TB Nurse Network Meeting Updates and Program Information
The TB Nurse Network Meeting on January 17, 2024, will cover various topics such as training opportunities, recent publications, new resources, and program updates. Presenters include Kathryn Morehouse and Shona Smith Rodriguez. The meeting will also address TB year-end data closeout timelines and the process of sending prior year count lists to CDC. Participants are reminded to keep themselves muted and can join via call-in option if needed.
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TB Nurse Network Meeting January 17, 2024 Call in Option Dial: 1-248-509-0316 Conference ID: 267 661 74#
Please keep yourself muted and camera off unless presenting or asking a question. Our team will be muting people as needed. If you are having problems with audio, you can utilize the call- in option and that information is listed in the Teams invite. Put any questions in the chat or raise your hand during the designated Q&A time and we will call on you. Meeting Basics This meeting is being recorded. Links to recordings and slides will be posted on our TBNN webpage. Do not mention any patient names or identifiable information when discussing cases or asking and answering questions.
Updates Training Opportunities Recent Publications New Resources Available Agenda Translated Materials Case Presentation: TB Nurse Case Management of an HIV+ Patient Open Forum
Program Updates TB seminar invites now being sent on GovDelivery Next Seminar this Friday, January 19th TB Nurse Network survey TB Team Member Name Updates Kathryn Morehouse Shona Smith Rodriguez Website Updates TST workshop website being moved to be part of regular TB website Tips and tricks document about the online portion of TB testing workshop is in progress Michigan TB cases and rates for 2023 will be posted to our website as soon as they are available Case numbers and rates for previous calendar year are always updated by the first Monday in February. Please don t inquire about them before this time and defer to the most recent data posted. They will be posted on our webpage here when they are ready. You can also view data from previous years.
TB Year-End Data Closeout Timeline Shona Smith Rodriguez, MPH MDHHS Tuberculosis Epidemiologist
January First two weeks Send prior year count lists and missing data from CDC missing/unknown report Differentiate between late-January (World TB Day MMWR publication, 03/24/24) and mid-March (Reported TB in the United States, 2023) deadlines Review and transmit data updates as the are received 1/19 Final check-in for new cases from all LHDs 1/24 Internal deadline for 2023 case counts and first round of missing data Friday 1/26 Preliminary 2023 case counts and case list to CDC with any updates to prior year counts and lists New cases and data updates messaged from MDSS to CDC
February Monday 2/5 State and county case counts and rates published to Michigan.gov/tb Early February Prep materials for Aggregate Report for TB Program Evaluation (ARPE) that report on contact investigations for prior two years Late February Send ARPE materials to LHDs with any TB cases counted in 2022 or 2023 Prep final March data reminders for 2021-2023 cases Finish all linking in CDC genotyping database
March First week Final missing/unknown data reminders for 2021-2023 cases Begin initial data analysis for World TB Day materials Second week Queue full year data sends for 2020-2023 cases to make sure all updates arrive to CDC Update analysis for World TB Day materials ARPE submission reminders 3/15 Internal deadline for final 2023 case report data Third week - Final World TB Day material prep 3/21 Final data for CDC 2023 annual surveillance report queued to CDC with outcomes for 2021 cases and MDR supplemental forms 3/22 2023 Data Summary at Michigan World TB Day Conference 3/24 World TB Day MMWR article is published 3/25 Final ARPE submission reminders 3/29 Submit 2022 and 2023 ARPEs
April through October These dates are highly subject to change April First round of 2020-2023 data corrections May/June Second round of 2020-2023 data corrections Sometime July October CDC annual surveillance report published online as Reported Tuberculosis in the United States, 2023
Thank you! Shona Smith Rodriguez, MPH MDHHS Tuberculosis Epidemiologist smiths79@michigan.gov
World TB Day 2024 Registration currently planned to open on 01/22. More information and the link will be sent out at that time. There will be a wait list if all the spots are filled Topics will include: Pediatric TB TB Epidemiology Legal Issues in TB Isolation Please email MDHHS-TB@michigan.gov with any questions
TB Training Opportunities Rutgers Global TB Institute TB Grand Rounds 02/02, 12-1 pm, Zoonotic TB Series Part I 02/23, 12-1 pm, Zoonotic TB Series Part II 2024 National Tuberculosis Conference April 16-19, 2024, in Baltimore, Maryland Hosted by The Union North America Region and NTCA Stay tuned for more information Co-Occurring Conditions Self-Study Module from National HIV Curriculum Lesson 1 is on Latent TB Infection LTBI for Nurses 3-week Blended Course Spring, dates and registration TBD TB Diagnosis and Treatment 5-week Blended Course Summer, dates and registration TBD Understanding the IGRA: What You Need to Know Webinar from Heartland on March 7th Registration not yet open HIV and TB: A Tale of 2 Epidemics Online CME Course Recording of webinar from Mayo held in Dec
