Program Evaluation Success Stories from TB Programs

Strategies toward Meeting National Objectives for Completion of Treatment for Contacts to Sputum AFB Smear-Positive Tuberculosis Cases

KY TB Program Staff presenting at the 2019 National TB Controller Association Annual Conference in Atlanta, GA.

KY TB Program Staff presenting at the 2019 National TB Controller Association Annual Conference in Atlanta, GA.

Each year the Kentucky Department for Public Health Tuberculosis Prevention and Control Program (KTP) evaluates progress towards achieving the national TB objective: “For contacts to sputum AFB smear-positive TB cases, who have started treatment for latent tuberculosis infection (LTBI), increase the proportion who complete treatment to 81% by 2020.”

In 2015, the KTP identified that only 54% of contacts completed LTBI therapy.  KTP conducted an evaluation specifically focused on the impact of activities currently being used by local staff to promote completion of therapy. We found that frequent staff turnover resulted in patients who moved outside of their jurisdiction often being “lost to follow-up.” New staff did not realize the need to timely coordinate care so that staff in new jurisdictions could actively engage contacts.

Upon reflection of our evaluation efforts, we identified the following facilitators and lessons learned for successful program evaluation:

  • Establish small realistic yearly state benchmarks for each objective to motivate staff and show steady achievement
  • Enhance biannual trainings for newly hired local staff to stress the importance of timely submission of interjurisdictional notifications to assure coordination of care for patients who relocate
  • Promote use of state and local incentives and enablers by highlighting information in biannual newsletters and disseminating request forms to all local clinics
  • Revise data collection tools for local staff to use to assure data is accurate; and assess if annual evaluation activities are valid, realistic, and practical

In 2018, the KTP dedicated its efforts to expanding surveillance expertise by engaging a full-time epidemiologist who could focus time and effort on the evaluation of barriers towards contacts completing therapy. Kentucky has been classified as having a medium-incidence for reporting active tuberculosis cases; therefore, gaining a dedicated epidemiologist would enhance current surveillance activities.

As a result of each of these efforts, Kentucky showed remarkable improvement towards meeting its own benchmarks (71% in 2016, and  74% in 2017) for completion of treatment among contacts to sputum smear-positive TB patients. Finally, in 2018, Kentucky met the 2020 national indicator with an 81% completion rate. Preliminary 2019 data predict that Kentucky will once again meet the 2020 national goal. Ongoing evaluation strategies and activities will assure that timely assessment, use of incentives and enablers to engage patients, and enhancing nurse-patient relationships will promote completion of therapy and effectively assure prevention of active TB disease.

Published in TB Notes, No. 4, 2020

Submitted by:
KY Tuberculosis Prevention and Control Program
Emily Anderson RN, BSN; Charles H. Rhea MPH; and Maria Lasley RN, BSN, MA, MBA