Title of Thesis:  A Cross-Sectional Study to Identify Factors Associated with Extrapulmonary Tuberculosis Among Foreign-Born In Dekalb County Georgia During 2008-2018 
   
Thesis Chair: Dr Ike Okosun

Purpose
Tuberculosis (TB) is a significant health problem in foreign-born and accounted for 57% of all tuberculosis cases in the United States in 2006. Almost 20% of American tuberculosis cases are classified as extrapulmonary tuberculosis (EPTB).  Epidemiologic evidence suggests that the prevalence of EPTB in the US is declining at a much slower rate than pulmonary tuberculosis (PTB). This study is designed to examine the factors that are associated with the risk of EPTB in foreign-born residents of DeKalb county. 

Methods
In this study, data from the Public Health Information Portal (PHIP), an online system from the Georgia Department of Public Health, was used. A cross-sectional study was conducted on US tuberculosis cases reported in DeKalb county from 2008 to 2018, classified as EPTB and PTB. EPTB encompassed lymphatic, pleural, bone and/or joint, genitourinary, meningeal, peritoneal, and unclassified EPTB cases. The data include demographic information, lifestyle variables, and clinical characteristics of the study subjects. Demographic characteristics and risk factors, including human immunodeficiency virus (HIV) status, were compared across TB status (EPTB vs. PTB). The odds ratio from the multivariable logistic regression analysis was used to determine the factors that are associated with the risk of EPTB. The independent variables fitted to the logistic regression model included gender, age, and regions of origin. 

Results
Compared to younger foreign-born, participants who are 18 years and older had a much higher odds (OR= 1.82, 95% CI: 0.81, 4.07) of EPTB, after adjustment for age, sex, HIV status, homelessness, and excess alcohol use. Foreign-born participants with HIV positive status had a much higher odd (OR= 1.41, 95% CI: 0.72, 2.78) of EPTB compared to HIV negative participants, controlling for confounding variables.

Conclusion
The result of this study indicates that being an older foreign-born (18 and older) and having HIV co-infection are associated with higher odds of extrapulmonary tuberculosis.  Awareness of the risk of extrapulmonary tuberculosis due to older age and positive HIV status may help in developing a prevention strategy among foreign-born.