Transforming latent tuberculosis infection (LTBI) testing and treatment at a federally qualified health center

Abstract

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  The Massachusetts Department of Public Health partnered with Lynn Community Health Center (LCHC) to scale up testing and treatment for latent tuberculosis infection (LTBI) for a non-US born patient population. The project team developed a workflow to manage patients through the LTBI care cascade with screening performed in primary care and diagnostic testing, evaluation, and treatment undertaken by a TB team within the health center. To support the clinical workflow, the team implemented process improvements, addressed access barriers, and made electronic health record (EHR) enhancements.
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  LCHC successfully increased LTBI testing and treatment for non-US born patients, while sustaining engagement through the care cascade.
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  Strategic distribution of responsibilities, attention to process refinement, EHR enhancements, and collaboration with public health experts helped make the scale-up possible.
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  Three core factors kept patients more engaged, minimized gaps in treatment, and alleviated burdens associated with LTBI treatment: 1) flexibility with scheduling visits, 2) focus on building trusting, supportive relationships between care providers and patients, and 3) consistent outreach, reminders, and follow-up with patients on treatment.
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  Maintaining high testing and treatment volumes requires consistent effort, sustained attention, and staffing continuity.