Tuberculosis
Clinic
Department of Public Health
Faduma Shegow
RN, MSN (PH), M.Ed.
Clinical Services Manager
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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38
40
42
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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????