HIVAIDS, Hepatitis B

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HIV/AIDS, Hepatitis BC and TB Prevention and
Control June 24, 2008
Health Resources and Services Administration2008
Primary Health Care All-Grantee Meeting

• Theresa Watkins-Bryant MD, FAAP
• Senior Medical Advisor
• U.S. Department of Health and Human Services
• Health Resources and Services Administration
• Office of the Administrator
• Office of Minority Health and Health Disparities

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Health Resources and Services Administration
(HRSA)

• Mission
• HRSA provides national leadership, program
  resources and services needed to improve access
  to culturally competent, quality health care.

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HRSA GOALS

• Improve Access to Health Care
• Improve Health Outcomes
• Improve Quality of Care
• Eliminate Health Disparities
• Improve the Public Health and Health Care
• Systems
• Achieve Excellence in Management Practice

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TB or not TB

• What are the relevant questions for health
  centers in 2008?

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TB or not TB

• Should the diagnosis of TB (either latent
  infection or active disease) be on the radar
  screens of health center practitioners?

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Reported TB Cases United States, 19822005
14,093
No. of Cases
Year
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MMWR Reports Decline in U.S. TB Rate

• The average annual percentage decline in the TB
  rate slowed from 7.3 during 1993-2000 to 3.8
  during 2000-2007
• MMWR MAR 21,2007/57(11)281-285

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Racial and Ethnic TB Disparities Persist

• In 2007 the TB rate in foreign born persons in
  the U.S. was 9.7 times higher than in U.S. born
  persons.
• MMWR MAR 21,2007/57(11)281-285

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MMWR MAR 21,2007/57(11)281-285
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Reported TB Cases by Origin and Race/Ethnicity,
United States, 2006
U.S.-born
Foreign-born
American Indian or Alaska Native (3)
White (5)
Asian (2)
Hispanic or Latino (39)
White (33)
Asian (40)
Black or African American (44)
Native Hawaiian/Other Pacific Islander (Hispanic or Latino (17)
Black or African American (14)
All races are non-Hispanic. Persons reporting
two or more races accounted for less than 1 of
all cases. American Indian or Alaska Native and
Native Hawaiian or Other Pacific Islander
accounted for less than 1 of foreign-born cases
and are not shown.
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TB Disparities Among African-Americans

• In 2007 among U.S. born racial and ethnic groups,
  the greatest disparity in TB rates was for U.S.
  born blacks.
• The TB rate for African Americans remains nearly
  8 times that of U.S. born whites.
• MMWR MAR 21,2007/57(11)281-285

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MMWR MAR 21,2007/57(11)281-285
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MMWR MAR 21,2007/57(11)281-285
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Bureau of Primary Health Care
NHOPI Native Hawaiians other Pacific
Islanders 28.7 of patients are best served in a
language other than English
Source Uniform Data System, 2006
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Additional Populations at Risk for TB

• HIV Infected Patients
• Substance Abusers
• Homeless Individuals
• Migrant Farm Workers
• Recently Incarcerated Patients

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Characteristics of Selected U.S.-born Persons
with TB, 2004
Black
White
U.S.-born non-Hispanic MDR TB defined as
resistance to at least isoniazid and
rifampin. HIV data for year 2004 may not be
complete Substance abuse defined as injecting
drug, non-injecting drug, or excess alcohol use
in year prior to TB diagnosis.
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Percent of TB Cases in Persons with History of
Substance Abuse, 19932004
Percent
Injecting drug, non-injecting drug, or excess
alcohol use in year prior to TB
diagnosis U.S.-born non-Hispanic
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Percent of TB Cases in Homeless Persons (Year
Prior to Diagnosis), 1993-2004
U.S.-born non-Hispanic
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Percent of TB Cases in Unemployed Persons (in 2
Years Prior to Diagnosis), 1994-2004
U.S.-born non-Hispanic
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Health Center Program CY 2004 Who Do We Serve?

• 91.1 of clients are below 200 poverty
• 40.1 are Uninsured
• 63.5 are Racial/Ethnic minority
• 726,813 Migrant/Seasonal Agricultural Workers
• 703,023 Homeless Clients
• Serve all ages

Source Uniform Data System, 2004
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TB or not TB

• What role can health centers play in eliminating
  TB disparities in the U.S.?

