TBCB Update

1
TBCB Update

• Fall CTCA Meeting
• October 7, 2009

2
Overview

• TBCB Strategic Planning (James Watt)
• Additional Resources
• New activities to understand the role of HIV on
  TB in California
• Drug Resistance Data (Jennifer Flood)
• Molecular Beacons Data
• Technical Instructions for pre-Immigration
  Evaluation--Update
• Update on Surveillance (Janice Westenhouse)

3
TBCB Strategic Planning

• Motivation
• 5 year CDC grant renewal
• Need for updated assessment of priorities
• Priorities identified
• Partnership with local TB control programs
• Public-private partnership
• Optimize resources for TB control in California

4
Partnership with LHJs

• Ongoing priority area
• Continue to emphasize communication and
  partnership

5
Increase Data FeedbackAnnual Data Summary

• Complement TIP
• Larger number of jurisdictions
• More frequent
• At a glance

6
TB Program Assessment Tool

• TB-PAT
• New tool for regular check in on program
  changes
• Policies
• Structure
• Opportunities and challenges
• Designed to support communication between local
  programs and liaisons

7
Key Informant Interviews

• 17 LHJs
• Low, medium and high morbidity
• 23 participants
• TB controllers and program managers
• Current TBCB services
• How much do you use each one?
• How are we doing?
• How should we resource each one?
• Services not currently provided

8
Results

• TBCB services generally appreciated
• TBCB services generally right sized
• Services felt to be particularly useful
• TBCB participation in joint guidelines
• MDR service
• Clinical consultation
• Program liaison support
• Outbreak Response Team
• Some services could be modified
• No services identified for reduction

9
Public-Private Partnership

• Support CTCA and local activities
• Data analysis
• Private provider outcomes
• Key epidemiologic trends
• TB and diabetes
• TB and HIV
• Address administrative issues

10
Optimize Resources

• Share new ideas
• Identify funding opportunities
• Monitor current funding streams
• Support prioritization discussion

11
Strategic Approach to TB Control in California

• TBCB
• Local TB Programs
• Laboratory
• Public health lab issues
• TB Program issues
• Private sector

12
Additional Resources

• Year-end savings
• Importance of local resource reductions
• Augmentation of 2009-2010 base award
• Support CTCA activities

13
New Activities Related to TB/HIV

• CDC focus on Program Coordination and Service
  Integration (PCSI)
• CDPH workgroup identified priorities
• Improved data sharing
• TB screening for HIV infected persons
• HIV testing for TB patients

14
Improved Data Sharing

• Current law limits data sharing between HIV and
  TB programs
• Current law prohibits collection of HIV status
  during TB surveillance

15
TB Testing of HIV Infected Persons

• HRSA funded project
• Objective assess TB services in HIV clinic
• LA County
• Collaboration with CDPH OOA on analysis of data
  from HIV providers

16
HIV Testing of TB Patients

• Toolkit for program evaluation
• CDC funded project to look at 2008 TB cases
  statewide
• IRB approval pending
• Objectives
• HIV prevalence
• HIV testing practices
• Care provided for HIV positive

17
Methods

• Step 1Local practice survey
• Step 2HIV prevalence among TB patients
• Local project deputy
• Collect information on HIV status
• Step 3HIV testing practices
• Random sample of cases
• Study staff review public health records
• Step 4Care
• All HIV positive cases
• Study staff review public health records

18
Next Steps

• Survey
• HIV testing policies
• Current barriers related to HIV coordination
• Ability to provide information on 2008 cases
• Local project deputy
• IRB requirements
• IRB submission

19
Genotyping

• MIRU-2
• TB GIMS
• Data sharing in cluster investigation
• New NTIP IndicatorIncrease the proportion of
  culture positive TB cases with a genotype result
  to 94 by 2015.