Scaling Up Latent Tuberculosis Infection Testing and Treatment for Non-US Born Patients in a Federally Qualified Community Health Center

Abstract

In the United States (US), tuberculosis elimination strategies include scaling up latent tuberculosis infection (LTBI) diagnosis and treatment for persons at risk of progression to tuberculosis disease. The Massachusetts Department of Public Health partnered with Lynn Community Health Center to provide care to patients with LTBI who were born outside the US. The electronic health record was modified to facilitate collection of data elements for public health assessment of the LTBI care cascade. Among health center patients born outside the US, testing for tuberculosis infection increased by over 190%. From October 1, 2016 to March 21, 2019, 8827 patients were screened and 1368 (15.5%) were diagnosed with LTBI. Using the electronic health record, we documented treatment completion for 645/1368 (47.1%) patients. The greatest drop-offs occurred between testing for TB infection and clinical evaluation after a positive test (24.3%) and between the recommendation for LTBI treatment and completion of a treatment course (22.8%). Tuberculosis care delivery was embedded in the primary care medical home, bringing patient-centered care to those at high risk for loss to follow up. The partnership between public health and the community health center promoted quality improvement.

Keywords: Community health center; LTBI; Non-US born; Tuberculosis.

Fig. 1

Lynn Community Health Center LTBI care cascade workflow. ^aQuantiFERON Gold in-tube (QFT-GIT). ^bTuberculin skin test. ^cChest X-ray; radiology on-site, no appointment required. ^dSee www.cdc.gov/tb/topic/testing/diagnosingltbi.htm for evaluation scope. ^eSee https://www.cdc.gov/mmwr/volumes/69/rr/rr6901a1.htm?s_cid=rr6901a1_w. ^fFour months self-administered daily rifampin (4R) or isoniazid and rifapentine once weekly by directly observed therapy for 12 weeks (3HP).  ^gSee https://ochin.org