Epidemiologic Studies Epidemiologic Studies Consortium ResearchConsortium Research

CTCA meeting October 22, 2010CTCA meeting October 22, 2010Lisa Pascopella, PhD, MPHLisa Pascopella, PhD, MPH

California Department of Health California Department of Health ServicesServices

Studies launched in past yearStudies launched in past year

Tuberculosis mortality in the United States: Tuberculosis mortality in the United States: Epidemiology and prevention opportunitiesEpidemiology and prevention opportunities

Treatment practices, outcomes and cost of Treatment practices, outcomes and cost of multidrug-resistant and extensively drug multidrug-resistant and extensively drug resistant TB in the United Statesresistant TB in the United States

Improving testing for TB and LTBI for persons Improving testing for TB and LTBI for persons with HIV infection at Health Resources and with HIV infection at Health Resources and Services Administration Part C-funded HIV Services Administration Part C-funded HIV clinicsclinics

Mortality study- Research Mortality study- Research questionsquestions

How frequent are TB-How frequent are TB-related deaths? related deaths?

What are the risk What are the risk factors?factors?

What is the proportion What is the proportion of TB-related deaths of TB-related deaths that were that were preventable? preventable?

9.49.28.37.98.68.78.5

9.49.49.8

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Can we avert future TB-related deaths?Can we avert future TB-related deaths?

Mortality study- MethodsMortality study- Methods

Population: Population: – TB cases 2005-2006 TB cases 2005-2006 – from LHJs reporting at least 8 deathsfrom LHJs reporting at least 8 deaths

Data collection:Data collection:– Retrospective chart reviewRetrospective chart review

Complete medical record, including hospital Complete medical record, including hospital recordsrecords

Mortality study- Anticipated outcomesMortality study- Anticipated outcomes

Improve understanding of causes of TB Improve understanding of causes of TB deathsdeaths

Create evidence basis for public health Create evidence basis for public health interventions aimed at reducing TB deaths interventions aimed at reducing TB deaths in U.S.in U.S.

Apply and refine a systematic TB death Apply and refine a systematic TB death assessment tool that could be used assessment tool that could be used routinely in the U.S.routinely in the U.S.

Mortality study: Preliminary CA Mortality study: Preliminary CA resultsresults

448 deaths with TB448 deaths with TB

277 records reviewed277 records reviewed

155 data abstractions completed155 data abstractions completed

53 reviewed by clinician53 reviewed by clinician

43 (81%) TB-related deaths43 (81%) TB-related deaths

MDR TB outcomes/cost study- MDR TB outcomes/cost study- Research questionsResearch questions

What are the current What are the current diagnosis, treatment and diagnosis, treatment and management practices for management practices for MDR/XDR TB patients?MDR/XDR TB patients?What are MDR/XDR TB What are MDR/XDR TB patient outcomes?patient outcomes?– What factors predict What factors predict

favorable/unfavorable favorable/unfavorable outcomes?outcomes?

What are the costs associated What are the costs associated with MDR/XDR TB in the U.S.?with MDR/XDR TB in the U.S.?

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MDR TB outcomes/cost study - MDR TB outcomes/cost study - MethodsMethods

Population: Population: – MDR/XDR TB patients 2005-2007MDR/XDR TB patients 2005-2007– LHJs reporting at least one MDR or XDR TB LHJs reporting at least one MDR or XDR TB

casecase

Data collection:Data collection:– Retrospective chart reviewRetrospective chart review

Complete medical record, including hospital billing Complete medical record, including hospital billing recordsrecords

MDR cost study- Anticipated outcomesMDR cost study- Anticipated outcomes

Study findings will inform:Study findings will inform:

Optimal MDR/XDR TB diagnosis Optimal MDR/XDR TB diagnosis proceduresprocedures

Future clinical trials of MDR/XDR TB Future clinical trials of MDR/XDR TB patient treatment regimenspatient treatment regimens

Improved case management Improved case management

Financial planning for TB program budgetsFinancial planning for TB program budgets

TB testing in HIV clinics study- TB testing in HIV clinics study- Research questionsResearch questions

How are TB services provided, How are TB services provided, relative to national guidelines, relative to national guidelines, at Health Resources and at Health Resources and Services Administration Services Administration (HRSA) Part C-funded HIV (HRSA) Part C-funded HIV clinics?clinics?What program elements What program elements encourage or serve as barriers encourage or serve as barriers to adherence to national to adherence to national guidelines?guidelines?What are the costs of TB What are the costs of TB testing and LTBI treatment at testing and LTBI treatment at selected HIV clinics?selected HIV clinics?

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TB testing in HIV clinics study- TB testing in HIV clinics study- MethodsMethods

Population: Population: – Four HRSA Part C-funded HIV clinics Four HRSA Part C-funded HIV clinics

Los Angeles (n=2)Los Angeles (n=2)New York (n=2)New York (n=2)

– Patients served by 4 clinics in 2009Patients served by 4 clinics in 2009

Data collection:Data collection:– Structured observation of HIV clinic servicesStructured observation of HIV clinic services– Key informant interviews of HIV clinic staff and TB Key informant interviews of HIV clinic staff and TB

program staffprogram staff– Retrospective chart review at HIV clinicsRetrospective chart review at HIV clinics– Policy abstractionPolicy abstraction

TB testing in HIV clinics study- TB testing in HIV clinics study- Anticipated outcomesAnticipated outcomes

Dissemination of findings through HRSA’s Dissemination of findings through HRSA’s AIDS Education and Training Centers, and AIDS Education and Training Centers, and CDC’s RTMCCsCDC’s RTMCCs

Improved TB services provision within Improved TB services provision within HRSA Part C-funded HIV clinicsHRSA Part C-funded HIV clinics

Improved collaboration between HRSA Improved collaboration between HRSA Part C-funded HIV clinics and TB care Part C-funded HIV clinics and TB care providersproviders

Study status: Full implementationStudy status: Full implementation

Mortality studyMortality study– Research Assistants abstracting complete Research Assistants abstracting complete

medical records of TB deathsmedical records of TB deaths

MDR TB outcomes/cost studyMDR TB outcomes/cost study– Research Assistants abstracting MDR/XDR Research Assistants abstracting MDR/XDR

TB patient chartsTB patient charts

TB testing in HIV clinics studyTB testing in HIV clinics study– Research Assistant observing TB service Research Assistant observing TB service

provision operationsprovision operations

Next stepsNext steps

Continued data abstractionContinued data abstraction

Analysis and interpretationAnalysis and interpretation

Share findings with participating health Share findings with participating health departmentsdepartments

National dissemination of findingsNational dissemination of findings

Thank you!Thank you!