A Mobile Health Intervention Utilizing Community Partnership to Improve Access to Latent Tuberculosis Infection Treatment Cassandra Garcia, MSN, RN, FNP-BC Mobile Clinic Provider Texas Children s Mobile Clinic Program April 5, 2019
Objectives 1. Identify the importance of screening for latent tuberculosis infection (LTBI) in children 2. Recognize the importance of treating children for LTBI Page 2 xxx00.#####.ppt 4/2/19 10:11:29 AM
LTBI Prior to January 2018 Tuberculin skin test (TST) placed if TB screening failed School nurse or TCMCP staff read TST results If TST positive, charity care referral to Infectious Disease Clinic at TCH Page 3 xxx00.#####.ppt 4/2/19 10:11:29 AM
LTBI Prior to January 2018 Barriers to receiving treatment at TCH: -Fear -Transportation issues -Language -Low Health Literacy -Employment Page 4 xxx00.#####.ppt 4/2/19 10:11:30 AM
Background Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis Usually affects the lungs but can attack any part of the body Not everyone infected with TB bacteria becomes sick Page 5 xxx00.#####.ppt 4/2/19 10:11:30 AM
Background Two TB-related conditions exist: 1. Latent TB Infection (LTBI) 2. TB disease Page 6 xxx00.#####.ppt 4/2/19 10:11:31 AM
Background AAP recommends testing be performed on recognition of high-risk factors CDC recommends medical evaluation for all children with LTBI, symptoms of TB, or history of contact with a person with infectious pulmonary TB LTBI treatment is recommended to prevent TB disease The Texas Children s Mobile Clinic Program (TCMCP) places TST to children with TB risk factors (CDC, 2017) Page 7 xxx00.#####.ppt 4/2/19 10:11:31 AM
Objective Starting in January 2018, evaluate and treat positive TST patients from the TCMCP for LTBI Page 8 xxx00.#####.ppt 4/2/19 10:11:32 AM
Methods TCMCP began performing a confirmative Quantiferon TB blood test (interferon-y release assay, IGRA) and chest x-rays for all TST positive patients Page 9 xxx00.#####.ppt 4/2/19 10:11:32 AM
Methods Providers -shadowed a TB specialist at the TCH ID Clinic -Connected with the Houston Health Department and Harris County Public Health Department to coordinate free treatment for pediatric LTBI Page 10 xxx00.#####.ppt 4/2/19 10:11:33 AM
Results 19 IGRAs were performed -13 (68%) were positive 8 completed LTBI treatment (a 12 dose regimen of rifapentine plus isoniazid (3HP)) at TCMCP 1 was referred to ID clinic at TCH due to medication side effects 4 currently receiving 3HP -Of the 8 who completed therapy, 8 (100%) completed at least 2 visits and 5 (62.5%) patients completed all 3 visits Page 11 xxx00.#####.ppt 4/2/19 10:11:33 AM
Discussion TCMCP patients are newly arrived uninsured immigrants with multiple social needs and transportation issues -Acceptance and completion of therapy are much higher than prior reports Utilizing 3-HP for LTBI treatment in a community is feasible Enhancing care for children with LTBI through this unique model of care in the community Page 12 xxx00.#####.ppt 4/2/19 10:11:34 AM
Conclusion A mobile screening and treatment program for LTBI is a unique way of reaching underserved children Requires strong community partnership for success Page 13 xxx00.#####.ppt 4/2/19 10:11:34 AM
References Latent Tuberculosis Infection: A guide for primary health care providers (2019). Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/tb/publications/ltbi/treatment.htm TB Treatment for Children (2016). Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/tb/topic/treatment/children.htm Page 14 xxx00.#####.ppt 4/2/19 10:11:35 AM
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