Tuberculosis Program Priorities
| Population Group In Order of Priority |
Service Provided |
Notes for Clarification |
| Clients with active tuberculosis | - Medical evaluation
- CXR
- Medication management
- Directly observed therapy
- Medical consultation by Dr. Karen Landers
- Contact investigation
| Private physicians may refer clients with known or suspected active Tuberculosis to MCHD for complete evaluation and care of their active Tuberculosis. See also:
Clients who test positive at another provider |
Recent contacts of a known case of
active pulmonary or laryngeal TB
(Recent is defined as within the past two years) | - Tuberculosis testing
- Medical evaluation
- CXR
- Medication management
- Medical consultation by Dr. Karen Landers
| Private physicians may refer clients who have recently been exposed to active pulmonary or laryngeal TB for complete evaluation. Treatment of latent TB infection will be provided as medically indicated. See also:
Clients who test positive at another provider Note: Clients with HMOs will be evaluated upon appropriate referral from their primary care physician so that the insurance may be billed for services provided by MCHD. If, after medical evaluation, treatment is recommended, the client will be referred back to the primary care physician for that care. |
Tuberculin converters who do not have a PCP and/or have limited financial resources.
Converter = Positive tuberculin skin test (TST) or interferon gamma release assay (IGRA) QFT or T Spot test now and documented negative test within the past two years
- or –
Increase in reaction size of
10mm or more within the previous two years for high risk populations
Increase in reaction size of
15mm or more within the previous two years for persons with no risk factors for TB | | Private physicians° may either - Seek medical consultation *, or
- Refer clients who test positive for complete evaluation. Treatment of latent TB infection will be provided as medically indicated.
See also:
Clients who test positive at another provider Note: Clients with insurance will be encouraged to establish care with a primary care physician from whom they can receive evaluation and treatment. |
High risk clients who do not have a PCP and/or have limited financial resources.
High risk is defined as: - Diagnosed HIV or AIDS
- Fibrotic changes on chest x-ray with prior TB
- Immunosuppressed clients (receiving equivalent of 15 mg/d or greater of prednisone for 1 month or longer, or taking TNF alpha antagonists
- Recent (within 5 years) immigrants from countries with high prevalence of TB
- Injection drug users
- Silicosis
- Underweight (10% below ideal)
- Diabetes mellitus
- Chronic renal failure/ hemodialysis
- Gastrectomy
- Jejunoileal bypass
- Solid organ transplantation
- CA head or neck
- Recent employees or residents of institutional settings and/or correctional facilities
- Chronic Malabsorption Syndrome
- Leukemia
- Hodgkin's Disease
| - Tuberculosis skin testing
- Medical evaluation
- CXR
- INH medication management
- Medical consultation to private providers*
| Private physicians° may either - Seek medical consultation *, or
- Refer clients who test positive (more info) for complete evaluation. Treatment of latent TB infection will be provided as medically indicated
See also:
Clients who test positive at another provider Note: Clients with insurance will be encouraged to establish care with a primary care physician from whom they can receive evaluation and treatment. |
| Residence 6 or more months in country with high prevalence of TB and left that country within the last 3 months. | - Tuberculosis skin testing
- Medical evaluation
- CXR
- INH medication management
| Eg missionaries, immigrants Client must have no other resources, eg PCP. |
Clients Who Tested Positive at Another Provider
If the client meets our priorities, but has limited financial resources, they can receive evaluation and treatment from the MCHD TB program after a TB test is placed and read by TB staff to verify the TB test results. If the test was given less than 8 days prior to the client visit and is read as positive by the TB staff, the staff may consult with the Health Officer about whether to repeat the test or schedule for chest clinic. Alternatively, an IGRA (TB blood test) may be performed.
Note: TB test will not be repeated if the client had vesicles with the prior test.
Clients That Do Not Meet Our Priorities for Tuberculin Skin Testing
(unless the client falls into one of the previous priority groups):
- Day care entry
- College entrance
- Adoption
- MD referrals
- Work clearance
- Self referrals
- Immigrants in country > 5 years
°Private physicians do not include delegate agencies or providers of MCHD. Delegate agencies evaluate and treat clients they identify with latent TB infection.
Medical consolation is provided by Karen Landers, MD, MPH, Health Officer, Marion County Health Department