Training Opportunities Related Topics Newcomer Health ECHO Series 2024 Last Tuesday of the month from January 30, 2024 December 3, 2024 Registration is ongoing and you can pick which sessions to attend EPIC, CareRef, and More: Optimizing Clinical Decision Support Tools Webinar from Minnesota Center of Excellence in Newcomer Health on 02/08 Ending the HIV Epidemic: Pillars in Practice Webinar Series First session is on Tuesday, January 23rd from 12-1 pm and is focused on diagnosing all people with HIV as early as possible Organized by New England AIDS Education and Training Center Hansen s Disease (Leprosy) Today: Ending Stigma, Embracing Dignity Live webinar on January 24th at 1 pm. Held by National TB Nurse Coalition and TB COEs. Complete the registration questions and knowledge check before clicking register. 24th Annual Michigan Communicable Disease Conference Save the Date April 29, 2024, at Crowne Plaza in Lansing Elevating Special Populations: Culturally Appropriate HIV Care in Native Communities Webinar TOMORROW, January 18th, 12-1 pm EST
Navigating Mental Health and TB: Soft Landing Please! Recording of webinar hosted by Curry TB Center 11/09/23 Bridges to Build: TB in the Asian & Asian American Community 2023 TB Elimination Alliance Summit Held November 8-9, recordings are available for both days Archived Trainings TB 101 Series Hosted by Rutgers from June-September 2023 All session recordings and resources are posted International Workshop on Clinical Pharmacology of TB Drugs TB Seminar Recordings Seminars recorded and posted to MDHHS TB website Recordings now available for 09/15, 10/20, 11/17, and 12/15/23
Recent Publications WHO s Global TB Report 2023 Published November 2023, to look at the stats from 2022 Fact sheet summary also available Second Nationwide Tuberculosis Outbreak Caused by Bone Allografts Containing Live Cells United States, 2023 Published January 5, 2024, by CDC Outbreak found to have affected 36 recipients CDC notes a second outbreak underscores the urgent need to implement improved donor screening and culture-based testing Tobacco Smoke and Tuberculosis Harvard Magazine article from 12/06/23 Harvard researchers found that tobacco smoke recruits specific immune cells to lungs that allow TB bacteria to proliferate Anti-inflammatory drugs dexamethasone and SP600125 could be used to inhibit TB growth in the lungs
New Resources TB and Autoimmune Illness Handout Resource that contains info on TB for people with autoimmune illnesses, specifically those on or about to start biologic disease- modifying antirheumatic drugs (bDMARDs). Developed by Dr. Morse and added to MDHHS website with permission. Translated versions to be posted soon. TB Medication Tips for Children Resource with tips on how to give TB meds to children. Developed by Dr. Morse and posted to MDHHS website. Translated versions available in Spanish and Vietnamese.
New Resources New version of What You Need to Know about Tuberculosis (right) Available in English, Spanish, and Ukrainian What You Need to Know About the TB Skin Test Translated versions now available in Vietnamese and Tagalog Updated version of Tuberculosis Infection Control: A Practical Manual for Preventing TB Available from Curry TB Center Expanded chapters, added December 2023
Many new translated materials available on the Multilingual Resources webpage Includes MDHHS resources like the risk assessments, as well as materials from CDC and other organizations Resources available in Bengali, Burmese, Dari, Pashto, Arabic, French, Hindi, Kinyarwanda, Nepali, Swahili, Vietnamese, Spanish, Haitian Creole, Ukrainian Translated Materials Not all resources available in every language above
Finding Translated Patient Materials Many recent questions on finding translated patient materials Check MDHHS website includes translated materials and links to other sources Find TB Resources: site from CDC with collection of TB-related materials Under Additional Search Options , you can filter by language (shown right). You can also select a topic or use keywords to find specific materials in that language. Not just CDC materials, many organizations have submitted their materials to this site. Southeastern National TB Center Products page: SNTC has many translated materials available, including CDC materials like the LTBI patient fact sheets. Type the language you are looking for into the filter bar at top of page CDC Patient & General Public Materials Some CDC materials available in additional languages on their website. Oregon Health Authority has many of their patient fact sheets available in multiple languages You can use the filter function to look for a specific language If you need help or cannot find resources available in a specific language, please email berlinc@michigan.gov.
