TB Program News and Announcements
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Drug Shortage Alert: Rifabutin
On April 21, the TB and Hansen’s Disease Branch notified TB programs of the continued medication shortages we have been experiencing since January. We continue to monitor TB drug availability and have seen fluctuations in fluoroquinolone and, now more critically, rifabutin. It appears disruptions in the supply chain are related to COVID-19 and material shortages.
To preserve medications for patients with limited treatment options, TB programs were notified of updated medication usage criteria.
Please contact the TB and Hansen’s Disease Branch for details:
elizabeth.foy@dshs.texas.gov
Posted 5/7/2020
Response to COVID-19
The TB and Hansen’s Disease Branch has developed guidance on temporary measures to minimize exposure to COVID-19 for clients and staff. Please continue to frequent this section, as information may change periodically.
1. Tuberculosis Action Plan to Minimize Exposure to COVID-19 (PDF : 763 kB)
2. Additional Resources and Information on the Coronavirus:
3. TB Clinical Care Response Team Contacts:
Otto Boneta, M.D., TB Medical Consultant and Preventive Medicine Residency Program Director
Email:
otto.boneta@dshs.texas.gov
Office Number: 956-444-3230
Fax Number: 956-444-3295
Mobile Number: 956-493-0121
Elizabeth Foy, B.S.N., R.N., TB and Hansen’s Disease Nurse Administrator
Email:
elizabeth.foy@dshs.texas.gov
Mobile Number: 512-806-4334
Rachel Munoz, R.N., TB Nurse Consultant
Email:
rachel.munoz@dshs.texas.gov
Mobile Number: 512-956-1044
Posted 3/23/2020
The Standing Delegation Orders and Standing Medical Orders
Standing Delegation Orders and Standing Medical Orders for Tuberculosis Prevention and Care for FY 2020 are now available.
The Standing Delegation Orders (SDOs) and Standing Medical Orders (SMOs) are written instructions, orders and procedures prepared by the Department of State Health Services Tuberculosis and Hansen’s Disease Branch to promote consistent evaluation and treatment practices for persons with suspected or confirmed TB disease and for latent TB infection.
The purpose of this document is to provide authority for specific acts of tuberculosis (TB) clinical services under authority of Rule Title 22, Texas Administrative Code §193.2, Standing Delegation Orders.
The intended audience for the SDOs and SMOs includes physicians, registered nurses, licensed vocational nurses, and non-licensed staff working in local health departments with TB programs and in DSHS Public Health Regions.
The revised Standing Delegation Orders and Standing Medical Orders for Tuberculosis Prevention and Care are effective September 1, 2019.
Posted 8/30/2019
Updated Recommendations for Screening of Health Care Personnel TB
On May 17, 2019, the Centers for Disease Control and Prevention (CDC) published
updated recommendations for screening of health care personnel (HCP) for tuberculosis (TB) [CDC]. These recommendations may impact current screening practices in health care facilities that routinely provide TB testing annually to all HCP.
The DSHS Tuberculosis and Hansen’s Disease Branch is currently reviewing these recommendations and will update the
Frequently Asked Questions (FAQ) web page when the review is final.
In the interim, health care facilities may opt to modify screening practices to fit the recent CDC recommendations, or continue their current screening practices. The DSHS TB Branch cannot approve or deny TB screening and testing policies developed by individual health care facilities, therefore it is recommended that facilities consult with their licensing or credentialing agency for any change in policy.
Posted 8/21/2019
DSHS Recommendations for Tubersol Use During the Aplisol Shortage
Due to the nationwide shortage of Aplisol announced by the Centers for Disease Control and Prevention (CDC) on June 6, 2019, the DSHS Tuberculosis and Hansen’s Disease Branch has issued recommendations to ensure continued availability of Tubersol, the purified-protein derivative (PPD) tuberculin antigen used exclusively in tuberculin skin tests (TSTs) administered in Texas.
It is anticipated there will be a greater nationwide demand for Tubersol due to the shortage of Aplisol, which is expected to last three to ten months. During this time, public health providers in Texas should adhere to the following recommendations:
- Closely monitor the distribution and use of purified protein derivatives (PPDs) among jails that meet Texas Health and Safety Code Chapter 89 requirements.
- Jails meeting Chapter 89 requirements have a capacity of at least 100 beds; or house inmates transferred from a county that has a jail that has a capacity of at least 100 beds; or house inmates transferred from another state.
https://statutes.capitol.texas.gov/Docs/HS/htm/HS.89.htm
- Note: The number of vials distributed should not dramatically exceed the expected number of tests administered per month as reported on the Monthly Correctional TB Report, Form number EF12-11462.
- Stop distribution of state purchased PPDs to non-Chapter 89 facilities.
- Stop distribution of PPDs to hospitals.
- Stop distribution of PPDs to targeted sites where the TB infection rate remains at or below the rate of infection for that community.
- State purchased T-SPOT tests shall not be distributed to correctional facilities, community based organizations or hospitals as a replacement for Tubersol.
Please contact Sandra Morris at 512-533-3128 or
sandra.morris@dshs.texas.gov with questions about these recommendations.
Posted 6/12/2019
Take on TB
DSHS has developed the Texas-specific TB disease data fact sheet
"Take on TB" (PDF : 208 kB) based on data from the
2016 TB Surveillance report (PDF : 675 kB). This fact sheet was adapted from
CDC’s infograph [CDC] for national data. DSHS partners are free to use surveillance and other local data to create their own
tailored [CDC] publication based on the DSHS fact sheet.
Posted 12/12/2017
Enroll in Medicaid as a TB Medicaid Provider
The Tuberculosis and Hansen’s Disease Branch encourages local health department TB programs to enroll in Medicaid as a TB Medicaid Provider.
Information on the enrollment process for first time enrollees can be found on the
Texas Medicaid and Healthcare Partnership (TMHP) website.
Clinics requesting reimbursement for TB services must also enroll as a TB Medicaid Provider. To enroll, the clinic must apply for a DSHS letter verifying their TB services, and may attach the letter to their Medicaid application. To apply for the letter, clinics may fill out the Medicaid Provider Application which may be downloaded from the
TB forms page.
Updated 9/8/2017
Cohort Review Implementation
In March 2013, the Tuberculosis Services Branch implemented the cohort review system in Texas. A cohort review is a systematic and retrospective review of the management of TB cases and contacts. It is an effective management tool that identifies trends impacting outcomes and provides the impetus for developing systems that enhance program performance.
It is the policy of the Tuberculosis Services Branch that in order to promote optimal case management and contact investigation practices statewide, DSHS health service regions and contracted local health department TB programs will hold quarterly cohort reviews. DSHS health service regional TB programs will work with low morbidity public health jurisdictions to implement the cohort review process. The Health Service Regions' Tuberculosis
Cohort Review Infrastructure form (PDF : 67 kB) provides the reporting framework for the cohort reviews.
Please refer to the
Cohort Review Policy (PDF : 45 kB) for further information.
The followings tools are available to conduct the cohort review and report findings to DSHS Tuberculosis Program Services Branch:
For help completing the summary form, download
An Overview of the Cohort Review Summary Form (PDF : 141 kB).
Updated 11/10/2015 |