TB Infection Control in PEPFAR Health Facilities Where do we begin? Bess Miller, M.D., M.Sc. Assoc Director, TB/HIV Prevention & Care Global AIDS Program CDC, Atlanta, Georgia, USA Chair, WHO STOP TB Infection Control Subgroup 6 th Annual Track 1.0 ART Program Meeting Washington, D.C. August 11-12, 2008 CS120024

10 Steps to Getting Started on TB Infection Control 1.Advocacy 2.Infection control plan 3.Safe sputum collection 4.Cough etiquette 5.Triage of TB suspects 6.Rapid diagnosis and treatment 7.Room air ventilation 8.Protection of health care workers 9.Linkage with other infection control programs 10.Monitor and Evaluate Advocacy

One Put up a poster. Start a Campaign and Include Patients, Health Workers, and the Community.

In a WHO report on health worker access to HIV/TB preventive, treatment, and care services in 5 African countries half of the facilities had no infection control plan. Infection Control Plan Identify a Person in Charge of Infection Control Liz Corbett, LSTMH, Treat, Train, and Retain 2007 Two

Ensure Safe Sputum Collection 46% of 30 clinics had a policy of taking TB suspects outdoors to produce sputum, but staff reported actually doing this in only 18% of clinics. Liz Corbett, Ibid. Three

Promote cough etiquette OPD Admissions Medical ward Casualty HIV clinic Morgue Pediatrics Four

Less than 1/3 of outpatient facilities triaged coughers from non-coughers. Triage TB suspects for “fast track” or separation What is triage? Only 1 in 10 facilities supply TB suspects with cloths or masks to cover their cough. Liz Corbett, Ibid. Five

Assure rapid diagnosis and initiation of treatment It’s all about theaaaaaa lab, the lab, the l Lab turn-around time – 1-2 days for smear Lab-program communications (FAX, cell-phone) Quality Assurance Six the lab, the lab.

Improve Room Air Ventilation Open windows on either side of room Assure cross- ventilation May use fans Don’t have patients wait in long narrow corridors Does Anyone Have a Cough? Seven

Protect Health Care Workers Provide an annual health assessment. Encourage VCT. Screen for TB. Provide respirators when appropriate. Consider isoniazid preventive therapy for HIV- infected health care workers Eight

Link TB Infection Control with other infection control efforts Nine

Monitor infection control Practices What gets measured gets done. Examples –Measure laboratory turn-around time for sputum specimens. –Have a staff member observe specific IC practices daily for one week. –Keep track of number of health workers in the facility who develop TB during 6 month period. –Monitor TB DOTS treatment completion rates. Ten

WHO STOP TB Partnership Infection Control Sub-working Group Purpose –Policy, technical guidance, review of evidence base –Human resource development, technical assistance –Implementation—PEPFAR on the front lines. –Monitoring and evaluation –Advocacy and communications –Research 200 members Next Subgroup Meeting – IUATLD (Union) Meeting, Paris Oct 2008

Acknowledgements Liz Corbett - LSTMH Reuben Granich - WHO Paul Jensen - CDC Rose Pray – WHO Fabio Scano - WHO Javid Syed - TAG Jeroen VanGorkom - KNCV, TB CAP Clair Kiernan - CDC Graphics James Andrews - CDC Graphics