TB and HIV Case Presentation SABRINA GAPPY, BSN, RN TB CASE MANAGER OAKLAND COUNTY HEALTH DIVISION
TB in Oakland County o Approximately 22 cases per year OC TB Cases per Year 2013 OC TB Cases per Year 2013 - - 2022 2022 o 2 full time TB Case Managers 30 o 1 full time LTBI Case Manager 25 o Opt Out Policy for HIV testing 20 # of Cases Tell the client what tests we are doing including HIV and client has to refuse test 15 10 o 2013 2023 = 7 TB cases also HIV positive 5 0 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Year
John Doe JD o Received a call from HF hospital on 2/24/2023 o 30-year-old male o Suspect for TB o Wondering they could take him out of isolation for a procedure o Symptoms: unintentional 50 lbs. weight loss, loss of appetite, abdominal pain o Denied night sweats, cough, SOB o Newly diagnosed with HIV
JDs HIV Diagnosis o Newly diagnosed with HIV Esophageal candidiasis Necrotic lymph nodes in abdomen Weight loss of 50 lbs Fevers Dx on 2/19/23 o CD4 and Viral Load pending o Multiple visits to ED prior to HIV dx Unknown whether provider missed or client declined HIV testing
Differentials o Unknown cause of gastritis, bowel wall thickening, and lymphadenopathy in abdomen o LFTs and Liver US WNL o Differential List: Autoimmune disease Metastatic disease Secondary to acute HIV o QFT pending TB added to differentials after positive QFT Chest Xray WNL
Risk Factors for HIV and / or TB o Travel: Dominican Republic and Mexico Aug 2022 Brazil 2021 Bali and Thailand in 2017 or 2018 All vacation, about 1 week each o Sexual health MSM No sex in last year Reports history of risky sexual behavior in past
TB Diagnosis o 2/18/23 HIV + o 2/20/23 QFT + o 2/24/23 Abdominal lymph node smear + o 2/25/23 CD4 < 25 o 2/28/23 Sputum smear +, PCR + for MTB o 3/13/23 Culture resulted + on lymph node for MTB o 3/21/23 Fully susceptible to RIPE o 4/4/23 Culture resulted + on sputum for MTB
Treatment Initiation TB TREATMENT HIV TREATMENT o Started on RIPE o Diagnosed with AIDS o 12-month treatment o Began antiretroviral therapy 2 weeks after starting RIPE monitor closely for IRIS o Monitoring for Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (IRIS) o Linked to HIV Care Coordination but client reluctant to work with them o Client stopped taking TB medications for a period and had to be restarted o Non-compliant with HAART medications and ID appointments o Dx with HIV encephalitis o Dx with opportunistic infection shingles o Viral load went from detectable to almost non- detectable then back to detectable Worried about resistance or compliance
Labs 2/19/2 3 3/14/2 3 3/20/2 3 4/17/2 3 5/17/2 3 6/21/2 3 7/25/2 3 8/23/2 3 9/26/2 3 10/25/ 23 WBC 3.3 1.81 2.11 3.16 1.76 2.6 2.79 4.0 4.8 2.8 Hgb 8.7 8.1 9.1 9.0 9.9 12.7 13.0 12.4 11.3 10.5 CD4 <25 - - - - 88 - 150 135 117 Detected 121,000 Detected 38 Detected 11,500 Undetec table <20 HIV RNA - - - - - Detected 543,868 AST 45 21 - 32 29 27 25 22 24 26 ALT 39 18 - 43 24 18 22 23 24 29
Where We Are Now o 8 months into treatment o Contact investigation no contacts provided to TB or HIV case coordinators o Compliant with TB eDOT o Tolerating TB treatment well, reports no side effects or opportunistic infections o Compliant with monthly TB appointments o HIV managed by collaborative ID physician client requests care does not overlap unless necessary o Client re-acclimating to what daily life looked like prior to diagnosis
Lessons Learned Building trust is crucial Supplying client with needs Advocating for disability benefits Coordinating care w/HIV team Meet clients where they are based on their readiness to accept diagnoses and care Respecting client boundaries Support clients when they need you
Please put any questions or topics for discussion in the chat or raise your hand and wait to be called on. Recommendations for places to price compare or order PPD? Has anyone noticed recent price increases or shortages? Open Forum Have other health departments encountered situations where a young child was a contact to an active pulmonary case and the parents would not allow them to be tested? How was the situation handled and was there anything that helped?
There will not be an April TBNN meeting due to the national conference. Slides and meeting recording will be posted to the TBNN webpage. Please email berlinc@michigan.gov if you have requests for future presentations or a question for the open forum. Wrap-Up Let us know about any contact list edits. Be on the lookout for the email about World TB Day registration opening!
