Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Adherence Monitor patients for adherence to self-administered latent tuberculosis infection (LTBI) treatment regimens at least every month throughout treatment. 32 It is difficult to identify who will and who will not be adherent. 33 If patients do not take medicine as directed, the effectiveness of the regimen decreases, and the patient will be at greater risk of progressing to disease in the future and of infecting others. Monthly Assessment of Adherence At each visit, the clinician should assess adherence by doing the following: 1. Ask patients how many doses they have missed since their last refill. If patients are asked, “Did you take all your pills last month?” the natural inclination is to agree and say “yes” even if they did not. 2. Have patients bring their bottle of medicine to the refill appointment, and count how many pills are left. 3. If adherence problems are identified, include patients in the problem-solving process. a. Ask patients why they think that doses are missed and what could be done better: change the time of day, the location where they keep or take their pills, etc. b. Find out if there are barriers to obtaining refills in a timely manner that could be corrected. c. Review with patients what they believe is their risk of developing tuberculosis (TB) if medicine is not taken. Provide education again, as needed. d. Mutually agree on a plan to improve adherence. e. Praise patients for cooperation. 4. If adherence seems to be good, praise patients. For information on what to include in a patient education session, see the Patient Education section 13.1. Directly Observed Therapy Patients in the following high-risk groups are strongly recommended for directly observed therapy (DOT). DOT is mandatory for the new RPT/INH 12 week regimen. DOT is mandatory for any intermittent regimen. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Latent Tuberculosis Infection Revised November 2012 8.16
DOT is strongly encouraged for those with the greatest risk for progressing to tuberculosis (TB) disease: Young children who are recent contacts to infectious cases. Human immunodeficiency virus (HIV)-infected persons. For more information, see the “Directly Observed Therapy” topic in the Case Management section 10.34. For more information on adherence strategies for different developmental stages, see Appendix B in the New Jersey Medical School National Tuberculosis Center’s Management of Latent Tuberculosis Infection in Children and Adolescents: A Guide for the Primary Care Provider (New Jersey Medical School Global Tuberculosis Institute Web site; 2009) at http://www.umdnj.edu/globaltb/downloads/products/PediatricGuidelines%20(Scr een).pdf A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Latent Tuberculosis Infection Revised November 2012 8.17
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Alaska Tuberculosis Program Manual
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Purpose............................
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Monthly assessment of adherence ...
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When to Expand a Contact Investigat
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Introduction CONTENTS About the Ala
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How to Use This Manual Portable Doc
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Printing To access the print dialog
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Abbreviations Refer to the list bel
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QFT QuantiFERON ® -TB test QFT-G Q
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Alaska Statutes and Regulations on
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National and State Program Objectiv
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Indicator 3 Thorough contact invest
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National Standards and Recommendati
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Roles and Responsibilities Contact
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Local Public Health Agencies Table
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Resources and References Resources
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Introduction Purpose Use this secti
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Contact investigation: Collecting,
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Reporting Tuberculosis Detecting an
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Prompt reporting (prior to culture
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Use the Infectious Disease Report F
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Data Collection Forms The following
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Genotyping Genotyping is a useful t
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References 1 ATS, CDC, IDSA. Contro
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child or a person acting on behalf
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When to Conduct Targeted Testing Al
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Alaska Program Standards for Health
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B Notifications CONTENTS Introducti
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Table 1: NUMBERS OF FOREIGN-BORN PE
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chest radiograph and if sputum AFB
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Follow-up of B1 and B2 Tuberculosis
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Evaluation of B1, B2, and B Tubercu
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Treatment Prescribe medications as
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12 Centers for Disease Control and
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Tuberculosis Classification System
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Table 2: PERSONS AT HIGH RISK FOR T
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Table 3: WHEN TO SUSPECT PULMONARY
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Diagnosis of Tuberculosis Disease T
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1. Exposure to Infectious TB: Ask p
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Physical Examination A physical exa
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For more information on chest radio
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Laboratories should report positive
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Guidelines for preventing the trans
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50 CDC. National plan for reliable
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Introduction Purpose The overall go
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Basic Treatment Principles Follow t
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Treatment Regimens and Dosages Use
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Table 3: FOUR TREATMENT REGIMENS FO
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† 4 Table 4: DOSES*OF FIRST-LINE
