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.

VIRGINIA COHORT DATA – 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

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%.

2009 2010 2011 2012 20130

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20

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60

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100SPUTUM CULTURE REPORT

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2015 NTIP Objective MET!

COLLECTING SPUTA

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

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%.

2009 2010 2011 2012 20130

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20

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80

90

100

% C

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2015 NTIP Objective MET!

SPUTUM CULTURE CONVERSION

CHANGE IN TB PROGRAM SPUTA COLLECTION RECOMMENDATIONS

Sputa culture conversion must be7 days after the prior positive cultureGoal - to document conversion in ≤60

days from start of treatment if possible

After smear conversionCollect one sputa every 7-10 daysMaximum of 3 sputa a monthCollect one sputa between day 55-60

NTIP Objective: Increase the proportion of culture-positive TB cases with initial drug-susceptibility results reported to 100%.

2009 2010 2011 2012 20130

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2015 NTIP Objective CLOSE!

DRUG SUSCEPTIBILITY RESULTS

Met the Virginia Target for 2013

THINGS TO REMEMBER

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 VirginiaCall and request an isolate be sent to

DCLSNTIP 2015 goal is 100%!

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%.

2009 2010 2011 2012 20130

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20

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40

50

60

70

80

90

100

% C

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2015 NTIP Objective MET!

RECOMMENDED INITIAL THERAPY

% C

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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

2009 2010 2011 2012 20130

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90

100

Objectives Not MET!

POTENTIAL CONTRIBUTORS TO INDICATOR PERFORMANCE

For those taking >366 days to complete:Intolerance leading to regimens without a

rifamycinIntolerance resulting in gaps in therapyNon-compliance with DOTFailure to convert sputa by 60 days after

treatment start that may result in need for 39 week treatment

POTENTIAL 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 calendarDocument doses converted to weeks

on Completion of Treatment form sent to the TB Program

Regularly update private MDs as to weeks completed

COMPLETION OF TREATMENT

Change in program evaluation study Concern re: those treated over 1 year Concern re: those not treated long enough

MDRAlternate regimens

Increase in case reviews Phone calls about treatment plans for

2014 TB cases

“TREATMENT COMPLETE”

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

KNOWN HIV STATUS

NTIP Objective: Increase the proportion of TB cases with positive or negative HIV test result reported to

88.7%.

2009 2009.5 2010 2010.5 2011 2011.5 2012 2012.5 20130

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2015 NTIP Objective MET!

% C

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HIV TESTING TIME FRAMES –VIRGINIA DEFINITION FOR COHORT

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

CONTACTS IDENTIFIED

NTIP Objective: Increase the proportion of TB patients with positive AFB sputum- smear results

who have contacts elicited to 100%.

2009 2009.5 2010 2010.5 2011 2011.5 2012 2012.5 20130

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CONTACTS EVALUATED

NTIP Objective: Increase the proportion of contacts to sputum AFB smear-positive TB patients who are

evaluated for infection and disease to 93%.

2009 2010 2011 2012 20130

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Objectives Not MET!

LTBI TREATMENT INITIATION

NTIP Objective: Increase the proportion of contacts to sputum AFB smear-positive TB cases with newly

diagnosed LTBI who start treatment to 88.0%.

2009 2010 2011 2012 20130

10

20

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40

50

60

70

80

90

100

Objectives Not MET!

% C

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LTBI TREATMENT COMPLETION

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%.

2009 2010 2011 2012 20130

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50

60

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80

90

100%

Coh

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2015 NTIP Objective MET!

“THE VIRGINIA INDICATOR” COMPLETED TREATMENT/INFECTED

Measure of TB Prevention161 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%)

Contacts Identified and

Evaluated

LTBI Infected withTreatment

Completed 44%

3134161

Contacts Infected

LTBI Treatment Completed

INH/Rifapentine Regimen (3HP)

A Valuable Tool to Increase LTBI Treatment Completion

Cohort Performance SnapshotVA 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

Thank you for Participating in Cohort Review!