Community-Based Tuberculosis Screening
Local health departments in selected urban and border counties receive funding from the Tuberculosis (TB) Program to establish a TB screening program in methadone drug treatment centers, HIV early intervention centers, homeless shelters and other organizations that serve high-risk groups. Individuals identified with latent TB infection are referred to the appropriate health department for treatment and other follow-up as appropriate.
The Correctional TB Program provides technical assistance to all county jails and other correctional facilities covered by Chapter 89 of the Texas Health & Safety Code (the statutes) and Title 25, Part I, Chapter 97, Subchapter H (the rules) of the Texas Administrative Code. These correctional facilities must have an approved TB control plan. The Correctional TB Program also consults with correctional facilities when they have a case of TB within their facility to facilitate identification of persons with risk of exposure and to facilitate continuity of care upon release or transfer. For more information about ensuring continuity of TB therapy for detainees of the U.S. Immigration and Customs Enforcement (ICE) see SOP 8.13.1, Appendix V ( 28 KB) | ( 21 KB).
The Communicable Disease Prevention and Control Act is a comprehensive statute (codified as Chapter 81, Texas Health and Safety Code) which provides for numerous control measures which are available for use in protecting the public health. When an individual who has, or is suspected of having, a communicable disease does not comply with the control order issued by the local health authority and/or DSHS, Subchapter G of Chapter 81 provides for court-ordered management of the patient.
The process by which a local health authority seeks court-ordered management of a person who has violated a control order is a cooperative effort between that local health authority/local health department staff and the city, county or district attorney whose office represents them in legal matters.
The Office of General Counsel of the Department of State Health Services is available to answer questions from local attorneys seeking court-ordered management in their jurisdictions.
Drug-Resistant TB Monitoring and Control
The DRTB Program coordinates, tracks, and monitors all reported laboratory confirmed drug-resistant TB cases throughout their course of treatment. The program works with medical providers to ensure rapid notification of the drug resistant status. It assists the provider in obtaining expert TB consultation to assure that the patient is provided with an adequate treatment plan and that the provider is aware of DSHS policies and requirements relevant to drug resistant TB. Consultations by designated TB experts are recommended and strongly encouraged for all cases with resistance to isoniazid only, rifampin only, or both isoniazid and rifampin (MDR) combined with other TB drugs. This program also monitors the directly observed therapy (DOT) policy, which is the standard of care in Texas in the treatment of TB patients.
Evaluation and Program Reviews
A regular system of reviews of TB programs has been established for local and regional health departments to assess the quality of service and to recommend strategies to improve the delivery of TB prevention and control services. Quantitative indicators of program performance are also monitored based on information contained in the TB case registry. Other indicators are derived from special performance or financial reports from local and regional TB programs.
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Tuberculosis (TB) genotyping is a laboratory-based approach to analyze the genetic material of Mycobacterium tuberculosis (M.tb). Common uses for genotyping results include, identifying unknown transmission relationships, establishing outbreaks, detecting false positives and laboratory cross-contamination events and distinguishing recent disease from activation of old disease. The TB genotyping program manages the genotyping database, tracks isolates submitted for genotyping, monitors genotyping results, performs cluster investigations and provides epidemiologic consultations. In addition, the program works very closely with laboratories and local health authorities to ensure all initial M.tb isolates are sent to the Department of State Health Services (DSHS) Laboratory in Austin per the Texas Administrative Code (Texas Administrative Code, Title 25, Part 1, Chapter 97, Subchapter A, Rule §97.3, (a), (4)).
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The Hansen's Disease Program provides treatment for individuals with this disease in the state of Texas. These services are federally funded through the National Hansen’s Disease Program (NHDP), an activity in the Department of Health and Human Services (DHHS), and the Bureau of Primary Health Care. The primary goal of the program is to prevent deformity and disability from HD through early diagnosis and treatment.
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The Refugee Health Program operates with funds from the Office of Refugee Resettlement (ORR) in the U.S. Department of Health and Human Services Administration for Children and Families (ACF).
The program supports local health departments in principal refugee resettlement areas with resources to provide health assessments to newly arrived official Refugees, Amerasian-immigrants, Cuban and Haitian parolees/entrants, certain Afghanis and Iraqis with Special Immigrant Visas (SIVs), asylees, and victims of severe forms of trafficking (VoTs). Eligibility for services is within 90 days of arrival in the U.S., date granted asylum, or date certified as a VoT. The ideal timeframe is to provide a health assessment within 30 days.
The program screens for communicable disease-related conditions, including tuberculosis, immunization status, intestinal parasites, STDs, and hepatitis. The program also provides a general physical assessment, in order to identify, educate, and refer for other health problems that would impede the refugee resettlement process, or be of significant personal consequence. All program-contracted health departments are guided by the ORR Medical Screening Protocol for Newly Arriving Refugees and by the Centers for Disease Control and Prevention's 'Refugee Health Guidelines' .
Assistance and consultation are provided to local and regional health departments in devising strategies to conduct contact investigations in congregate settings such as schools, workplaces and residential institutions. Technical assistance with other TB prevention and control issues is also available upon request.