After Alabama TB outbreak residents are paid to get tested

Marion, Alabama is a small, rural community in one of the poorest counties in the United States. It's also at the heart of a tuberculosis outbreak that has, so far, taken three lives.

Marion has a population just under 3,600 and is part of Perry County, where 47 people have tested positive for TB infection and another 20 have been diagnosed with active TB in the past two year. Almost all of those affected are African-American.

The outbreak first began in November of 2014, but it's been difficult for health officials to stop the spread of the illness. Pam Barrett is the Director of TB Control for the Alabama Department of Public Health. She tells As it Happens host, Carol Off, that local residents have not been forthcoming with information to help stop the spread of TB.

"This population of cases that we have had has been very unwilling to give us their contact information, so we have been unable to test and screen people who have been in contact with known cases. It's a unique situation and the monetary incentives are working" says Barrett.

Because residents have been reluctant to come forward and be screened for TB, the Perry County Public Health Department is now paying people to get tested.

"We're giving $20 if you come and are tested, $20 if you come back to get your results, and then if you need a chest x-ray we'll give you $20 to keep your x-ray appointment, and if treatment is recommended we will give you $100 when you finish your treatment."

Residents are now lining up for hours so that they can get screened, and get paid. Barrett doesn`t deny that the money is likely the motivating factor, not the fear of the disease.

Barrett says they have provided paid incentives in the past, but not to this extreme. She points to the community's mistrust of authority as the reason behind the cash payments.

"We have been unable to do the proper contact investigation because the cases would not tell us who their contacts were. And a lot of times they're waiting until they're extremely sick before they would seek medical care, therefore making their infectious period much longer."

To put scale of the Marion TB outbreak in perspective, Barrett says there are 253 cases per 100,000 members of the population. By comparison, the state rate for Alabama in 2015 was 2.8 per 100,000.

Barrett notes that once patients are diagnosed and start medication, they are quickly no longer infectious.

Residents can be tested for TB in Marion on Mondays, Wednesday and Fridays throughout the month of January.