Assessment of Program Evaluation Activities in Tuberculosis Control Programs — United States, 2009–2010 Silvia M. Trigoso, MPH Fellow, Public Health Prevention Service (PHPS) TB Program Evaluation Network Annual Conference September 21, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

Today’s Presentation  Purpose  Objective  Methods  Results  Limitations  Conclusions  Recommendations  Questions

Purpose of the Assessment To understand the status, progress, and challenges in planning and implementing program evaluation activities in TB control programs.

Objective Assessment addressed 3 evaluation questions:  What is the evaluation focus area(s) reported in the CoAg and interim reports and is it in alignment with National TB Program Objectives and Performance Targets for 2015?  To what extent does the TB control program’s evaluation plan incorporate elements of the CoAg outlined evaluation guidance?  What are challenges and opportunities reported in implementing proposed PE activities?

Methods  Variables were created and database developed for data collection and management.  Data sources included grantees’ program evaluation plans and interim reports submitted to FSEB as part of the CoAg.  Reviewed program evaluation sections submitted as part of the CoAg FOA and interim reports submitted in August  Data analysis was conducted and results were obtained.

Results

Evaluation Focus Areas Reported by Grantees, 2010 Interim Report (n = 58) Completion of Treatment6 TB Case Rate4 Contact Investigation24 Laboratory Reporting1 Treatment Initiation1 Sputum Culture Conversion8 Data Reporting2 Recommended Initial Therapy2 Universal Genotyping2 Known HIV Status13 Evaluation of Immigrants and Refugees4 Sputum-Culture Reported3 Program Evaluation/Evaluation Focal Point1 Human Resource Development1 Training Focal Point0 Focus Area# of Grantees

Limitations  Assessment was limited to what grantees reported on submitted reports.  Not all grantees had program evaluation plans.  Could not obtain interim reports for all grantees.  Grantee’s interim reports did not reflect an update of PE activities conducted between reporting time period.

Conclusions  The three most frequently reported focus areas for evaluation are: (1) contact investigation; (2) known HIV status; and (3) sputum culture conversion.  Over 80% of grantees report at least more than 1 focus area. 10 grantees report a focus area not in alignment with National TB Objectives for  Over 65% of grantees did not change their focus area for evaluation. For some grantees who did change focus areas it was reported to be because of technical assistance provided by FSEB program evaluation representatives or program consultants.  There is a difference in PE CoAg guidance reported in interim report with most grantees decreasing in level.  The most frequently reported external challenge reported by grantees is limited staff and resources for conducting evaluation activities.

Recommendations  Stronger program evaluation reporting guidance is needed. Reporting formats vary across regions.  Identify areas for program evaluation team (PET) to provide TA.  Understanding challenges grantees face in implementing PE activities (e.g., limited staff/resources + TB staff turnover) provides PET opportunity to be a valuable and useful resource.  Encourage use of monitoring tools to guide focus areas for evaluation and impacting TB programs (i.e. local data, NTIP, ARPEs).

Acknowledgements  Brandy Peterson & Awal Khan  Program Consultants  Field Services and Evaluation Branch  Tom Chapel, CDC Chief Evaluation Officer

Contact Information Silvia M. Trigoso Public Health Prevention Service Fellow For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Place Division name here