Date post: | 06-Jan-2018 |
Category: |
Documents |
Upload: | cora-richard |
View: | 221 times |
Download: | 1 times |
© 2015 Denver Public Health
Michelle K Haas, Kaylynn Aiona, Pete Dupree, Ellen Brilliant, Robert Belknap
Improving access to Tuberculosis evaluation and care: a path to
Tuberculosis elimination for Colorado
© 2015 Denver Public Health
• Understand the Epidemiology of Tuberculosis in Colorado
• Describe the challenges in eliminating Tuberculosis in Colorado
• Discuss barriers to access to Tuberculosis care, including prevention
Goals of this Session
© 2015 Denver Public Health
• Tuberculosis is a leading cause of preventable death globally
• National efforts aimed to identify and treat both latent and active Tuberculosis (TB) have been associated with a decrease in TB incidence over time
• TB elimination, defined as 1 case/million, is a key goal for public health professionals engaged in prevention of communicable diseases
Background
© 2015 Denver Public Health
United States, 2013: 9,582 TB cases (incidence 3.0/100,000 persons)
U.S.-born vs. Foreign-born Persons, United States, 1993–2013
Data from www.cdc.gov
© 2015 Denver Public Health
TB Incidence Rates, Metro Denver
© 2015 Denver Public Health
TB Incidence Rates by Nativity in Metro Denver
CDC goal of 1 case/million
Total Foreign-born Population in Metro Denver, (American Community Survey 2013): 342,310
© 2015 Denver Public Health
Countries of Origin for Foreign-born Persons with TB in Colorado, 2010-2014
CountryCountry # cases # cases Mexico 85Ethiopia 21India 15Somalia 13Philippines 11Vietnam 10
76% of total TB cases among individuals born outside of the US
TB incidence in 2014: 1.2/100,000
© 2015 Denver Public Health
Objectives
• Objective 1: Identify which active cases were preventable
• Objective 2 : Determine the proportion of individuals diagnosed with latent TB who complete therapy
© 2015 Denver Public Health
Objective 1: Identify which active cases were preventable
• Proportion of active TB cases that were preventable among foreign-born individuals seen at the Denver Metro TB clinic
• preventable case: foreign-born, tuberculin skin test (TST) or interferon-gamma release assay (IGRA) positive and in the US > 6 months
© 2015 Denver Public Health
• Retrospective cohort review of active and latent TB cases in the Denver Metro area from 2009-2014
• We assessed country of origin, IGRA or TST positivity and length of time in the US
Methods-Objective 1
© 2015 Denver Public Health
At least 44% of TB cases in Denver Metro are preventable
Preventable cases of reported active TB from 2009-2014, Denver Metro Area
N %Total Cases 307 -Foreign-born 246 80
Report date > 6 months from arrival 187 61
TST or QFT positive at diagnosis 135 44 Median years in US until diagnosis=7.5
55%45%
© 2015 Denver Public Health
Objective 2: Determine the proportion with latent TB who complete therapy
• Determine the proportion of individuals with latent TB (LTBI) who initiate and complete therapy
• Evaluate individuals identified with latent TB who were offered treatment – Proportion who began treatment for latent TB– Proportion who did not complete therapy for latent TB
• Risk factors for not completing LTBI therapy
© 2015 Denver Public Health
• Among latent TB cases we describe the proportion of individuals who initiated therapy from 2009-2014
• 2013: the proportion who completed therapy over time – Risk factors for not completing LTBI therapy were
evaluated among adults– Treatment completion: pharmacy refill data;
excluded if found to have active TB (n=2) or had missing data (n=76). Analysis was performed using a multivariable log binomial regression in SAS.
Methods-Objective 2
© 2015 Denver Public Health
Only half of individuals diagnosed with LTBI complete therapy
35% never start treatment
Once treatment is started, 77% complete*
*national average for completion of LTBI therapy among contacts is 67%
© 2015 Denver Public Health
• 481 individuals initiated LTBI therapy in 2013, with 403 meeting our inclusion criteria
• 90 patients (22%) did not complete LTBI therapy. • Individuals were more likely to discontinue therapy if :
– Primarily English-speaking • English vs. other-non Spanish: RR (1.8 95% CI 1.2-2.7)• Spanish vs. other-non Spanish: RR (1.34 95% CI .82, 2.2)
– Were ever homeless (RR= 2.4, 95%CI 1.3, 4.4)– Had a normal CXR (RR= 2.15, 95% CI 1.3, 3.6)
Risk factors for not completing LTBI therapy: few targets for interventions
Data collected and analyzed by Hillary Dunlevy, Kaylynn Aiona and Will Eaton
© 2015 Denver Public Health
• The vast majority of TB cases in Colorado and Denver Metro are among foreign-born individuals
• 44% of active TB cases in Denver Metro were preventable– 55% of preventable cases among foreign-born individuals
• Only ½ of individuals seen at Denver Metro TB Clinic completed preventative therapy
Summary
© 2015 Denver Public Health
• Determine factors associated with not initiating LTBI therapy
• Share this information with local providers and representatives of communities at risk for TB – Assess current knowledge, attitudes toward TB and current
screening practices – Gain a greater sense of barriers to TB care for individuals
at risk
Next Steps
© 2015 Denver Public Health
• How can we: – Increase access to TB infection evaluation for the
estimated ½ a million individuals at risk in Colorado?– Strengthen community engagement? – If we strengthen community engagement, how do we
sustain this as TB becomes an increasingly rare disease?• Bundle with other public health packages?
– Will this allow us to achieve TB elimination or will we need to do more?
Your thoughts?
© 2015 Denver Public Health
Thank you!Contact information:Michelle Haas, M.D.Denver Metro Tuberculosis ClinicDenver Public Health605 Bannock StreetDenver, CO 80230Ph: [email protected]