1. Colorado Department of Public Health and Environment Tuberculosis Prevention and Control Program

2. History of TB On March 24 th, 1882, Dr. Robert Koch announced the discovery of Myco-bacterium tuberculosis This discovery was the most important step taken toward the elimination of TB.

3. World TB Day March 24th

7. The 22 Countries listed account for 80% of the TB Cases in the World

8. Global TB One-third of the world's population, is currently infected with TB over 90% in developing countries More than 8.4 million people become sick with active TB each year About 2 million people die each year from TB TB is the leading infectious killer among people living with HIV/AIDS

12. Patient country of origin

13. TB in Colorado: 2008 Cases by Race/Ethnicity (n=103)

14. TB in Colorado: 2008 Case rates (per 100,000) by race/ethnicity

15. CDPHE TB Program receives funds from Centers for Disease Control and Prevention State General Funds Public Health and Human Services Block Grant

16. CDC funding formula Incident cases – 30% U.S.-born minorities and foreign-born persons – 35% Persons co-infected with HIV – 5% Persons with MDR TB – 5% Substance abusers – 5% Homeless – 5% Persons with smear or culture positive pulmonary TB – 15%

18. The Role of Public Health in TB Prevention and Control

19. Role of public health

20. Public health structure Counties receive funding from CDPHE to provide TB services Active TB disease Evaluation of Class B TB Immigrants and Refugees Contact investigations Treatment for latent TB infection (in partnership with private providers)

21. Local health agencies Denver Public Health has a TB clinic that serves 7 metro counties 70-80% of cases Outlying counties work directly with the private providers to assure appropriate diagnosis, treatment, monitoring, and follow- up of active and latent TB Provide DOT Perform contact investigations

22. CDPHE TB Program Provide consultation and technical assistance active disease latent disease contact investigations outbreaks Conducts case management oversight of active TB cases in outlying counties

23. CDPHE Funding Formula for Local Health Departments Average number of cases (5 years) Number of TB suspects started on treatment Number of patients started on LTBI treatment

24. TB Program Funding Formula

25. CDPHE TB Contracts CDPHE currently contracts with 20 local health departments Contract period July 1, 2009 through June 30, 2010 Contracts include the ability to charge for DOT and Diagnostic testing (xrays).

27. TB resources CDC Division of TB Elimination web site http://www.cdc.gov/nchstp/tb/default.htm Interactive Core Curriculum on Tuberculosis: What the Clinician Should Know Self Study Modules on Tuberculosis CDPHE TB Program web site http://www.cdphe.state.co.us/dc/TB/tbhome.html CDPHE TB Program – 303.692.2638