Socioeconomic poverty makes the people of Palau at a near-critical risk for vulnerability
to both natural disasters and to diseases. Chronic diseases, such as heart disease, cancer, and
diabetes, top the list of diseases that negatively impact the health of Palauans, and infectious
diseases, such as leprosy and tuberculosis (TB), are also quite a problem. Per capita, $881 a year
is spent on the health care needs of the citizens of Palau. However, no money has been set aside
for the management and treatment of health problems in the indigent people who work
temporarily on this island-nation. These temporary migrant workers are often quite poor, have
little or no access to medical care while they are in Palau, and are not currently tested for
Mycobacterium tuberculosis (MTB) or other diseases when they immigrate to Palau. The
prevalence of latent tuberculosis infection (LTBI) and active MTB in this population is currently
unknown, and these individuals could pose a great risk to the native Palauan population due to
the presence of infectious diseases, including tuberculosis.
The proposed TB testing program would begin at the international airport, where either
the tuberculin skin test (TST) or the QuantiFERON-TB Gold (QFT-G) test would be
administered to migrant workers. Individuals who have obvious symptoms of MTB upon arrival
or test positive would have further testing at follow-up visits to Palau National Hospital.
Appropriate treatment would then be initiated. Since the presence of human immunodeficiency
virus (HIV) can affect testing results and can change the therapy recommendations for those
patients with MTB, HIV testing would also be done upon entry into the country by the standard
methods (enzyme-linked immunosorbent assay and a second confirmatory test by Western Blot).
A database would be created on these indigent workers, with their names, addresses, and points
of contact and results of their TSTs or QFT-G tests, HIV test, and chest radiographs, so that the
epidemiology of TB and HIV can be described accurately in this population, especially as to
prevalence of disease. This database would make it easier to seek out those who require
treatment.
If this proposed TB testing program is adopted, the epidemiology of these diseases could
be better described. Those identified as having LTBI, active MTB, and HIV could be treated,
which could prevent the spread of these diseases to the native Palauan population. If identified
early, they could be treated using far fewer funds than would be required should they be
identified late in the course of their disease.