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TB Contact Investigation Interviewing Skills Course

Day 4: Meeting with Contacts for TB Assessment 508 Compliance

  • Meeting with Contacts for TB Assessment (20 slides)

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Slide Number

508 Compliance Text

1

(Title Slide).  Meeting with Contacts for TB Assessment

 

2

Learning Objectives

After this session, participants will be able to:

1.     Explain why contact assessments are conducted

2.     Explain how contacts are referred for assessment

3.     Explain what information needs to be obtained from a TB contact

4.     Describe how to maintain confidentiality when meeting with contacts

 

3

Why Conduct a Contact Assessment?

 

1.     Determination of contacts’ TB symptoms

2.     Gathering of social and medical information

3.     Referral or in-person testing for TB infection with a TST or IGRA

4.     Provision of treatment as indicated

 

4

How Are Contacts Referred for an Assessment? (1)

       Health department referral

o   Health care worker informs the contact about exposure and the need for a medical evaluation

o   Case referral

o   Case agrees to inform the contact about exposure and the need for a medical evaluation

5

How Are Contacts Referred for an Assessment? (2)

       The case should be given a choice of whether to inform contacts about their exposure to TB prior to health department referral process

       Discuss referral options with case

6

When and How Should a Contact Assessment be Conducted?

       The initial contact assessment should be within 3 working days of the contact having been identified

       Should be conducted in-person

       The investigator should use effective communication skills

[Image: Health care worker greeting a contact at the contact’s house.]

7

How Do You Conduct the Contact Visit? (1)

Introduce yourself and explain purpose of visit

       Ask to speak to the contact

       Verify the contact’s identity

       Ask to speak in privacy

       Inform the contact that the purpose of the visit is to discuss a health matter

       Discuss the contact’s potential exposure to TB, but maintain the case’s confidentiality

8

How to Maintain the Case’s Confidentiality When Meeting with a Contact

       Do not reveal the case’s name

       Use gender neutral language

       Do not mention the name of the case’s health care worker, place and dates of diagnosis, or hospitalization

       Do not reveal specific dates or environment in which exposure occurred

       Confidentiality should not be violated even if the contact refuses to be evaluated

9

How to Maintain the Contact’s Confidentiality

       Inform the contact that medical evaluations may be shared with health care workers who have a “need to know”

       Assure the contact that their information will not be shared with family, friends, or others without consent

       Stress that confidentiality is reinforced by local and state policies, statutes, and/or regulations

10

How Do You Conduct the Contact Visit? (2)

       Provide education on TB

       Describe TB assessment process

o   Assess for TB symptoms

o   Administer TST/ IGRA or schedule an appointment

       Ask questions to gather social and medical information to assess the contact’s TB risk and further guide CI efforts

       Identify barriers to care and treatment

11

Educating the Contact about TB

       Explain

o   The difference between LTBI and TB disease

o   The progression from LTBI to TB disease

o   Testing for TB infection

      Initial test

      Possibility for follow-up test

       Stress the importance of taking LTBI treatment, if needed

12

Tips for Educating Contacts about TB

       Have culturally and language-specific education materials available

       Avoid using medical terms and recognize when to refer questions to appropriate personnel

13

Determination of Contacts’ Potential TB Symptoms

During the initial assessment, all contacts with symptoms of TB disease should be medically examined immediately

[Image: A physician and a TB contact reviewing a chest x-ray.]

14

Referral or In-Person Testing for TB Infection with a TST or IGRA

       Contacts should receive a TST or IGRA unless a previous, documented positive result exists

       A TST induration of 5 mm or larger is positive

       A contact with a

o   Positive TST or IGRA should  be medically examined for TB disease

o   Negative TST or IGRA should
be re-tested 8 to 10 weeks after date of last exposure (window period)

[Image: Induration being measured with a TST ruler.]

15

Obtaining Social and Medical Information

Key information to obtain from contacts:

       Current TB symptoms (if any) and onset dates

       Previous LTBI or TB (and related treatment)

       Previous TST or IGRA results

       HIV status

o   Offer HIV testing if status unknown

       Other medical conditions or treatments that increase TB risk

       Socio-demographic factors

16

Provision of Treatment

       The decision to test a contact should be considered a commitment to treat

       Contacts with a positive TST or IGRA should be offered LTBI treatment

o   Once TB disease is excluded

o   Regardless of whether they received BCG vaccine in the past

o   Unless there is a compelling reason not to treat

       Contacts with TB disease need to be treated under DOT

 

17

Reminder: Communication Tips

       Two-way communication is essential to ensure the contact

o   Understands the information

o   Appreciates the seriousness of the situation

       Be sure to

o   Use open-ended questions

o   Reinforce the contact’s understanding by asking him or her to explain your message

18

Meeting with a Contact: Demonstration by Facilitators

[Image: Two facilitators demonstrating how to conduct an interview for a TB contact investigation.]

19

Meeting with a Contact Exercise

Refer to Appendix U

[Image: Cartoon image of two people talking.]

20

Review

1.     Why are contact assessments conducted?

2.     How are contacts referred for assessment?

3.     What information needs to be obtained from a TB contact?

4.     How can confidentiality be maintained when meeting with contacts?

 
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  • Contact CDC–INFO
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