Integrating Latent TB Infection Services into Primary Care in Massachusetts

March 19th, 2021 | Viewpoint

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In early 2020, our Technical Assistance for Service Integration (TA4SI) project was in the middle of working with infectious disease providers across Massachusetts to integrate tuberculosis (TB) infection services as part of their agencies’ offered services, rather than referring clients to other facilities. Since approximately 80% of cases of TB disease in the U.S. occur in people who have had latent TB infection, providing convenient testing and treatment services for clients is essential to prevent TB disease.

As the pandemic began to hit the northeastern U.S., these same community providers had to turn their attention to the COVID-19 crisis. We reviewed the situation closely with our client, the Massachusetts Department of Public Health (MDPH) Bureau of Infectious Disease and Laboratory Sciences, and revised our approach. Despite the crisis, our team was determined to maintain its commitment to helping providers implement high-quality services for existing infectious diseases—particularly HIV, viral hepatitis, sexually transmitted infections, and TB. 

In 2019, the estimated number of people living with latent TB infection in Massachusetts was 261,000–381,000. The incidence of TB differs across communities:

  • 35.7 times higher among Asian residents (95% CI 23.1–55.2) than white residents
  • 14.1 times higher among Black residents (95% CI 8.5–23.24) than white residents
  • 5.0 times higher among Hispanic residents (95% CI 2.8–8.7) than white residents

2019 data showed that 84% of TB disease cases in Massachusetts occurred in people born outside the U.S.

JSI’s TA4SI team adjusted quickly. Leveraging our relationships and collective expertise, JSI and DPH colleagues mapped the service delivery components required for patient TB diagnosis and care, including interventions for risk assessment, testing, evaluation, treatment, adherence support, and reporting and analysis. 

In late 2020, TA4SI released a series of 10 fact sheets based on the Components for Testing and Treatment of Individuals with Latent Tuberculosis Infection graphic (below), along with a resource inventory for use by clinical and non-clinical providers. These resources focus on each component in the cascade of care for latent TB infection and support activities such as process mapping and billing. 

Figure 1. The Components for Testing and Treatment of Individuals with Latent Tuberculosis (TB) Infection graphic designed by TA4SI and MDPH to guide agencies scaling up latent TB infection services

Figure 1. The Components for Testing and Treatment of Individuals with Latent Tuberculosis (TB) Infection graphic designed by TA4SI and MDPH to guide agencies scaling up latent TB infection services

Figure 2: Screenshot of the Fact Sheet on Component A: Risk Assessment to provide clinical and non-clinical staff an overview of how to identify individuals at increased risk of TB infection

Figure 2: Screenshot of the Fact Sheet on Component A: Risk Assessment to provide clinical and non-clinical staff an overview of how to identify individuals at increased risk of TB infection

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