§ 2017Tuberculosis(TB)rateper100,000person§ UnitedStates– 2.8§ SanDiegoCounty– 7.1
§ 80%ofcasescouldhavebeenpreventedbytreatinglatentTBinfection(LTBI)
§ Californiaspent$78millionfortreatmentofactiveTBin2018.
§ 5casesofactiveTBinSanDiegoCountypublichighschoolsduring2018demonstratetheneedforeffectivepreventioninterventions.
§ AdolescentsareathigherriskofprogressingtoactiveTBdiseaseafterexposure.
APilotProjectforSchool-BasedScreeningandTreatmentofLatentTBInfectionIsisY.Cunningham,BSN,RN,CPN,FNP/PNP-DNPStudent1 – SusannahGraves,MD,MPH2 –
MaryBarger,PhD,MPH,BSN1 – MartiBrentnall,MPH2 – HowardTaras,MD3,4
BACKGROUND
Thisevidence-basedprojectaimedtoincreaseawarenessabouttuberculosis,increasescreening,andoffershorterregimensofLTBItreatmentintheschoolsetting.
PURPOSE
CONCLUSIONS/IMPLICATIONS
PROJECTPLANPROCESS
COST-BENEFITANALYSIS§ Totalcostofmaterialsforthisproject=$1000§ TreatmentcostofactiveTB=$34,000/case§ TreatmentcostofdrugresistantTB=$110,000/case§ Testing1000studentsafterexposure=$40,000§ Itslowcostandtheuseofexistentprocesses&resources
makesitbeneficialandreplicableamongotherschools.
IDENTIFIEDTBRISKFACTORS
PROGRAMRESULTS
§ Aone-timeeducationinterventionincreasedawarenessandknowledgeaboutTBamongstudents.§ TherewasahighpercentageofstudentsatriskforTB,manyofwhomwerenotpreviouslytested.§ TheseresultshighlighttheneedtoincreaseTBriskawarenessandscreeningamongadolescents.§ RequiringthecompletionofaTBriskassessmentaspartofthehealthrequirementsforhighschool
admissionmayincreasescreeningratesamongthispopulation andpreventfutureactivecases.§ ATBriskassessmentwillnowbeincludedinadmissionpackagesatthisschool.§ AccesstoTBscreeninginSDIRwasgrantedtotheschoolnurseasaresultofthisproject.§ 50%ofTBtestresultswereenteredinSDIRbytheschoolnurse,thusimprovingthequalityofdata.§ Wewereunabletoassessthefeasibilityofoffering3HPviaDOTatschoolbutthisshouldbe
consideredforfutureprojects.
• Highschoolregistration• TBeducationinterventiontoFreshmanstudentswithpre/posttest
1.TBRiskAssessmentDistribution
• Incentives– Raffleofwirelessheadphonesandmovietickets
2.TBRiskAssessmentReturned
• RecommendationforTBtestingifat-risk• Lettertochild’sproviderwithoptionfor3-monthregimenofisoniazid-rifapentine (3HP)viadirectlyobservedtherapy(DOT)atschool
3.ConfidentialPackageDistribution
• Tested?- Studenttobringresultstoschoolnurse• Incentives– Targetgiftcards/raffleofheadphones• AccesstotheSanDiegoImmunizationRegistry(SDIR)wasgrantedafterfollow-upwascompleted
• TBtestingandresultswerecheckedinSDIR• Schoolnurseenteredmissingdatafromrecordsincountyimmunizationdatabase
4.PhoneCallFollow-Up
• Tobeprescribedbychild’sprovider• 3HPtobegivenviaDOTatschool• RifampinandIsoniazidregimenstobegivenathome• Incentives– $50Walmartgiftcardfortreatmentcompletion(athomeorschool)
5.LTBITreatmentOptions
FreshmanStudentsn=294
ReturnedTBRiskAssessment56(19%)
TBRiskPositive24(43%)
PriorTBTest3(12.5%)
TestedAFTERProgram4(16.7%)
Tested>8yrs ago7(29.2%)
NEVERTested10(41.7%)
TestingCurrent- AllNegative7(29.2%)
TestingNOTCurrent17(70.8%)
TBEDUCATIONINTERVENTIONRESULTS
60.5
84.7
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Pre-Test Post-Test
AverageScoresonTBKnowledge
135
4333
9 5
170
2618
4 8
0
20
40
60
80
100
120
140
160
180
Agreecompletely Agreesomewhat Neutral Disagreesomewhat
Disagreecompletely
WouldAgreetoTBTesting
PREQ7 POSTQ7
152
25 31
9 10
181
2214 7 4
0
20
40
60
80
100
120
140
160
180
200
Agreecompletely Agreesomewhat Neutral Disagreesomewhat
Disagreecompletely
WouldAgreetobeTreatedforLTBI
PREQ8 POSTQ8
PositiveChange>Neutral– 14%NegativeChange<Neutral– 3.5%
PositiveChange>Neutral– 15%NegativeChange<Neutral– 2%
70% 17%
9%
ImprovedKnowledgeAboutTB
Agreecompletely AgreesomewhatNeutral DisagreesomewhatDisagreecompletely
ACKNOWLEDGEMENTSLincolnHighSchool:JoseSoto-Ramos,Principal;Bree-AnnaWilliamson,RN;MarthaJazo-Bajet,RNCountyofSanDiego,HealthandHumanServicesAgency(HHSA),TuberculosisControlBranch:YolandaLopez,TBOutreachEducator;MarisaMoore,EpidemiologistCaptain;ChristineMurto,RefugeeHealthCoordinator;AntonetteAntonio,NP
AUTHORAFFILIATIONSANDCORRESPONDENCE1UniversityofSanDiego,2CountyofSanDiegoHHSA,3SanDiegoUnifiedSchoolDistrict, 4UniversityofCaliforniaSanDiegoCorrespondence:[email protected];Referencesuponrequest.
MeanDifference24.57(95%CI:21.14-28.01)
TBRiskFactor(n=25) n(%)1.BeenaroundsomeonewhohadTB 0(0)2.HistoryofpositiveTBtest(self/family) 7(28)3.Borninahigh-riskcountryoutsidetheUS 7(28)4.Beentoahigh-riskcountryfor >3weeks 4(16)5.GoestoMexicofrequently 8(32)6.Evereatenqueso frescoorunpasteurizeddairy 9(36)7.Beenaroundsomeonewhoishomeless,used
drugs,orwasrecentlyinjail4(16)
8.TakesPrednisoneorothermedicinesthatlowertheimmunesystem
2(8)
9a.EvertakenmedicineforapositiveTBtest 1(4)9b.Completedtreatment 1(4)Note:10(40%)ofstudentshad>2riskfactors
*StudentwhocompletedLTBItreatmentwasexcludedfromat-riskgroup.*Questions3and4werechangedafterregistrationtoincludenameofcountry.*QuestionsadaptedfromSDCountyTBRiskAssessmentandrecommendationsfromtheSDPediatricTBTaskForce.
PROGRAMRESULTS
February27,2019