Evaluation: LTBI Contact Treatment in DC

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

2. DC’s Program Evaluation • DC Quick Facts • Plan Development • Methods • Results • Lessons Learned

3. 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

5. Evaluation Plan Development:CDC Evaluation Framework

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

7. 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%.

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

9. Logic Model

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

11. 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.

12. Step 4: Gather Credible EvidenceMethods 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

13. 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

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

15. 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.

16. 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

17. Post Script