From 1994 to 1997, staff at The Johns Hopkins University School of Hygiene and Public Health, Baltimore, developed a tuberculosis (TB) screening and prevention program by linking health care resources aimed at the control of tuberculosis, with community-based resources for under-served populations in Baltimore City.

In tuberculosis, the imposition of services devoid of community support and investment has often resulted in low levels of patient adherence to prescribed treatments.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Old Disease, New Challenge: Tuberculosis in the 1990s.

The target population was residents of East Baltimore, a community of low socioeconomic status that has 25 to 30 percent of Baltimore's annual cases of tuberculosis.

Key Findings: Due to a lower than expected infection rate, all aspects of the planned project were scaled back, and the project's primary goal of developing a sustainable, grassroots TB prevention program was not achieved.

Nonetheless, lessons surfaced which may inform future community-based TB prevention programs, including:

• Widely cast community-based TB screening efforts are of limited value in identifying candidates for chemoprevention.
• Participation in voluntary screenings is likely to be very low, in part due to the low salience of TB compared to other social problems in economically distressed communities.
• The use of outreach workers or community health workers in multiple-role positions (i.e., participant recruiters, health educators, "links" between community and the health system, data collectors, community representatives, advocates, etc.) presents tremendous challenge to workers inexperienced with more than one of these individual tasks.