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TB Contact Investigation Interviewing Skills Course

Day 2: Interviewing for TB Contact Investigation 508 Compliance

  • Interviewing for TB Contact Investigation (10 slides)
  • Interview Format (28 slides)
  • Interview Process (24 slides)
  • Problem Solving During the Interview (10 slides)

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Slide Number

508 Compliance Text


(Title Slide).Interviewing for TB Contact Investigation


Learning Objectives

After this session, participants will be able to:

Describe the objectives of the initial case interview

List the steps of the interview format

Describe ways to confront and solve problems that may arise during the interview


Difference Between STD Interview and TB Interview

STD Interview

Usually only 1 interview conducted

Rapport building not so much a priority

Only have to ask about one specific type of contact (sexual) so much less people you will need to follow up with

Transmission period specific

TB Interview

Multiple interviews required

Building rapport is key since you need to ensure patient returns to clinic…and you will have multiple opportunities to re-interview

Have to ask about multiple types of contacts (e.g., all sex partners, family, friends, co-workers, classmates)

Transmission period may be vague, and for a long period of time


What is the Main Goal of a TB Interview?

The main goal of a TB interview is to identify contacts.Why?

So you can assess them for TB disease and infection and get them on appropriate treatment.

[Image: Five stick figures.]


When Should the TB Interview Be Conducted?

Initial interview should be conducted

Within 1 business day of reporting for infectious cases

Within 3 business days for others

Second interview (re-interview) should be conducted 1 to 2 weeks later

Additional interviews may be needed to gather more information and to build trust


Where Should the Interview Take Place?

Interview should be conducted in person


TB clinic

Case's home or living space

Other location convenient for the case

At leastone interview should be conducted in the case’s home or living space

[Image: A health care worker interviewing a TB case in the case’s home.]


What are the Objectives of the Initial Interview?

Establish rapport

Educate the case about TB and the CI process

Verify and expand on information collected in the pre-interview phase


Places WHERE they spent time

Persons with WHOM they spent time

Participation in activities and events (WHAT and WHEN)


What are the Objectives of the Re-Interview?

Identify gaps in information

Identify additional contacts

Review/refine the infectious period

Continue to build trust and rapport

[Image: A health care worker shaking hands with a TB case.]


Effective Interviewer Musts

Build rapport

Maintain confidentiality

Arrange for privacy

Listen actively

Be objective and nonjudgmental

Be creative

Develop a style that works for you


The TB Interview: Video

[Image: A health care worker interviewing a TB case.]


(Title Slide). Interview Format


Interview Format



Information collection and confirmation

Contact identification

Conclusion of the interview


TB Interview Checklist

Refer to Appendix O

[Image: TB interview checklist.]


(Title Slide). Interview Format: Introduction


Interview Introduction (1)

The first interaction with the case can influence the remainder of the interview

Building trust and rapport early in the interview process is essential

[Image: A health care worker greeting a TB case at the case’s home. The case is holding her baby.]


Interview Introduction (2)

Introduce yourself and shake hands if appropriate

Provide a business card or other identification

Explain your role in the TB program

Ask the case how they are feeling

Demonstrate respect towards the case

[Image: A health care worker introducing herself to a TB case.]


Explain the Purpose of the Interview

Explain the purpose of the interview to the case

To identify contacts at risk of infection and refer them for medical assessment

To provide TB education


Discuss Confidentiality

Explain that information will only be shared with persons who need to know

Health care providers who provide direct care

Public health authorities for the purpose of TB control

Stress that confidentiality is reinforced by local program policies and state regulations


(Title Slide). Interview Format: Education.


Importance ofEducation

Increases knowledge of TB

Influences desired behavior

Identification of contacts

Treatment adherence

Infection control activities

Helps the case make informed decisions

[Image: A health care worker providing education to a TB case.]


What Education Should be Provided to the Case?

The case should be educated about the following:

Components of treatment and care plan

Infection control measures

Importance of maintaining medical care

Importance of the contact investigation


1. Treatment and Care Plan

Explain that medications kill TB germs when taken properly

Stress the importance of treatment adherence and follow-up medical care

Establish a specific schedule for treatment

[Image: A health care worker talking to a TB case.]


2. Infection Control Measures

Review the importance of the case using a mask or tissue to cover cough

In some situations, the interviewer may need to wear a respirator to protect themselves from inhaling TB germs/bacteria

Discuss the importance of ventilation

Describe other topics as appropriate

Home isolation

Visitors to the home

Return to work or school

[Image: A TB case wearing a face mask.]

[Image: A health care worker wearing a respirator.]