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2008-2009 Division-wide Priorities (Domestic and
Global)

• Interrupt transmission of M. tuberculosis
• Reduce TB in foreign-born populations
• Reduce TB in racial/ethnic minority populations
• Mitigate/reduce impact of multi- and
  extensively-drug resistant TB
• Reduce HIV-associated TB

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TB Resources for Health Center Providers

• www.cdc.gov/tb
• CDCs Regional Training and Medical Consultation
  Centers (RTMCCs)
• Stop TB in the African American Community
  http//www.cdc.gov/tb/TBinAfricanAmericans/default
  .htm
• Migrant Clinicians Network TBNet
  http//www.migrantclinician.org/network/tbnet
• CureTB http//www2.sdcounty.ca.gov/hhsa/ServiceDet
  ails.asp?ServiceID437
• Future HRSA virtual office on Health Disparities
  Collaboratives website www.healthdisparities.net

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CDC Communication and Education Resources

• Webpage with links to resources
• DTBE and CDC Websites
• Graphical button
• CDC.gov Feature
• Data and Statistics
• Posters
• e-Card
• Graphical Web Buttons
• CDC Connects article

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Health Department-Health Center TB Linkages

• National Tuberculosis Controllers Association
  (NTCA)/National Tuberculosis Nurses Coalition
  (NTNC)
• TB Controllers (states,territories and 10 big
  cities) http//tbcontrollers.org
• Big CitiesBaltimoreChicago
• DenverDetroit
• HoustonLos AngelesNew York CityPhiladelphiaSan
  DiegoSan Francisco

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RTMCCs- Health Center Linkages

• Regional Tuberculosis Training and Medical
• Consultation Centers
• The Francis J. Curry National Tuberculosis Center
  in San Francisco serves the Western Region which
  consists of fifteen jurisdictions Alaska,
  California (including Los Angeles, San Diego, and
  San Francisco), Colorado, Hawaii, Idaho, Montana,
  Nevada, Oregon, Utah, Washington, Wyoming, and
  the U.S. Pacific Island Territories.
• The Center welcomes inquiries from our Western
  Region partners regarding training, educational
  products, technical assistance, and medical
  consultation.

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RTMCCs- Health Center Linkages

• Regional Tuberculosis Training and Medical
  Consultation Centers
• Heartland National TB Center at UT at Tyler in
  San Antonio, TX
• The Heartland region includes the following
  states Arizona, Illinois, Iowa, Kansas,
  Minnesota, Missouri, Nebraska, New Mexico, North
  Dakota, Oklahoma, South Dakota, Texas, and
  Wisconsin.

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RTMCCs- Health Center Linkages

• Regional Tuberculosis Training and Medical
  Consultation Centers
• Northeastern Regional Training and Medical
  Consultation Consortium in the New Jersey Medical
  School Global TB Institute in Newark, NJ.
• The Consortium provides training, technical
  assistance and medical consultation to healthcare
  professionals throughout the Northeastern United
  States. Our region spans Connecticut, Delaware,
  District of Columbia, Indiana, Maine, Maryland,
  Massachusetts, Michigan, New Hampshire, New
  Jersey, New York, Ohio, Pennsylvania, Rhode
  Island, Vermont and West Virginia and the cities
  of Baltimore, Detroit, New York City and
  Philadelphia

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RTMCCs- Health Center Linkages

• Southeastern National Tuberculosis Center at the
  University of Florida Medical College,
  Gainesville and Lantana, FL
• Serves Kentucky, Virginia, North Carolina, South
  Carolina, Georgia, Alabama, Florida, Tennessee,
  Mississippi, Arkansas, Louisiana, Puerto Rico and
  the USVI

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Future HRSA-CDC TB-Hepatitis C Collaboration

• Discussions regarding interagency collaboration
  on TB elimination and Hepatitis C
  prevention/treatment strategies in African
  American communities.
• Initial efforts will be directed towards creating
  infrastructure for coordinating TB and Hepatitis
  C care between co-located health centers and
  health departments.

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the issue now confronting the nation is whether
we will allow another cycle of neglect to begin
or, instead, whether we will take decisive action
to eliminate tuberculosis.
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Questions?
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CONTACT

• Theresa Watkins-Bryant MD, FAAP
• Senior Medical Advisor
• U.S. Department of Health and Human Services
• Health Resources and Services Administration
• Office of the Administrator/Office of Minority
  Health and Health Disparities
• 5600 Fishers Lane Rm. 6C-26
• Rockville, MD 20857
• Telephone [phone]
• Fax [phone]
• E-Mail twatkins-bryant_at_hrsa.gov