Transcript Fritz_2016_PHAP_Spring_Seminar_Presentation.pptx

The Use of Community Partnerships for Intervention:
Examining Outcomes for Tuberculosis Targeted Testing
in a Unique High-Risk Population in Los Angeles
County
Nora Fritz
Public Health Associate
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
Public Health Associate Program Spring Training
April 4-8, 2016
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
Significance to Public Health


Since 2007, 26 genotypically linked (G10161/G10167,
PCR00556) tuberculosis (TB) patients have been reported in
Los Angeles County.
This high-risk cluster reports stays at specific settings known
as Grupos, which are suspected as ongoing transmission
sites with undiagnosed TB.
LAC Grupo Logo:
(from left to right)
“Alcoholics
Anonymous: Unity,
Service, Recovery”
*Current as of 2015
Background and Rationale for the Project

Bi-monthly on-site
TB screening at four
Grupos between
11/24/14 and
10/08/2015.
Partnership to
provide TB
evaluation and
follow-up therapy
for TB infection
(TBI).
LAC TB Cases by Reason for TB Evaluation in
G10161/G10167, PCR00556 2007-2015 (n=26)
12
Count

10
Targeted
Testing
8
Reason
Unknown
TB Symptoms
7
6
2
4
2
2
0
2
2
2
1
1
1
1
1
1
1
2007
2010
2011
2012
2013
2014
Year
1
1
Abnormal CXR
Incidental Lab
Result
2015
*Current as of 2015
Background and Rationale for the Project Continued


Image 1: 20 (76%) of the 26 cases in G10161/G10167, PCR00556 had
Grupo history during exposure period identified during patient interviews;
Source: Genotype Cluster and Investigation Assessment Unit, TBCP, NodeXL
*Current as of 2015
Three-tier
Grupo
categorization
system.
Selection of
Grupo targeted
testing locations
based on tier
level and Grupo
cooperation.
Methods: Tuberculosis On-Site Testing and
Tuberculosis Follow-up

Tuberculosis Control Program (TBCP) Role:
 Interviewed residents
 Educated residents
 Coordinated test results and referrals
 Arranged follow-up
 Collected and organized data

Central City Community Health Center (CCCHC) Role:
 Performed Quantiferon (QFT) interferon gamma release assays (IGRAs)
 Coordinated test results and referrals

Community Health Services (CHS) Role:
 Provided follow-up for TBI
Overall Screening Results

374 (100%) residents
were interviewed by
TBCP.
209 (56%) residents
were screened with
IGRAs.
 69 (33%) residents
were IGRA positive.
 36 (52%) of 69
residents were lost to
follow-up and did not
receive chest X-rays.
Screened Clients by Tiered Grupo
(n=209)
Count

50
45
40
35
30
25
20
15
10
5
0
43
41
33
Indeterminate
26
22
17
4
Negative
Positive
8
1
4 4
6
Grupo 1, Tier Grupo 2, Tier Grupo 3, Tier Grupo 4, Tier
I
III
II
II
Grupo by Tier
*Current as of 2015
TBI Follow-up Results

6 residents had abnormal chest X-ray results. Of these, 3
(50%) were diagnosed with active TB and completed or are
still completing treatment through CHS.
 All 3 confirmed cases had exposure in Tier I and II Grupo locations.
 The remaining 3 (50%) residents with abnormal chest X-ray results
were ruled out for active TB.

37 (18%) total residents were diagnosed with TBI.
 33 (89%) residents were identified via positive IGRA results during
targeted testing.
 4 (11%) additional residents were identified with prior positive TB test
results during resident interviews.
TBI Follow-up Results Continued
Reasons for Not Completing
Therapy (n=37)
6
1
Adverse Effects
3
1
Completed therapy
2
Currently on Therapy
Lost to follow-up
Not offered LTBI
24
Initiated therapy, but
were lost to follow-up
*Current as of 2015

10 (27%) residents started
TBI therapy.
 3 (30%) residents started
3HP.
 1 (33%) completed therapy.
 2 (20%) residents started 4
months of RIF.
 1 (50%) completed therapy.
 5 (50%) residents started 6
months of INH.
 1 (20%) completed therapy.
Implications for Practice

Partnering with community organizations is key to
reducing TB transmission in Grupos.

Using genotype results can help support traditional TB
control practices, including contact investigation activities.

TB screening activities indicate that TB transmission is
ongoing within Grupos which requires ongoing
intervention practices.

Multidisciplinary partnerships can lead to active case
finding, contact identification, and linking clients to care.
Co-Authors:
J. Gomez2,4, S. Poonja2,4, A. Austin1, K. Do2,4, C. Curley1, A. Aquino3, L. Linde2,4,
C. Tello-Alfaro2, A. Chang2
1Department
of Public Health, Community Health Services; Los Angeles, CA
2Department of Public Health, Tuberculosis Control Program; Los Angeles, CA
3Martin Luther King Jr. Center for Public Health; Los Angeles, CA
4Centers for Disease Control and Prevention; Atlanta, GA
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
Questions?
Nora Fritz
[email protected]
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected]
Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support