Public Health and Corrections: A Model of Program Collaboration and Service Integration (PCSI)
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1 Public Health and Corrections: A Model of Program Collaboration and Service Integration (PCSI) Jason Cummins, MPH Program Manager & Senior Epidemiologist 2016 Southeastern TB Controllers Meeting October 7, 2016
2 CDC s NCHHSTP 2009 White Paper Program Collaboration and Service Integration Programmatic silos vs synergy Overlapping risk factors for disease Opportunities for: Targeted screening and testing Increased efficiency Reduced cost Assured treatment Enhanced disease surveillance Continuity of care upon release 2
3 TB Control & Prevention in Corrections
4 Incarcerated Population Newly incarcerated inmates have an increased prevalence of HIV, syphilis, chlamydia, gonorrhea, and Mycobacterium tuberculosis 1 The U.S. Department Justice reports that at least 95% of all state prisoners will be released from prison at some point Primary and secondary prevention Education Screening and testing Treatment during incarceration 1 Bick, Joseph A. Infection Control in Jails and Prisons. Clinical Infectious Diseases. 2007; 45:
5 Framework for Integrated Diagnostics TDOC Intake Prisons CEDEP State Lab 5
6 Tennessee Department of Correction (TDOC) 14 state prisons within TDOC located in 11 counties in Tennessee 29,323 inmates (May 2016) One intake facility for male and female inmates each
7 TDOC Intake Facilities Tennessee Prison for Women (TPW) Bledsoe County Correctional Complex (BCCX) 7
8 Planning and Implementation
9 Identify Stakeholders Inmates Tennessee Department of Correction (TDOC) Tennessee Department of Health Tuberculosis Elimination Program (TTBEP) HIV/STD/Viral Hepatitis Program Information Technology Division (ITSD) Division of Laboratory Services General population 9
10 Planning Steps Review of current intake screening and testing procedures What tests were being done? Where were the tests being sent for analysis? How were the prisons receiving the results? Proposed new screening and testing procedures Implement use of QuantiFERON TB-Gold In-Tube (QFT) testing to replace tuberculin skin test (TST) Blood collection for HIV testing to replace oral swab testing Information technology (IT) needs at each intake facility Physical equipment Firewalls Training TDOC staff Transportation of specimens Cost comparison (old process vs. new process)
11 Proposal: New TDOC Intake Screening Process Old Process TST placed and read inhouse by prison medical staff QFT drawn as ordered by MD Additional labs drawn: HIV (oral swab) RPR Gonorrhea (urine) Chlamydia (urine) Labs sent to Garcia Clinical Laboratory in Michigan via FedEx Lab reports available in Garcia portal New Process QFT replaced TST as method for testing for TB infection and sent to state lab Additional labs drawn: HIV (blood) RPR Gonorrhea (urine for men, vaginal swab for women) Chlamydia (urine for men, vaginal swab for women) Labs sent to state lab via state courier Lab results available in Patient Tracking Billing Management Information System (PTBMIS) Lab results accessed and routed to appropriate health dept. program 11
12 Implementation Timeline April 2015 Internal CEDEP meeting with different programs May 2015 Kick-off meeting (CEDEP, TDH lab & TDOC) Visit to TPW and BCCX June-September 2015 Various meetings to discuss logistics of implementation October 2015 Tennessee Prison for Women (TPW) November 2015 Bledsoe County Correctional Complex (BCCX) 12