3. Importance of Maintaining Medical Care

Discuss the importance of:

Adhering to all medical appointments and directly observed therapy (DOT)

Sputum collection, chest x-rays, and medical evaluations

[Image: A health care worker providing DOT to a TB case.]


4. Importance of Contact Investigation

Stress the importance and urgency of identification of all contacts

Emphasize the role of the case in helping to protect family and friends from TB


What is Effective Education?

Listening carefully

Asking questions

Understanding the case’s needs and concerns

Demonstrating a caring attitude

Helping to solve problems

Clarifying misinformation


Tips for Providing Effective Education (1)

Use visuals

Visuals can complement verbal and written information




Real-life examples


[Image: A health care worker providing education to a TB case using a flipbook.]


Tips for Providing Effective Education (2)

Use culturally appropriate materials

[Image: A collage of culturally appropriate TB educational materials available from the CDC. There is a brochure specifically for TB contact investigations.]


Tips for Providing Effective Education (3)

Speak clearly and simply

Use simple non-medical terms

Use familiar words the case will understand

Simple: “These pills will help you get better”


Complex: “This drug, isoniazid, is a bactericidal agent that is highly active against Mycobacterium tuberculosis.”


Medical Terminology Exercise

Appendix P


The TB Interview: Video

[Image: A health care worker interviewing a TB case in an office.]


(Title Slide.) Interview Format: Information Collection and Confirmation


Information Collection and Confirmation

During the interview, information previously collected during the pre-interview phase should be reviewed and confirmed

Personal information

Medical information

Infectious period


Confirm Personal Information

Full name, aliases, and nicknames

Date of birth

Place of birth

If born in another country, date arrived in United States

Current address

Telephone number

Next of kin

Emergency contact information

Physical description

Other locating information

[Image: A clipboard with pen and paper.]


Confirm Medical Information (1)

Obtain and/or confirm:

Known exposure to TB (who, where, when)

Recent hospitalization for TB (name of hospital, admission date, discharge date)

Other medical conditions

HIV status

Substance use (frequency, type, how long)

Medical provider for TB (private or public clinic, name, telephone number, address)

DOT plan (where, when, by whom)

Any barriers to adherence


Confirm Medical Information (2)

Review the following symptoms, including onset dates and duration:


Coughing up blood


Unexplained weight loss

Night sweats

Chest pain

Loss of appetite




[Image: A woman with TB disease coughing into a tissue.]


Confirm Medical Information (3)

Discuss the case’s current diagnosis

TST or IGRA results

Site of disease

Symptom history

Radiographic and bacteriologic results

[Image: A health care worker interviewing a TB case.]


Review the Infectious Period

Refine the previously established infectious period based on a medical record review

Review the significance of the infectious period with the case and discuss its role in the contact identification


(Title Slide). Interview Process: Contact Identification


Contact Identification (1)

Contact identification is the most important part of the initial interview with the case

Get as much information as possible about contacts from the case during the interview

Talk to the case as if it is the last time you will see them


Contact Identification (2)

To help identify contacts, interviewers should collect and confirm information regarding:

Places WHERE they spent time

Persons with WHOM they spent time

Participation in activities and events (WHAT and WHEN)


Identify Places WHERE Case Spent Time (1)

Ask the case where they spent time during the infectious period


Work, school, or volunteer sites

Social, leisure, religious, or recreation sites

Sites where illicit activities might have occurred

Homeless shelters or jails

[A diagram split into three sections showing common locations where TB cases may spend time. These include locations of work/school, leisure/recreation, and household/residential.]


Identify Places WHERE the Case Spent Time (2)

After getting the list of places, ask the case about

Amount of time spent at each

Environmental characteristics

Number of rooms

Room size/square footage



Windows open or closed

HVAC systems

[Image: Cartoon image of a house.]


Identify Places WHERE the Case Spent Time (3) – Residence

Residence can include:



Congregate settings

Nursing home

Assisted living facilities


Correctional facility


[Image: Cartoon image of a house.]


Identify Places WHERE the Case Spent Time (4) – School

If attending school, collect information regarding:

Name of school, address, telephone number

Grade in school

Hours per day/week

Transportation type to and from school, length of commute

[Image: Students sitting on a staircase leading up to a high school.]

[Image: School buses.]


Identify Places WHERE the Case Spent Time (5) – Workplace

If employed, collect information regarding:

Employer name, address, telephone number

Full or part-time, hours worked per day/week

How long employed

Transportation type to and from work, length of commute

Occupation/type of work

Indoor or outdoor work space, enclosed or open work space

If unemployed

Source of income


Identify WHO the Case Spent Time With (1)

Ask the case who they spent time with during the infectious period, for example:

Wife, husband, or partner


Household members

Other family members





[Image: Stick figures.]


