1. Epidemiologic Studies Consortium Research CTCA meeting October 22, 2010 Lisa Pascopella, PhD, MPH California Department of Health Services

2. Studies launched in past year Tuberculosis mortality in the United States: Epidemiology and prevention opportunities Treatment practices, outcomes and cost of multidrug-resistant and extensively drug resistant TB in the United States Improving testing for TB and LTBI for persons with HIV infection at Health Resources and Services Administration Part C-funded HIV clinics

3. Mortality study- Research questions How frequent are TB- related deaths? What are the risk factors? What is the proportion of TB-related deaths that were preventable? Can we avert future TB-related deaths?

4. Mortality study- Methods Population: –TB cases 2005-2006 –from LHJs reporting at least 8 deaths Data collection: –Retrospective chart review Complete medical record, including hospital records

5. Mortality study- Anticipated outcomes Improve understanding of causes of TB deaths Create evidence basis for public health interventions aimed at reducing TB deaths in U.S. Apply and refine a systematic TB death assessment tool that could be used routinely in the U.S.

6. Mortality study: Preliminary CA results 448 deaths with TB 277 records reviewed 155 data abstractions completed 53 reviewed by clinician 43 (81%) TB-related deaths

7. MDR TB outcomes/cost study- Research questions What are the current diagnosis, treatment and management practices for MDR/XDR TB patients? What are MDR/XDR TB patient outcomes? –What factors predict favorable/unfavorable outcomes? What are the costs associated with MDR/XDR TB in the U.S.?

8. MDR TB outcomes/cost study - Methods Population: –MDR/XDR TB patients 2005-2007 –LHJs reporting at least one MDR or XDR TB case Data collection: –Retrospective chart review Complete medical record, including hospital billing records

9. MDR cost study- Anticipated outcomes Study findings will inform: Optimal MDR/XDR TB diagnosis procedures Future clinical trials of MDR/XDR TB patient treatment regimens Improved case management Financial planning for TB program budgets

10. TB testing in HIV clinics study- Research questions How are TB services provided, relative to national guidelines, at Health Resources and Services Administration (HRSA) Part C-funded HIV clinics? What program elements encourage or serve as barriers to adherence to national guidelines? What are the costs of TB testing and LTBI treatment at selected HIV clinics?

11. TB testing in HIV clinics study- Methods Population: –Four HRSA Part C-funded HIV clinics Los Angeles (n=2) New York (n=2) –Patients served by 4 clinics in 2009 Data collection: –Structured observation of HIV clinic services –Key informant interviews of HIV clinic staff and TB program staff –Retrospective chart review at HIV clinics –Policy abstraction

12. TB testing in HIV clinics study- Anticipated outcomes Dissemination of findings through HRSA’s AIDS Education and Training Centers, and CDC’s RTMCCs Improved TB services provision within HRSA Part C-funded HIV clinics Improved collaboration between HRSA Part C-funded HIV clinics and TB care providers

13. Study status: Full implementation Mortality study –Research Assistants abstracting complete medical records of TB deaths MDR TB outcomes/cost study –Research Assistants abstracting MDR/XDR TB patient charts TB testing in HIV clinics study –Research Assistant observing TB service provision operations

14. Next steps Continued data abstraction Analysis and interpretation Share findings with participating health departments National dissemination of findings

15. Thank you!