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Figure 1:TREATMENT ALGORITHM FOR DR
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a. In remote locations in Alaska, m
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Antituberculosis Drug Rifampin (RIF
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Antituberculosis Drug Rifapentine (
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Reporting Reactions The table below
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Response to Treatment For consultat
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Figure 2: MANAGEMENT OF TREATMENT I
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Post-Treatment Evaluation Routine f
Page 119 and 120: Treatment in Special Situations Tre
Page 121 and 122: Resources For consultation regardin
Page 123 and 124: with an increase in overall complet
Page 125 and 126: Liver Disease Management of TB in p
Page 127 and 128: After the initial phase (first two
Page 129 and 130: Extrapulmonary Tuberculosis The bas
Page 131 and 132: Resources and References Resources
Page 133 and 134: Diagnosis of Latent Tuberculosis In
Page 135 and 136: Forms All required and recommended
Page 137 and 138: High-Risk Groups Certain factors id
Page 139 and 140: Diagnosis of Latent Tuberculosis In
Page 141 and 142: continually exposed to populations
Page 143 and 144: Administration of the Tuberculin Sk
Page 145 and 146: See “Two-Step Tuberculin Skin Tes
Page 147 and 148: See “Live-Virus Vaccines” under
Page 149 and 150: For more information on IGRAs and t
Page 151 and 152: Table 5: TARGETED TESTING FOR LATEN
Page 153 and 154: Resources and References Resources
Page 155 and 156: Treatment of Latent Tuberculosis In
Page 157 and 158: Policy Detailed information on the
Page 159 and 160: Window period prophylaxis is treatm
Page 161 and 162: Regimens Identify an appropriate re
Page 163 and 164: Dosages Once the appropriate regime
Page 165 and 166: Side Effects and Adverse Reactions
Page 167 and 168: If a patient reports to a healthcar
Page 169: Antituberculosis Drug Rifampin (RIF
Page 173 and 174: Table 7 describes the duration of t
Page 175 and 176: Alcoholism Alcohol-Related Treatmen
Page 177 and 178: Medication Administration and Pharm
Page 179 and 180: National Tuberculosis Controllers A
Page 181 and 182: 24 CDC . “Recommendations for Use
Page 183 and 184: Diagnosis and Treatment of Latent T
Page 185 and 186: All children suspected or diagnosed
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Page 189 and 190: History of BCG vaccination is not a
Page 191 and 192: Because of their higher specificity
Page 193 and 194: Table 3: COUNTRIES AND AREAS WITH A
Page 195 and 196: Treatment of Latent TB Infection (L
Page 197 and 198: For consultation regarding the trea
Page 199 and 200: Monitoring DOT is mandatory for INH
Page 201 and 202: For young infants, some experts rec
Page 203 and 204: TABLE 8: SIGNS AND SYMPTOMS OF PULM
Page 205 and 206: Treatment of Tuberculosis Basic pri
Page 207 and 208: Regime n 1 2 3 ❺ Table 10: FOUR T
Page 209 and 210: † 35 Table 11: DOSES*OF FIRST-LIN
Page 211 and 212: Monitoring Response to Treatment Ch
Page 213 and 214: Child Care and Schools: Children wi
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Page 217 and 218: 10 Centers for Disease Control and
Page 219 and 220: Case Management CONTENTS Introducti
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patient-centered approach to case m
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Alaska TB Program: Timeline for the
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For assistance with language issues
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Ascertain the extent of TB illness
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medical/health problem. The date of
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necessary to teach people how to ta
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Treatment Plan Components Recommend
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Implementation Activities To begin
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o Indicate the number of doses prov
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Review the status of the contact in
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For more information, see the “Di
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importance of continued treatment a
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5. Review information with the prov
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Completion of Therapy The case mana
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Case Closures Other than Completion
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Conduct a case management meeting o
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Biweekly (BIW) doses of TB medicati
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Use DOT with other measures such as
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It is important not to send a mixed
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Medical Orders Progressive Interven
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CDC. Module 9: “Patient Adherence
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36 New Jersey Medical School Nation
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75 CDC. Module 9: patient adherence
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Introduction Purpose A contact inve
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For roles and responsibilities, ref
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Decision to Initiate a Contact Inve
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chest radiographic findings that ar
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In general, a contact investigation
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Time Frames for Contact Investigati
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Circumstances unique to Alaska may
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Circumstances unique to Alaska may
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Activity Purpose Maximum Time Inter
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Infectious Period Determine the inf
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In general, for the purposes of con
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General Guidelines for Interviewing
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Healthcare workers should remember
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Index Patient with Positive Acid-Fa
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Index Patient with Negative Acid-Fa
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Contact Evaluation, Treatment, and
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Definition of abbreviations: HIV =
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Note: An IGRA may be used in place
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When to Expand a Contact Investigat
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Figure 7: EVALUATION, TREATMENT, AN
