1. V IRGINIA C OHORT D ATA – 5 YEAR TRENDS AFTER 4 YEARS OF LOCAL COHORT REVIEW Virginia achievement on National TB Indicators for the past 5 years – where we are and where we need to be Debbie Staley March 24, 2015 World TB Day

2. NTIP objective: Increase the proportion of TB cases with a pleural or respiratory site of disease ≥ age 12 with a sputum-culture result reported to 95.7%.

3. COLLECTING SPUTA Recommended for all TB suspects to rule out respiratory disease, even those identified as extra-pulmonary

4. NTIP Objective: Increase the proportion of TB patients with positive sputum culture results who have documented conversion to sputum culture-negative within 60 days of treatment initiation to 61.5%.

5. C HANGE IN TB P ROGRAM S PUTA C OLLECTION R ECOMMENDATIONS Sputa culture conversion must be 7 days after the prior positive culture Goal - to document conversion in ≤60 days from start of treatment if possible After smear conversion Collect one sputa every 7-10 days Maximum of 3 sputa a month Collect one sputa between day 55-60

6. NTIP Objective: Increase the proportion of culture- positive TB cases with initial drug-susceptibility results reported to 100%. Met the Virginia Target for 2013

7. T HINGS TO R EMEMBER The Code of Virginia §32.1-50 E requires labs doing business in Virginia to submit an isolate if M.tb to the state lab Verify submission by reference labs doing business in Virginia If a sample is processed by an out-of-state lab and NOT doing business in Virginia Call and request an isolate be sent to DCLS NTIP 2015 goal is 100%!

8. NTIP Objective: Increase the proportion of patients who are started on the recommended initial 4-drug regimen when suspected of having TB disease to 93.4%.

9. % Cohort Achievement NTIP Objective: For patients with newly diagnosed TB for whom 12 months or less of treatment is indicated, increase the proportion of patients who complete treatment within 12 months to 93%. (Exclusions include RIF resistance, meningeal TB, <15 years old with disseminated TB, death during treatment and those who left the country within 12 mo. of tx.) COMPLETION OF TREATMENT Objectives Not MET!

10. P OTENTIAL CONTRIBUTORS TO INDICATOR PERFORMANCE For those taking >366 days to complete: Intolerance leading to regimens without a rifamycin Intolerance resulting in gaps in therapy Non-compliance with DOT Failure to convert sputa by 60 days after treatment start that may result in need for 39 week treatment

11. P OTENTIAL CONTRIBUTORS TO INDICATOR PERFORMANCE For those with treatment that is too short per standards: Count doses and convert to weeks / don’t count only weeks on the calendar Document doses converted to weeks on Completion of Treatment form sent to the TB Program Regularly update private MDs as to weeks completed

12. C OMPLETION OF T REATMENT Change in program evaluation study Concern re: those treated over 1 year Concern re: those not treated long enough MDR Alternate regimens Increase in case reviews Phone calls about treatment plans for 2014 TB cases

13. “T REATMENT C OMPLETE ” Completed the planned course of treatment, or Completed all of the initiation phase and at least 80% of continuation phase if pulmonary and initially smear negative Exempt if left the country in ≤366 days from treatment start and still on treatment Fax the “Completion of Treatment” form with dose calculations as soon as treatment is complete Clinical cases allow for a 16 weeks treatmetn

14. K NOWN HIV S TATUS NTIP Objective: Increase the proportion of TB cases with positive or negative HIV test result reported to 88.7 %. % Cohort Achievement

15. HIV T ESTING T IME F RAMES – V IRGINIA D EFINITION FOR C OHORT Up to 8 weeks after start TB medication start, or Within 12 months before diagnostic work-up, or If previously diagnosed HIV+, any documentation of infection at any time Purpose – to provide benefit of anti-retroviral therapy if infected, improving outcomes

16. C ONTACTS I DENTIFIED NTIP Objective: Increase the proportion of TB patients with positive AFB sputum- smear results who have contacts elicited to 100 %. % Cohort Achievement

17. C ONTACTS E VALUATED NTIP Objective: Increase the proportion of contacts to sputum AFB smear-positive TB patients who are evaluated for infection and disease to 93 %. % Cohort Achievement Objectives Not MET!

18. LTBI T REATMENT I NITIATION NTIP Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases with newly diagnosed LTBI who start treatment to 88.0 %. % Cohort Achievement

19. LTBI T REATMENT C OMPLETION NTIP Objective: For contacts to sputum AFB smear positive TB cases who have started treatment for newly diagnosed LTBI, increase the proportion who complete treatment to 79.0 %. % Cohort Achievement 2015 NTIP Objective MET!

20. “T HE V IRGINIA I NDICATOR ” C OMPLETED T REATMENT /I NFECTED Measure of TB Prevention 161 Completed Rx ÷ 366 Infected= 44.0% of infected completed LTBI Rx 3134 identified contacts 2626 completely evaluated (83.8%) 366 testing positive for infection 197 starting treatment for infection (53.8%) 161 completing treatment (81.7%)

21. Contacts Identified and Evaluated LTBI Infected with Treatment Completed 44% 3134 161

22. Contacts Infected LTBI Treatment Completed INH/Rifapentine Regimen (3HP) A Valuable Tool to Increase LTBI Treatment Completion

23. Cohort Performance Snapshot VA Target Met 2015 NTIP Target Met Sputa Culture Report Sputa Culture Conversion Drug Susceptibilities Standard 4-Drug Initial Treatment Treatment Completion in ≤ 366 days HIV Testing Contacts Identified Contacts Completely Evaluated LTBI Treatment Initiated LTBI Treatment Completed

24. Thank you for Participating in Cohort Review!