13 Implementation Logistics Equipment New computers Incubators IT implementation Setting up PTBMIS accounts Supplying label printers to each site Training on Lab Order Entry (LOE) Accessing results Transporting specimens to the state lab Additional routes for courier Timeframe requirements from prisons Screenings and evaluations completed prior to prisoner classification Testing logistics Chlamydia and Gonorrhea testing TPW sending vaginal swabs BCCX sending urine samples 13
14 Training TDOC Staff QFT collection and handling Electronic ordering via PTBMIS Accessing electronic lab results Utilizing the statewide courier system
15 Results through August 31, 2016
16 Men s Intake Facility Results November 2015-August Number of Results Unsatisfactory Indeterminate Positive Negative 0 QFT HIV Syphilis Chlamydia Gonorrhea Test
17 Women s Intake Facility Results October 2015-August Number of Results Unsatisfactory Indeterminate Positive Negative 0 QFT HIV Syphilis Chlamydia Gonorrhea Test
18 QFT Results Tennessee Prison for Women (TPW) Positive (%) Negative Indeterminate Unsatisfactory Total (%) (%) (%) (2.0) 193 (97.5) 1 (0.5) 0 (0.0) (5.4) 362 (93.5) 3 (0.8) 1 (0.3) 387 Total 25 (4.3) 555 (94.9) 4 (0.7) 1 (0.2) 585 Bledsoe County Correctional Complex (BCCX) Positive (%) Negative Indeterminate Unsatisfactory Total (%) (%) (%) (4.4) 497 (88.0) 43 (7.6) 0 (0.0) (5.4) 4140 (94.1) 2 (0.05) 20 (0.5) 4398 Total 261 (5.3) 4637 (93.4) 45 (0.9) 20 (0.4) 4963
19 HIV Results Tennessee Prison for Women (TPW) Positive (%) Negative (%) Unsatisfactory (%) Total (0.0) 181 (92.8) 14 (7.2) (0.5) 382 (99.2) 1 (0.3) 385 Total 2 (0.3) 563 (97.1) 15 (2.6) 580 Bledsoe County Correctional Complex (BCCX) Positive (%) Negative (%) Unsatisfactory (%) Total (1.5) 510 (98.5) 0 (0.0) (0.7) 4343 (99.2) 0 (0.0) 4376 Total 39 (0.8) 4853 (99.2) 0 (0.0) 4894
20 RPR Results Tennessee Prison for Women (TPW) Positive (%) Negative (%) Total (1.0) 192 (99.0) (2.1) 377 (97.9) 385 Total 10 (1.7) 569 (98.3) 579 Bledsoe County Correctional Complex (BCCX) Positive (%) Negative (%) Total (0.8) 514 (99.2) (0.8) 4344 (99.2) 4377 Total 37 (0.8) 4858 (99.2) 4895
21 Chlamydia Results Tennessee Prison for Women (TPW) Positive (%) Negative (%) Total (0.0) 113 (100) (1.4) 358 (98.6) 363 Total 5 (1.1) 471 (98.9) 476 Bledsoe County Correctional Complex (BCCX) Positive (%) Negative (%) Total (2.7) 508 (97.3) (2.2) 4272 (97.8) 4370 Total 112 (2.3) 4780 (97.7) 4892
22 Gonorrhea Results Tennessee Prison for Women (TPW) Positive (%) Negative (%) Total (0.0) 113 (100) (0.3) 362 (99.7) 363 Total 1 (0.2) 475 (99.8) 476 Bledsoe County Correctional Complex (BCCX) Positive (%) Negative (%) Total (0.0) 522 (100) (0.1) 4364 (99.9) 4370 Total 6 (0.1) 4886 (99.9) 4892
23 Conclusions, Limitations & Next Steps
24 Limitations No explanation regarding the low rates of chlamydia and gonorrhea in the inmate population when compared to Tennessee state rates No explanation regarding the higher rate of chlamydia in the male inmates vs. female inmates Incomplete information regarding additional risk factors for disease among inmates being tested
25 Next Steps Cost-effectiveness study Compare test results and treatment outcomes for TB infection
26 Acknowledgements TDH Central Office Dr. Jon Warkentin Dr. Carolyn Wester Trudy Stein-Hart Bob Herdman Mike Newman Michael Creighton Shirley Gore Ernest Miser TDH Laboratory Services Dr. Richard Steece Jim Gibson Paula Gibbs DeAnne Sharp Wayne Pearson Southeast Region Staff Debbie Walker Mary Elbell TDOC Dr. Kenneth Williams Marie Wright Tennessee Prison for Women medical staff Bledsoe County Correctional Complex medical staff QIAGEN staff 26
27 Thank you 27
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