§ 2017Tuberculosis(TB)rateper100,000person§ UnitedStates– 2.8§ SanDiegoCounty– 7.1

§ 80%ofcasescouldhavebeenpreventedbytreatinglatentTBinfection(LTBI)

§ Californiaspent$78millionfortreatmentofactiveTBin2018.

§ 5casesofactiveTBinSanDiegoCountypublichighschoolsduring2018demonstratetheneedforeffectivepreventioninterventions.

§ AdolescentsareathigherriskofprogressingtoactiveTBdiseaseafterexposure.

APilotProjectforSchool-BasedScreeningandTreatmentofLatentTBInfectionIsisY.Cunningham,BSN,RN,CPN,FNP/PNP-DNPStudent1 – SusannahGraves,MD,MPH2 –

MaryBarger,PhD,MPH,BSN1 – MartiBrentnall,MPH2 – HowardTaras,MD3,4

BACKGROUND

Thisevidence-basedprojectaimedtoincreaseawarenessabouttuberculosis,increasescreening,andoffershorterregimensofLTBItreatmentintheschoolsetting.

PURPOSE

CONCLUSIONS/IMPLICATIONS

PROJECTPLANPROCESS

COST-BENEFITANALYSIS§ Totalcostofmaterialsforthisproject=$1000§ TreatmentcostofactiveTB=$34,000/case§ TreatmentcostofdrugresistantTB=$110,000/case§ Testing1000studentsafterexposure=$40,000§ Itslowcostandtheuseofexistentprocesses&resources

makesitbeneficialandreplicableamongotherschools.

IDENTIFIEDTBRISKFACTORS

PROGRAMRESULTS

§ Aone-timeeducationinterventionincreasedawarenessandknowledgeaboutTBamongstudents.§ TherewasahighpercentageofstudentsatriskforTB,manyofwhomwerenotpreviouslytested.§ TheseresultshighlighttheneedtoincreaseTBriskawarenessandscreeningamongadolescents.§ RequiringthecompletionofaTBriskassessmentaspartofthehealthrequirementsforhighschool

admissionmayincreasescreeningratesamongthispopulation andpreventfutureactivecases.§ ATBriskassessmentwillnowbeincludedinadmissionpackagesatthisschool.§ AccesstoTBscreeninginSDIRwasgrantedtotheschoolnurseasaresultofthisproject.§ 50%ofTBtestresultswereenteredinSDIRbytheschoolnurse,thusimprovingthequalityofdata.§ Wewereunabletoassessthefeasibilityofoffering3HPviaDOTatschoolbutthisshouldbe

consideredforfutureprojects.

• Highschoolregistration• TBeducationinterventiontoFreshmanstudentswithpre/posttest

1.TBRiskAssessmentDistribution

• Incentives– Raffleofwirelessheadphonesandmovietickets

2.TBRiskAssessmentReturned

• RecommendationforTBtestingifat-risk• Lettertochild’sproviderwithoptionfor3-monthregimenofisoniazid-rifapentine (3HP)viadirectlyobservedtherapy(DOT)atschool

3.ConfidentialPackageDistribution

• Tested?- Studenttobringresultstoschoolnurse• Incentives– Targetgiftcards/raffleofheadphones• AccesstotheSanDiegoImmunizationRegistry(SDIR)wasgrantedafterfollow-upwascompleted

• TBtestingandresultswerecheckedinSDIR• Schoolnurseenteredmissingdatafromrecordsincountyimmunizationdatabase

4.PhoneCallFollow-Up

• Tobeprescribedbychild’sprovider• 3HPtobegivenviaDOTatschool• RifampinandIsoniazidregimenstobegivenathome• Incentives– $50Walmartgiftcardfortreatmentcompletion(athomeorschool)

5.LTBITreatmentOptions

FreshmanStudentsn=294

ReturnedTBRiskAssessment56(19%)

TBRiskPositive24(43%)

PriorTBTest3(12.5%)

TestedAFTERProgram4(16.7%)

Tested>8yrs ago7(29.2%)

NEVERTested10(41.7%)

TestingCurrent- AllNegative7(29.2%)

TestingNOTCurrent17(70.8%)

TBEDUCATIONINTERVENTIONRESULTS

60.5

84.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Pre-Test Post-Test

AverageScoresonTBKnowledge

135

4333

9 5

170

2618

4 8

0

20

40

60

80

100

120

140

160

180

Agreecompletely Agreesomewhat Neutral Disagreesomewhat

Disagreecompletely

WouldAgreetoTBTesting

PREQ7 POSTQ7

152

25 31

9 10

181

2214 7 4

0

20

40

60

80

100

120

140

160

180

200

Agreecompletely Agreesomewhat Neutral Disagreesomewhat

Disagreecompletely

WouldAgreetobeTreatedforLTBI

PREQ8 POSTQ8

PositiveChange>Neutral– 14%NegativeChange<Neutral– 3.5%

PositiveChange>Neutral– 15%NegativeChange<Neutral– 2%

70% 17%

9%

ImprovedKnowledgeAboutTB

Agreecompletely AgreesomewhatNeutral DisagreesomewhatDisagreecompletely

ACKNOWLEDGEMENTSLincolnHighSchool:JoseSoto-Ramos,Principal;Bree-AnnaWilliamson,RN;MarthaJazo-Bajet,RNCountyofSanDiego,HealthandHumanServicesAgency(HHSA),TuberculosisControlBranch:YolandaLopez,TBOutreachEducator;MarisaMoore,EpidemiologistCaptain;ChristineMurto,RefugeeHealthCoordinator;AntonetteAntonio,NP

AUTHORAFFILIATIONSANDCORRESPONDENCE1UniversityofSanDiego,2CountyofSanDiegoHHSA,3SanDiegoUnifiedSchoolDistrict, 4UniversityofCaliforniaSanDiegoCorrespondence:IsisCunninghamisiscunningham@gmail.com;Referencesuponrequest.

MeanDifference24.57(95%CI:21.14-28.01)

TBRiskFactor(n=25) n(%)1.BeenaroundsomeonewhohadTB 0(0)2.HistoryofpositiveTBtest(self/family) 7(28)3.Borninahigh-riskcountryoutsidetheUS 7(28)4.Beentoahigh-riskcountryfor >3weeks 4(16)5.GoestoMexicofrequently 8(32)6.Evereatenqueso frescoorunpasteurizeddairy 9(36)7.Beenaroundsomeonewhoishomeless,used

drugs,orwasrecentlyinjail4(16)

8.TakesPrednisoneorothermedicinesthatlowertheimmunesystem

2(8)

9a.EvertakenmedicineforapositiveTBtest 1(4)9b.Completedtreatment 1(4)Note:10(40%)ofstudentshad>2riskfactors

*StudentwhocompletedLTBItreatmentwasexcludedfromat-riskgroup.*Questions3and4werechangedafterregistrationtoincludenameofcountry.*QuestionsadaptedfromSDCountyTBRiskAssessmentandrecommendationsfromtheSDPediatricTBTaskForce.

PROGRAMRESULTS

February27,2019