Diana Fortune, RN, BSN has the following disclosures to make:

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1 Community TB Prevention Diana Fortune, RN, BSN Barbarah Martinez, RN, BSN September 23, 2015 TB Nurse Case Management September 22 24, 2015 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Diana Fortune, RN, BSN has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1

2 OBJECTIVES Describe the roles and responsibilities for TB treatment and prevention in the public health sector Describe the roles and responsibilities for TB treatment and prevention in the private health sector RESPONSIBILITY OF SUCCESSFUL TB TREATMENT Overall goals for treatment of Tuberculosis To cure the individual patient Minimize the transmission of TB to other persons State and local health departments have the primary responsibility for prevention and controlling the disease of TB 2

3 PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation 3

4 PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development State/local programs develop TB control policies Regional TB Control Plan TB Control Plan (how many states have one of these?) Community stakeholder involvement Expert in medical/non-medical management of TB Distribute it widely Plan should ensure systems eliminate financial & cultural barriers PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation 4

5 CONTACT INVESTIGATIONS Work with providers ( hospitals, correctional facilities, homeless shelters, schools, businesses..) if the health department is not actively involved contacts are likely to be missed. CI are 2 nd only in importance to treating persons with active TB. The Health Department is legally responsible to complete/conduct a CI for contacts to persons with TB in their jurisdiction PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation 5

6 CLINICAL AND DIAGNOSTIC SERVICES FOR PATIENTS WITH TB AND THEIR CONTACTS TB programs should ENSURE services are available for person with suspect/confirmed TB Provide direct services TB Clinics within health departments Link patients to private providers EITHER WAY Health Departments responsible to ensure quality, timely & complete services What Services: Radiology services CXR & reports within 24 hrs Laboratory services AFB smear within 24 hrs; NAAT/PCR 48 hrs(?) Pharmacies How will patients get their medications Expert medical & NURSING consultation Pediactric cases Drug resistance cases Any complicated case. PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation 6

7 TB Programs are the EXPERTS! Get out in your community Local health care providers Community based organizations Hospitals Schools of nursing Medical School Homeless Shelters Corrections talk more about his one later! Never fear you are not alone! RTMCCs Heartland NTCA Other state programs TRAINING AND EDUCATION PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation 7

8 Standardized collection of data RVCT GIMS EDN ARPE SURVEILLANCE DATA AND INFORMATION MANAGEMENT Access to treatment regimens App for TB infection Video DOT Social Media This field is wide open how can we use technology to treat/cure our patients! Don t let anyone discourage you PUBLIC HEALTH SECTOR PROVIDERS Planning and Policy Development Contact Investigations Clinical and Diagnostic services for patients with TB and their contacts Training and Education Surveillance data and information management Monitoring and Evaluation 8

9 MONITORING AND EVALUATION PRIVATE HEALTH SECTOR PROVIDERS Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries How can we innovatively provide on-going education and support with our partners 9

10 CLINICIANS Private practice, ER Docs, FQHCs and etc. Ensure - understand public health medical conditions: TB, STDs, HIV & other State/local laws for reporting How to report phone call, specific form Making TB Diagnosis Prompt is the patient infectious, isolation, who to call Expert consultation medical What is your state process, do you partners know the process? Again reporting if they don t notify public health we cannot assist Treatment follow current recommendations The role of the private clinician in TB Control will increase as TB morbidity in US decreases & jurisdictions reduce or even eliminate public health clinical services for TB Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS 10

11 COMMUNITY HEALTH CENTERS Provide care for populations that encounter barriers Low income families Immigrants/refugees Uninsured Homeless Poor women and children Community health centers are INTEGRAL to efforts to diagnose/treat persons with TB Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS 11

12 HOSPITALS Get to know you Infection Control Nurses Join APIC Ensure public health notified before (!) infectious person with TB discharged Some states have laws requiring notification Ensure known address, untested contacts at home, etc. Be available to do educational presentations Check in with hospitals during the time each year they do risk assessment MMWR: Guidelines for Preventing the Transmission of TB in Health Care Settings This is time each year they need data from you! Good time to connect Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS 12

13 ACADEMIC INSTITUTIONS Schools of medicine, pharmacy, public health AND nursing Get on their agenda help to incorporate TB into their curricula NM Pharmacy Collaboration - train pharmacists to do TSTs Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS 13

14 COMMUNITY BASED ORGANIZATIONS (CBOS) Good to partner with for difficult to reach communities Highly regarded More accepting than public health often times Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Correctional Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS 14

15 CORRECTIONAL FACILITIES DID YOU KNOW?? TB Disease is believed to be the leading cause of death for prisoners worldwide. CORRECTIONAL FACILITIES Common sites of TB Transmission Prevalence of TB disease and TBI higher than general population Testing/treatment can have BIG bang for your buck Using 3HP has dramatically increased COT Share BOP data Jails vs. Prisons Harder to track in jails Does your state/jurisdictions have a correctional liaison? What is their name? Heartland Developing AWESOME on line course Ms. Jessica comments here?! 15

16 Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS CIVIL SURGEONS Licensed physicians certified by U.S. Citizenship & Immigration Services (CIS) Conduct required health screening exams applying permanent residency CDC provides guidance; no regulatory role Critical Component Access to high risk populations Screen for TBD and TBI 16

17 Who are our private health partners: Clinicians Community health Centers Hospitals Academic institutions Community based organizations Corrections Facilities Civil surgeons Pharmaceutical and biotechnology industries PRIVATE HEALTH SECTOR PROVIDERS New Partners in this fight against treating person with TB Vaccine development New medications New diagnostics How can you be involved? PHARMACEUTICAL AND BIOTECHNOLOGY INDUSTRIES Websites to visit: Global Alliance for TB Drug Development The AERAS Global Tuberculosis Vaccine Foundation The Foundation for Innovative New Diagnostics 17

18 RESOURCES Core Curriculum on Tuberculosis: What the Clinician Should Know; 6 th edition 18