Tuberculosis

Clinic

Department of Public Health

Faduma Shegow

RN, MSN (PH), M.Ed.

Clinical Services Manager

ShegowFA@elpasotexas.gov

915-212-6609

Tuberculosis Clinic Location

5115 El Paso Drive, Suite B, Door 3

El Paso, Texas 79905

Telephone

(915) 212-0200 option 4

Or direct (915) 212-6609

Hours of Operation

Monday - Thursday: 7:00 am to 6:00 pm

❑ Evaluations are by appointment only. Walk ins are accepted for PPD testing and for treatment with last patient seen no later than 4:30 unless prior arrangement are made with staff.

(Clinic closed for lunch from 12 to 1 pm)

Mission

To control the spread of Tuberculosis (TB) in El Paso

and El Paso County by prompt identification and

appropriate treatment of persons infected with TB and

identification and treatment of persons or groups at

highest risk of progressing from latent TB to active

disease and spreading disease.

Objectives

Identify the prevalence and TB Testing

methods

Present TB treatment options

Discuss the role of APRNs in diagnosing and

monitoring TB

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What is TB?

A germ that is spread through the air

Damages lungs

Can harm other parts of the body

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History of TB

Mentioned in the Bible

Found in Mummies

Can be found worldwide

No cure until 1946

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How TB Is SpreadGerms spread when someone who

has active TB Coughs

Sneezes

Laughs

Sings

Talks

How TB is Not Spread

From sharing food, forks, plates, or glasses

Bathrooms or showers

Clothes or blankets

Handshakes

From surfaces

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Symptoms for TB Disease Cough (lasting more than 2 weeks)

Weight loss

Night sweats

Chest pain

Fever

Hemoptysis

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Symptoms of TB Infection

None

You can be infected and not develop the

disease

10% of those infected will develop the

disease

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TB Infection vs. TB Disease

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TB Germs are not active

No symptoms Does not feel sick Chest x-ray normal Needs medication to

treat infection

TB Germs are active

Shows symptoms

Feels sick

Chest x-ray abnormal

Needs medication to treat disease

Who’s At Risk For TB Infection?

Recent contact to someone with Active TB

People with immunocompromised system i.e. HIV infection

Employees of hospitals, nursing homes, prisons, homeless shelters

People from a country

where TB is common

Drug/Alcohol addicts

Children < 5 yrs old

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From Infection to Disease

Easier for infection to become disease if:

Individuals have other health problems

like diabetes, cancer, HIV, are

immunosuppressed

Abuse alcohol or inject illegal drugs

Infection occurred in the last 2 years

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Getting Tested for TB A skin test shows if there is TB Infection

The test is usually done on the arm

An injection underneath the skin

A blood draw for IGRA test- TSPOT/QFT Gold

How to Tell if the Test is PositiveSkin test should be checked in 2 days

When positive, a bump will grow on the skin

The bump is at least 5mm in size

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If the Test is Positive

Usually means infected with the TB germ

Patient will need a chest x-ray

Need to determine if the patient has the

active disease through a Chest X ray

and/or Sputum

Patient may need medication

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If the Test is Negative

Arm will look smooth

No bump appears where injected

Usually means there was no TB infection

May need a follow up test

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TB Test ActivityUsing the TB test arm models:

Use the TB rulers to measure bump

size

A positive test could be as small as

5mm

Negative tests do not have a bump

Redness alone is not a positive test

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TB Can be Cured

If the patient has the TB Infection

Patients will be given one medication

Medication will prevent conversion of the

TB Disease

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TB Can Be Cured

If the patient has TB Disease

Patient will receive with four medications

Medications are taken for six to nine

months

Needs to be careful not to infect others

Health Department will help patient with

the treatment

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What should I do if I have TB?

Follow up with your doctor

Take your medicines

Stay home as long as your doctor says

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TB Can be Cured

Treatment is readily available to everyone

Get the facts

Follow your treatment plan

Protect yourself and those around you

Spread the word, not the disease

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How is TB spread across the

border?• Screening is not done at port of entries

• Patients who are sick sometimes seek treatment in

El Paso

• Self medication/treatment from across the border

increases the risk of Resistant TB

• Mexico does not have same resources for

preventive treatment/screening

• El Paso and the State of Texas connects to four

other states

Services

❑ Testing

❑ Treatment

❑ Education

❑ Referrals

❑ Investigation- Finding contacts

❑ Collaborate with other facilities to include all

local hospitals, local jails, other clinics and

physicians, nursing homes, assisted living

facilities, homeless shelters etc…to develop TB

policies/protocols and provide guidance for

treatment.

