Julia Skapik, MD, MPH, FAMIA, is NACHC’s Chief Medical Information Officer.
Many Americans think tuberculosis (TB) was a scourge of the 19th and 20th centuries that’s behind us in the digital age; yet 13 million Americans are currently estimated to be infected with inactive TB. Ten percent (10%) of people with inactive TB progress to active disease, which is highly transmissible but preventable through treatment.
As we pass another World TB Day, we want to thank Community Health Centers that support the U.S. response to tuberculosis. We’re inspired by your vigilance in screening and testing. To strengthen this response, the Centers for Disease Control and Prevention (CDC) is partnering with NACHC and health centers in the new TB campaign: Think. Test. Treat.
New TB Campaign Focuses on Patient Education
Think. Test. Treat. offers materials for healthcare professionals, patients, and the general public in eight languages. The materials break down key facts in simple terms and address misunderstandings around TB, clearly describing recommendations for TB screening and treatment. The toolkit includes posters, videos, educational handouts, and easy-to-share social media posts for different platforms and audiences, which CDC ships to health centers at no cost on request.
The Think. Test. Treat. campaign encourages health care organizations to:
- Talk about TB with patients and communities—to help people understand how screening and treatment prevents active disease and the spread of TB.
- Discuss risk factors for each patient—because people from countries or settings (incarceration, temporary shelters) that have high TB prevalence or who have certain conditions (HIV, immunosuppression, diabetes) are at risk.
- Explain recommendations for testing — CDC recommends the TB blood test which offers more accuracy and convenience.
- Provide treatment for latent TB—a short course of a rifamycin-based regimen is effective and more likely to be completed.
Rebecca Calderara, an ARNP at International Community Health Services (ICHS) in Seattle, notes that patients in her community have a high incidence of TB exposure. She says:
“ICHS serves people in over 70 languages – so having these materials in multiple languages with simple graphics makes them very usable – it’s easy for a provider to give patients a simple education aid on latent TB.”
Caldera also told NACHC that campaign materials have made a huge impact on care navigator training. She explains: “[W]e’ve held an hour-long didactic training on TB control with our partners from the county’s TB Control Program, we post campaign messages on our intranet for providers, and we have folders in each exam room with education materials in different languages for our patients.”
How to Integrate TB into Office Visits
While the Think.Test.Treat. campaign simplifies testing and treating latent TB, there are still significant challenges for health center staff. Building a TB test and care strategy into an already busy office-visit workflow with same-day labs is difficult. Rebecca notes that the largest care gaps they see are when patients are asked to get a chest x-ray after a positive test, and in ensuring patients complete treatment. Care navigators and latent TB infection (LTBI) nurses have made gains at ICHS by following-up with patients who drop out due to language or other social-need barriers.
Rebecca says, “forming a relationship with the public health department, where we can ask a local TB expert for guidance, has been instrumental in our success and in our ability to train providers – ”She also offers, “care navigators, nurses, and pharmacy leads who help with follow-up calls make a big difference.”
She wants other health centers to know, “You can do it! It’s definitely possible to screen and treat for LTBI in primary care.”
TB Resources for Community Health Center Care Teams
Take a look at the new Think.Test.Treat page especially for healthcare providers, and new digital resources from the CDC:
- Know the risk factors for latent TB infection, and recommend testing for patients at increased risk.
- Use TB blood tests (Interferon Gamma Release Assays [IGRAs]) because they can be done in one visit, and are the most accurate for patients who have been vaccinated for TB.
- Treat latent TB infection with shorter, rifamycin-based treatment regimens to prevent TB disease.