Transcript Community-Driven Tuberculosis Interventions for Aboriginal

Community-Driven Tuberculosis
Interventions for Aboriginal
Communities
Jessica Harper & Nash Dhalla
February 19, 2015
Hyatt Regency Vancouver
Conflict of Interest:
Neither presenter (Nash Dhalla, RN, BScN or
Jessica Harper, RN, BScN) have any affiliation
financial or otherwise, with a commercial or
other industry interest that may bias our
presentation.
Outline
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TBSAC: Who we are
What is TB?
TST vs IGRA
Feasibility of Portable
Incubator in LTBI
testing
5. Challenges
6. Next Steps
TB Services in BC
• Centralized: pharmacy, labs, database, physician
consultant, and nurse consultant services provided
by TB Services, BC Centre for Disease Control
• TB Services for Aboriginal Communities (TBSAC):
provides TB services to Health Centers located onreserve, funded and delivered in partnership with
First Nations Health Authority (FNHA).
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TB Services
First Nations
Communities
First Nations
Health Authority
CDC Coordinator-TB,
Funding, Education,
Resources
Community Health Nurse
Community Health Worker
DOT Workers
Health Directors
Community Members
TB Services for
Aboriginal
Communities
Physician Consultation
Nurse Consultation
Case Management
Pharmacy, Lab, Diagnostics, X-Ray,
Surveillance, Training and
Education
TB Team
BCCDC (TBSAC)
• Dr. Victoria Cook, TBSAC
Physician
• Shawna Buchholz, Clinical
Nurse Educator
• Nash Dhalla, Nurse
Consultant
• Karen Beinhaker, Nurse
Consultant
FNHA, Health Protection
• Jessica Harper, CDC
Coordinator, TB
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Background: What is TB?
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Mycobacterium tuberculosis
Airborne disease
Generally infects the lungs
In BC: incidence rate of ~7 per 100 000
Symptoms: coughing, fever, weight loss, night sweats
• Curable and Preventable!
Background: What is LTBI?
• “Sleeping” Latent TB infection (LTBI):
– Infected with bacteria?
– Symptoms present?
– Infectious?
YES
NO
NO
• A healthy individual infected with LTBI has a 5-10%
risk of developing active TB over their lifetime
(BCCDC TB Control Manual, 2012)
Background:
Diagnosing & Treating LTBI
• Tuberculin Skin Test (TST) is an intradermal injection of
0.1ml of purified protein derived from M.Tuberculosis
bacteria
• Follow up Chest X-ray to check for active TB
Background:
Diagnosing & Treating LTBI
• Recommended for preventative therapy:
– Isoniazid for 9 months –270 doses
OR
– Rifampin for 4 months –120 doses
• Decision to start treatment is based on:
– Context of TST – likelihood of false positive
– Reason client was being tested
– Risk of progression to active disease
– Ability to adhere to medication
– Possible intolerance to medication
– Alcohol use, desire for pregnancy, etc.
(BCCDC TB Control Manual, 2012)
The IGRA Test
• Interferon Gamma
Release Assay (IGRA)
• Detects interferon gamma
released from WBC
• Two tests: Quantiferon
Gold and T-Spot
• BC: offered in Vancouver,
New Westminster,
Victoria, Prince George
and Kelowna
IGRA vs. TST
(TB Manual: Interferon Gamma Release Assay Testing Guideline for Diagnosis of Latent
Tuberculosis Infection by Physicians, 2013, pg. 2)
TST vs. IGRA
TST
IGRA
Good for serial testing
Not as good for serial testing
Inexpensive
More expensive
Universally accessible
Skill, equipment and timeframe
needed limit accessibility
Low specificity in certain
populations (BCG-60%)
Two visits
High specificity in all populations
One visit
Variability in test interpretation Low variability in test
by reader *****
interpretation by reader
WHY IGRA?
• To identify the proportion of patients in whom treatment for
LTBI could be avoided because an IGRA test was negative yet a
TST test was positive.
• To determine if there is a statistically significant difference in
treatment adherence between BC residents who have had
LTBI confirmed with an IGRA test and those whose diagnoses
was made using a TST only.
IGRA Feasibility In First Nations
Communities
• Currently IGRA is offered at the BCCDC, in New
Westminster, Victoria, Kelowna and Prince
George
• Increase access to testing for patients who are
less likely/able to travel for testing:
– Remote communities
– Outbreak investigation
– Enhanced communities
• Identify and treat true LTBI
• Are communities interested in the IGRA test?
IGRA testing: Feasibility
• TBSAC Team & Community Leaders discussed
IGRA
– Based on enhanced community survey
– Strong links with HCP
– Geographic location
– IGRA available in Canada 2007 with strong
evidence base
– BCG Factor
– Community engagement
Results: Feasibility Test
 Community approval
 Meet with BCCDC lab to agree on expectations of
how samples are delivered
 Develop detailed protocol on sample collection,
processing and transportation to lab
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Confirm site visit date(s)
Conduct site visit & feasibility test
Determine results
Summarizing results
Lessons learned
Vision of the FNHA
In partnership with BC First Nations
Communities the FNHA TBSAC program is
working towards the Vision of:
“Healthy, Self-determining and Vibrant BC First
Nations Children, Families and Communities.”
Acknowledgements
BCCDC- Zoonotic Lab
Yvonne Simpson
Muhammad Morshed
Quantine Wong
FNHA and TBSAC team
April MacNaugton
Dr. Isaac Sobol
Dr. Victoria Cook
Jane Lopez
Maggie Wong
Shawna Buchholz
Karen Beinhaker
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First Nations Communities
Healthcare Professionals
Community members
Community leaders
Thank You!
Contact Information
TBSAC Nurses:
• Nash Dhalla: (604)707-2695
[email protected]
• Karen Beinhaker: (604)7072732
[email protected]
• Shawna Buchholz: (250)8784928
[email protected]
FNHA Nurse:
• Jessica Harper: (604)693-6955
[email protected]
TBSAC Fax: (604)707-2690
TBSAC Toll Free:
1-888-569-2299
FNHA Health Protection
Toll Free:
1-844-364-2232
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Thank You!