Testing

❑ Clinical History

❑ Quantiferon/ TSPOT Testing- Diagnostic

evaluation tool primarily used. It is 1 of the 2

different types of IGRA tests. (monospot/QF

Gold) Can be used for latent TB and active

TB in individuals 5 years old and above. If a

patient is immunosuppressed this test may

not work. Advantage: test results not

affected by BCG administration.

❑ PPD testing- used for children under 5 and

other issues (draw).

❑ Chest X Ray- referral

❑ Sputum cultures- determines resistance

Treatment

We offer 12 week treatment for those who meet CDC protocol for Latent TB. This is a fast track treatment and the latest regimen for combating latent TB. The medications used to treat latent TB infection include:

isoniazid (INH)

rifampin (RIF)

rifapentine (RPT)

Active TB treatment is based on susceptibility of organisms and sensitivity:

➢ RIPE protocol (see next slide)

➢ 2nd line drugs if resistant:

Cycloserine

p-Aminosalicylic acid

Ethionamide

Capreomycin

Levofloxacin

➢ Treatment can be 6 months-2 years

➢ Usually oral daily doses until initial phase, continuation phase 2-3 x a week. ??????

➢ DOT workers administer the medications to all active patients.

CDC Algorithm

How does El Paso DPH help combat

TB?• Outreach screening to high risk areas- homeless shelters,

jails

• Work closely with hospitals, jails and schools to develop

policies and procedures for screening including development of screening tools

• Collaborate with State, Region, Fort Bliss, New Mexico DPH

and Juntos

• Provide and encourage treatment for patients with latent

tuberculosis

• Provide free treatment for active and latent tuberculosis

Staff

❑ 1- Nurse Supervisor

❑ 1- Surveillance Specialist

❑ 4- Registered Nurses

❑ 2- Clinical Assistants

❑ 2- Contact Investigators

❑ 3- Public Health Technicians

❑ 3- Direct Observed Therapy/Medical Assistants

Fees

❑ Most insurances accepted including

Medicaid and Medicare

❑ Evaluation and testing fees follow income-

based sliding scale set by Federal Poverty

Guidelines (Note: The fee charged to clients

who do not provide proof of income and/or are

uninsured is $159.00 for evaluation)

❑ Proof of Income (required as of June 20, 2011)

❑ Employer paycheck stub

❑ Copy of prior year income tax return

Limitations

Funding- does not cover expenses (food, housing, clothing etc.)

Limited staff- No FT MD or Social Worker

Active program instead of preventive

Cannot force screening or treatment for preventive measures or contacts

Screening is not mandatory for schools, and most facilities

Misreading of PPDs/X-rays

Legal issues: taking rights of a patient away vs. public health protection

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Year: 2015 Year: 2016 Year: 2017

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43

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Number of TB Cases by Year -El Paso County

Source: Department of Public Health TB Clinic

0

50

100

150

200

250

300

350

Year: 2015 Year: 2016 Year: 2017

250

350

289

Number of TB Suspects by Year -El Paso County

Source: Department of Public Health TB Clinic

Source: Centers for Disease Control and

Prevention, Surveillance Slide Set, 2017;

https://www.cdc.gov/tb/statistics/reports/

2017/default.htm

Source: Centers for Disease Control and Prevention, Surveillance Slide Set,

2017; https://www.cdc.gov/tb/statistics/reports/2017/default.htm

Source: Centers for Disease Control and

Prevention, Surveillance Slide Set, 2017;

https://www.cdc.gov/tb/statistics/report

s/2017/default.htm

Source: Centers for Disease Control and Prevention, Surveillance Slide Set,

2017; https://www.cdc.gov/tb/statistics/reports/2017/default.htm

APRN/PROVIDERS RoleOnce you have a confirmed Active or

Suspect TB patient:

1. Report the findings to the

Department of Public Health TB Clinic

915-212-0172 secure fax

2. Refer the patient to the TB Clinic

915-212-6609 for an appointment

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Questions????