Question - Richard M. Fairbanks School of Public Health

Question - Richard M. Fairbanks School of Public Health

MAKING A GOOD PROGRAM DEVELOPING STRATEGIES TO EXPAND LATENT BETTER TUBERCULOSIS TESTING AND TREATMENT IN HIGH RISK COMMUNITIES Marion County Public Health Department TB Control Sarah Koch, TB Coordinator, MSN, BSN, RN Helen Townsend, MPH, BSN, RN Midia Fulano, MPH ,BSN, RN Disclosures NON E

WHAT WOULD YOU DO? T b e r c lo s s ( T Oise se: O n l y t h e T i p ,of t h e l c e b e , r g T h e r e a r e t w o t y p e s o f T B c o , n d i t io n s : _..; T B d i s e a s e a n d l a t e n t T B i n f e c t i o n . ........_-- :

i P e o p fl re o wmi t ah c t i . v e T B g e r m s . T h e y usually have s y m p t o m s a n d m a y Q r e a d T B g e r m , s t o othe_r_sT B d i s e a s e == are sick - u_s... o.p.-rtrnant of H e k b . .- . d H U IT. l * .D S,erV'J.Ces Cent1:!1"5 f o r D . a s e

Co-nrol a n d Pre.vera110,,, To l e a r n m o r e a b o u t T B , v i s i t w w w.c d c . g o v / t b Objectives Participants will leave this session with insight into: 1intensifying efforts to locate and treat persons with LTBI 2developing communication and education plans to reach clients and health care providers (HCPs) 3developing new, novel, or enhanced partnerships with high-risk populations and HCPs TB

History 7 Recent Infection as a Risk Factor Factors that increase the risk of getting infected with TB: Residence in or travel to a country with high rates of TB Close contacts to persons with infectious TB Children 5 years Residents and employees of high-risk congregate settings (e.g. homeless shelters, correctional facilities, healthcare facilities)

8 Increased Risk for Progression to TB Disease Persons more likely to progress from LTBI to TB disease include HIV infected persons Injection drug use Transplantation with immunosuppressant use Those receiving TNF- antagonists for treatment of rheumatoid arthritis or Crohns disease Certain medical conditions such as Silicosis, Diabetes The Case for Targeted Testing

TB testing for individuals at increased risk for developing disease Key Risk Groups for TB in United States Foreign-born: 67% of cases; case rate 13 times higher than US-born Racial/ethnic minorities: ~85% of cases; case rates 7-28 times higher than whites HIV infected: ~ 7% of cases Homeless: ~ 6% of cases Incarcerated: ~ 4% of cases Substance abuse: 7-12% of cases CDC 2015, LoBue, P. Homeless OutbreakNo. of Homeless

Year Counted 2009 Cases (linked) 10 2010 10 2011 2 2012 7 2013

3 2014 1 2015 0 Total 33 Tu b e r c losis CT ) D is e a s e :

Only th e Tip of t h e Iceberg There are t w o types of T B conditions: T B d i s e a s e a n d l a t e n t T B i n f e c t i o n . 'a--- = - People with f r o m active T B germs . They usually have s y m p t o m s a n d m a y TB disease ..;;;;;.;- P, ! e a d T B g e r m s t o o t h e r s . are sick .. -- u_s._ D p a n r n e n : t . o f

H e a l t h l ln d H1.tn:1aos..ervJc1111, cent1!t'5 for 011ease c n r n l and J>re..,et1-110f"I To l e a r n m o r e a b o u t T B , v i s i t www.cd c.gov/tb Why Burmese are at Risk of TB Disease? Burmese Year Counted No. of Burmes e Cases 2009

4 No. of Burmese LTBI (approximate) 161 2010 5 83 2011 5

120 2012 6 294 2013 8 363 2014 9

300 2015 16 287 2016 * Total 53 1608 Strategies

Form advisory group that will include TB experts and community leaders. The purpose of the advisory group is to provide education to local providers and hospitals providing care to the target population . Partner with community leaders in the Burmese community Work with community stakeholders to identify the needs of the target population and determine best practices for increased LTBI identification, treatment, and management. Identify and partner with members of the Burmese community that work in the education system, health care system, and other organizations within Indianapolis/Marion County develop best practices within the target population.

Develop partnership with residency programs and nursing schools and refugee agencies to educate future health care providers on TB and LTBI. Strategies Quarterly health fairs TB skin testing or IGRA testing chest x-ray referrals dental services immunization services lead screening WIC services assistance enrolling in appropriate health insurance programs provided by CKF patient navigators Health fair participants with positive TB tests will be referred to a bi- weekly TB clinic

sponsored by the proposed project. THANK YOU!

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