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TREATMENT COMPLETION RATES FOR LTBI, ARKANSAS, 2006-2010: WHAT DO WE DO WITH NEGATIVE FINDINGS ? Mukasa LN, MBChB PhD., Bates JH, MD., Phillips J. MD.,

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Presentation on theme: "TREATMENT COMPLETION RATES FOR LTBI, ARKANSAS, 2006-2010: WHAT DO WE DO WITH NEGATIVE FINDINGS ? Mukasa LN, MBChB PhD., Bates JH, MD., Phillips J. MD.,"— Presentation transcript:

1 TREATMENT COMPLETION RATES FOR LTBI, ARKANSAS, : WHAT DO WE DO WITH NEGATIVE FINDINGS ? Mukasa LN, MBChB PhD., Bates JH, MD., Phillips J. MD., Abernathy RS, MD., Karpoff E. BSN RNP., Diatta N., Patil N, MD MHSA. Arkansas Department of Health

2 Background/Statement of Problem  Treatment completion for LTBI was original focus area for program evaluation in Arkansas, 2006  LTBI is reportable in Arkansas  Over the years, treatment LTBI remained priority  Thirty seven percent of the cases, were missed opportunities  We sought to increase LTBI Tx completion to 65% by 2010

3 Background…  Average 2500 LTBI cases diagnosed per year  Reporting LTBI initially incomplete using paper forms  In 2005, we predicted that the TB case rate would be 2.0 per 100, 000 population in 2010 if interventions at time were maintained  We sought to accelerate TB elimination by aggressively treating LTBI

4 A Missed TB Opportunity was defined as a TB case:  Known to have a prior LTBI diagnosis  Known to be HIV positive before TB diagnosis  From established targeted intervention groups  Nursing Homes  Prisons  Health Care Workers  Foreign-born students  Age less than 5 years  Reported After Death

5 Prediction of Arkansas TB Case Rates YearTB Case Rate PredictedObserved *Rate Per million population

6 Aims/Objectives 1)Evaluate Completion LTBI Treatment )Illustrate concept second generation surveillance  Case rate vs. Treatment LTBI  Clustering vs. Treatment of LTBI 3) Discuss next steps

7 Methods  Stakeholders included clinicians, colleges, poultry workers, correction institutions and nursing homes  LTBI cases came from targeted testing and contact investigation  Cases LTBI were captured using a standard form  Analysis was approached in 3 ways:  Treatment completion rates for LTBI  Construction of a missed opportunity measure  Genotype cluster analysis

8 Data Flow Web-Enabled TB Registry TB Contacts LTBI Cases E-forms Evaluation Treatment LTBI Contact Investigations Targeted Testing

9 Arkansas 75 Counties Within 5 Regions: A Centralized Public Health Infrastructure Little Rock Predictive Model of LTBI Treatment to include Regions is Pending

10 Results  Treatment completion rates for LTBI ranged from 50 to 55% during the 5-year study period  35-40% of all TB cases were missed opportunities  13.5% of all cases were known prior LTBI  64% of case-isolates were in genotype clusters

11 TB Cases Reported from Prior LTBI, Arkansas, YearTotal CasesPrior LTBI NumberPercent Overall

12 TB Trends by Treatment Completion for LTBI, Arkansas, YearTB CasesTB Case Rate**Foreign-born (%)Completion TLTBI (%) * TLTBI =Treatment LTBI* Provisional Data** Cases per 100,000 population

13 Genotype Clustering, Arkansas, , (n=401) 64% 36% Spoligotype-MIRU method

14 Electronic Contact Form

15 2-Page Electronic LTBI Form

16 The TB Trends in Arkansas and the US are in similar direction Are we constructing another U-shaped Curve of Concern ?

17 Conclusions/Recommendations  The goal of increasing LTBI treatment completion rates from 50% to 65% was not achieved. Complete data analysis is pending  We could not link the modest decline in TB incidence, to treatment LTBI  The level of clustering by genotype suggests substantial ongoing TB transmission  Deployment of two electronic forms for TB contacts and LTBI will greatly improve surveillance and real-time analysis of LTBI in Arkansas  The introduction of the long awaited “game changers”, namely IGRA and 3-month regimen for LTBI is ongoing in Arkansas.  The new tools in deployment, we believe, will reverse the negative findings in our our study

18 Next Steps  Computerize all LTBI records  Construct predictive models Treatment Completion  Logistic Regression Treatment completion (Y/N)=region + gender+ age + US-born status, etc…  Cox’s Proportional Hazards Model Curves Months on Isoniazid by group e.g region, US-born status, etc..  Study and adopt interventions from other programs


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