Identify WHO the Case Spent Time With (2)

Ask for names and aliases of contacts

Ask if contacts

Have TB symptoms

Have weakened immune systems

Are children younger than 5 years of age

[Image: Two women talking to each other.]


Identify WHEN and WHAT Activities or Events the Case Participated In (1)

Ask about activities duringinfectious period

Travel, vacations

Social events


Ask the case to review calendar or appointment book

Review cell phone logs and social networking sites (e.g., Facebook)

[Image: Cartoon image of an airplane.]

[Image: Cartoon image of a calendar.]


Identify WHEN and WHAT Activities or Events the Case Participated In (2)

Examples of social/recreational places and activities

Hangouts, bars, clubs

Team sports

Community centers

Bands, choir

Places of worship

Ask about the number of hours per day/week, and means of transportation

[Image: A glass of beer at a bar.]

[Image: Men playing basketball.]


What Information Should Be Collected About Contacts?


Relationship to the case

Address, telephone number, and other locating information

Hours of exposure per week and date of first and last exposure

Setting in which exposure took place

Age, sex, race, and physical description


Process for Collecting Contact Information (1)

Contact and place information can be gathered using the following format:




Exposure time

Setting size



Process for Collecting Contact Information (2)


Get a name and/or alias

Ask the case to list as many contact names as possible before moving on


Process for Collecting Contact Information (3)


Ask the case what their relationship is to the contact









Any other “mate”


Process for Collecting Contact Information (4)

Locating Information

Collect information on how to get in touch with the contact:

Address or map to home/living space

Phone number

Best time to contact

Email address


Process for Collecting Contact Information (5)

Exposure Time

Gather exposure information for each contact:

First and last time the case saw the contact

Frequency of interaction

Use significant dates (birthdays, holidays, etc.) to jog case’s memory


Process for Collecting Contact Information (6)

Setting Size

Determine the size of the setting in which exposure took place:

Size of a bedroom?

Size of a car/van?

Size of a house?


Process for Collecting Contact Information (7)


Obtain a detailed physical description for each contact


Hair color and length




Identifying features (e.g., tattoos, piercings)


Contact Identification Exercise

Refer to Appendix Q

[Image: A cartoon image of two people talking.]


(Title Slide.) Interview Process Conclusion of the Interview


Conclusion of the Interview (1)

Answer the case’s questions.

Review and reinforce all components of the adherence plan.

Evaluate the case’s remaining needs or potential adherence problems.

Confirm the date of the next medical appointment, if known.


Conclusion of the Interview (2)

Arrange for both a re-interview and home visit, if not already completed.

Confirm referral procedure of each contact.

Leave information on how the case can contact you.

If appropriate, shake the case’s hand, express appreciation, and close the interview.


(Title Slide.) Problem Solving During the Interview


Potential Interview Problems

The case:

Does not believe or trust the health care worker

Will not talk

Is distracted or not paying attention

Is hostile, abusive, or aggressive


Methods to Confront and Solve Problems

Provide Information

Direct Challenge


Withdrawal of Reinforcement


1. Provide Information

Use a factual statement to challenge what a case has told you.

For example:

If the case says: “I knew I shouldn’t have shaken my neighbor’s hand when he offered it.”

How would you confront this statement by providing information?


2. Direct Challenge

A direct challenge is confronting a statement that is false. Use when the case says something which can lead to greater problems if not addressed.

For example:

A case denies any contact with children. However, there are toys in the front yard and a picture of the case and a baby hanging on the wall.

How would you directly challenge this statement?


3. Self Involvement

Used to challenge information or commitments a case has made in interviewer’s presence.

For example:

A case states that they don’t have a phone number for a contact. When looking through their cell phone address book, with permission, you notice a number for that contact.

How would you use self-involvement to address this statement?


4. Withdrawal of Reinforcement

Designed to appeal to a case’s need for positive reinforcement: the interviewer expresses disappointment with the case’s present behavior and/or withdraws positive feedback previously given.

For example:

“You know, I thought you acted responsibly by coming into the clinic so quickly; however, by saying that you don’t care if your co-workers get examined for TB, that’s demonstrating little concern for their health.”


If You Continue to Have Challenges…

Recognize the need to stop and reschedule a stalled interview.

Assign another team member to conduct the interview at a later time if you are unable to gather necessary information.


The TB Interview: Video

[Image: A health care worker interviewing a TB case in an office.]



What are the objectives of the initial case interview?

What are the steps of a TB interview?

What are some ways in which to confront and solve problems that may arise during the interview?

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