Evaluation: LTBI Contact Treatment in DC Kim Seechuk, MPH Bureau of TB Control District of Columbia

DC’s Program Evaluation  DC Quick Facts  Plan Development  Methods  Results  Lessons Learned

Washington DC Quick Facts  61 Square Miles  Eight Wards  600,000 population  50% Black  13% Foreign born  9% Hispanic  59,000 median income  18% below poverty

Evaluation Plan Development: CDC Evaluation Framework

Step 1: Engage Stakeholders  Conducted internal and external stakeholder assessment  Ultimately engaged internal stakeholders only in evaluation planning

Program Objectives  Increase the proportion of contacts to sputum AFB smear-positive TB patients with newly diagnosed LTBI who start treatment to 75%.  For above contacts who have started treatment for LTBI, increase the proportion of that complete treatment to 65%.

Step 2: Describe the Program Baseline  59 (32 sm+) cases in 2007  90 LTBI contacts  64 (71%) started treatment  39 (61%) completed treatment Baseline Year

Logic Model

Resources . 5 FTE graduate intern x 6 months .1 FTE prevention specialist .1 FTE Program Manager  Access to TB medical and program team

Step 3: Focus Evaluation Design Evaluation Goals:  Describe current processes for bringing contacts with LTBI to treatment initiation and completion;  verify baseline findings;  describe characteristics of contacts that successfully begin and finish treatment;  suggest changes to current process to improved treatment initiation and completion.

Step 4: Gather Credible Evidence Methods Quantitative Review −Program policies and protocols −2008 LTBI* medical/case management charts  Observation of staff/patient interaction −Physician, nurse case manager, TB investigator  Qualitative Interviews −patients who started and did/did not complete treatment. *number of LTBI contacts was very small, so expanded to all persons who started LTBI treatment

Step 5: Justify Conclusions Results  Observations  No actual written protocol for treatment offer  Treatment offer was purview of the physician; no  Consistent review of patient information sheet by nurse on those who accepted  Chart/Data Review – 2008 data  33% (102/309) of LTBI patients completed therapy  Black race and being foreign-born were associated with not completing treatment  History of incarceration was associated with successfully completing treatment

Qualitative Interviews  37 Patients contacted for interviews  6 completed  43% phone # wrong or disconnected  30% never answered Bust

Step 6: Ensure Use and Share Lessons Learned  Writing protocols-review & reinforce w/staff  Determining steps to enhance treatment offer beyond physician offer  Language appropriate patient materials  Considering:  Increased case manager contact in first 2 weeks of starting treatment  Pilot with community provider serving target group (foreign born, black) to conduct LTBI treatment follow up.

Lessons Learned (cont)  High percentage of patients are transient  Get multiple sources of locating information  Check assumptions about what staff think is happening  Be realistic about what can be accomplished  Assure data sources are easily accessed  Assure evaluation is properly resourced  Stay focused  Avoid letting evaluation purpose drift or languish

Post Script