Tuberculosis Elimination Program Services
Reported cases of tuberculosis are tracked through the State TB Registry. The TB Elimination Program analyzes all diagnostic results, clinical management information, and contact investigation reports. Through program surveillance reports, we continue to update all Infection Control Practitioners, Physicians and other Health Care Providers, and Policy Makers, about current TB morbidity trends in their community and throughout the state.
Direct Care of Patients with Tuberculosis:
The Division of Public Health supports three specialty tuberculosis clinics in Delaware. One clinic is in New Castle County, one is in Kent, and one is in Sussex. These clinics are staffed by Public Health Nurses (PHN’s) who specialize in tuberculosis, and by Pulmonary Consultant Physicians. The clinics provide direct medical care and follow-up to patients with latent TB infection and TB disease. All screening activities, contact investigations and case management services are provided through the clinics.
Public Health Nurse Case Management, including Directly Observed Therapy and Contact Investigations:
Public Health Nurse Case Management is employed to ensure that all TB patients in the state receive comprehensive assessment and monitoring throughout their treatment. The goal of this case management service is that all persons with active tuberculosis are identified and complete appropriate therapy without interruptions, and that transmission of M.tb is prevented. These PHN’s serve as the first line of tuberculosis infection control consultants to the community, especially in congregate/institutional settings. They receive TB case/suspect reports and follow through to conduct an initial assessment of the patient, as well as the patient’s home/community. If the patient is being treated by his/her Primary Care Provider, the PHN will review pertinent diagnostic and treatment information, and work together with patient and physician to provide all necessary services. It is extremely important for the PHN to be involved with the patient from the beginning so that appropriate isolation issues are addressed, a thorough contact investigation can be initiated, and the patient and family can receive education and support through the duration of treatment.
Directly Observed Therapy (DOT):
Directly Observed Therapy includes a wide range of services, in addition to the observation of the patient’s ingestion of all doses of TB drugs. DOT is the Standard of Care for patients with tuberculosis in Delaware. It is most important that any patient with drug resistant disease, HIV/AIDS, previous treatment failure, and children, are put on DOT. DOT is an intervention of proven improved treatment outcomes for these groups. We rely on physicians and nurses to discuss and promote this mode of therapy with their clients. For fully drug-susceptible TB, treatment given two or three times per week (after 2-3 weeks of daily treatment), by DOT, is as effective as daily treatment, until cure. This schedule makes adherence easier for the patient; and may also reduce drug side effects, since the patient receives the same benefit from a smaller amount of medication. The physician’s endorsement of DOT greatly influences the patient’s acceptance.
The Division of Public Health provides all anti-tuberculosis medications free of charge to Delaware residents. This service applies to treatment for latent TB infection as well as treatment of active TB. If the client continues to see their private physician while we provide this pharmacy service, we require that clients be seen and evaluated monthly with a face-to-face visit. This monitoring is in accordance with American Thoracic Society and Centers for Disease Control recommendations and the Standard of Care for treatment of latent TB infection or TB disease. During the course of treatment the Public Health Nurse will need to ensure that monitoring is conducted according to these standards, as part of the pharmacy agreement with physician and client.
The Delaware Public Health Laboratory (DPHL) provides state-of-the-art technology for the isolation and rapid identification of Mycobacterium tuberculosis , and drug susceptibility testing. These services are free of charge and courier services are available.
Educational Resources and Clinical Consultation:
The TB Elimination Program maintains a library of educational materials for clinicians and clients. Resources include all guidelines and recommendations for diagnosing and treating tuberculosis, and other clinical publications and journals related to TB. Literature pertaining to specific complications of diagnosis and treatment, and other clinical issues is also available. All of our clinics, as well as the program office have client videos and literature available in several languages.
We welcome the opportunity to provide educational programs on tuberculosis to the medical community whenever possible. If a provider should need to have a clinical consultation with a particular expert in the field of tuberculosis, we would be happy to refer you to the appropriate individual. If you should need to request in-services for staff who are caring for patients with tuberculosis we would be happy to provide this training. Public Health Nurses who specialize in tuberculosis are available to provide support and training to hospital nursing staff and Visiting Nurses at any time. These services are intended to provide support to health care providers in ensuring appropriate infection control standards, as well as ensuring proper protocols for monitoring adverse effects or relieving symptoms related to anti-tuberculosis medications.
It is the role of the local Division of Public Health TB Clinic and the TB Elimination Program to ensure that clinical Standards of Care are met and that American Thoracic Society and Centers for Disease Control Guidelines are adhered to when treating patients with TB. These include close monitoring of patients (monthly), collecting bacteriologic specimens, appropriate medication regimens, etc. When health care providers are unable to adhere to these standards, we request that they refer the patient to a Division of Public Health TB Clinic for specialized care.