation scienc...

## Key facts

- **NIH application ID:** 10017706
- **Project number:** 5F31HL149463-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA-IRVINE
- **Principal Investigator:** Valerie Anne Pham
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $37,529
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10017706

## Citation

> US National Institutes of Health, RePORTER application 10017706, Implementation and Effectiveness of CDC Guidelines for Green Card Applicants with Latent Tuberculosis Infection (5F31HL149463-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10017706. Licensed CC0.

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