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CDC’s “Framework of Program Eva
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Definitions of abbreviations: AIDS
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elease assay; LTBI = latent tubercu
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officials to distinguish between di
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References 1 ATS, CDC, IDSA. Contro
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44 CDC, NTCA. Guidelines for the in
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Available Laboratory Tests Table 2:
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Table 3: PCR Testing Algorithm and
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Table 4: SPECIMEN COLLECTION METHOD
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5. If possible, send the specimen o
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Specimen Shipment There are three m
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Resources and References Resources
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Patient Education CONTENTS Introduc
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treatment, common side-effects of m
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Education Topics During the initial
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10. Explain the signs and symptoms
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Patient Education Materials Get th
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References 1 CDC. Module 4: treatme
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National Guidelines The following g
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Transfer Notifications CONTENTS Int
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For roles and responsibilities, ref
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Follow-Up Type When to Initiate Not
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Action Transfers Within Alaska Tran
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Provide the patient with a. A copy
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References 1 CDC. International not
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Infection Control CONTENTS Introduc
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of TB infection control principles
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Administrative Activities 13 Key ac
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Personal Respiratory Protection Alt
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For regulations in your area, refer
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Employee Health All employees, phys
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Figure 1: TWO STEP TESTING AND FOLL
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Isolation To reduce disease transmi
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Table 4: CRITERIA FOR PATIENTS TO B
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When to Initiate Airborne Infection
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Confirmed Tuberculosis Disease A pa
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Multidrug-Resistant Tuberculosis Di
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Environmental Controls in the Patie
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Return to Work, School, or Other So
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Tuberculosis Infection Control in P
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Transportation Vehicles To prevent
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7 CDC. Guidelines for preventing th
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Forms: Alaska State Public Health L
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ALASKA STATE PUBLIC HEALTH LABORATO
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Anchorage Alaska State Public Healt
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INDEX CASE INFORMATION Name: DOB: /
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CONTACT Name: Tuberculosis Contact
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Directly Observed Therapy (DOT) Cal
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B. Documents patient care activitie
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Alaska TB Program Section of Epidem
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Treatment Summary for Active TB Nam
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Interjurisdictional Tuberculosis No
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Latent Tuberculosis Infection (LTBI
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Alaska Tuberculosis Program 9210 Va
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Instructions for Collecting Sputum
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TB Case Management Information Requ
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Table 1: First-line anti-tuberculos
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Return the fax to the Drug Room (90
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Stock Orders: A small supply of
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TB/LTBI Medication Return Form Reas
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TB/LTBI Stock Medication Request FA
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TB Medication Dose Monitoring Regim
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TB Medication Dose Monitoring Regim
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ALASKA DEPARTMENT OF HEALTH AND SOC
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Tuberculosis Discharge Planning Che
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PART 2: 8. Have you ever been told
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Tuberculosis Treatment Contract Dep
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Statutes and Regulations Contents I
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Regulations Infection Control 7 AAC
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place of work is remote from patien
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(2) the child or a person acting on
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Glossary acid-fast bacilli (AFB): M
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eaction size on a later test, which
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disseminated TB: See miliary TB. dr
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immunocompromised and immunosuppres
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include medical history and TB symp
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thousands to millions of copies of
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secondary (TB) case: A new case of
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eproducing TB organisms from respir
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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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