Public Health Region 8 - Tuberculosis 1115 Waiver Project

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bestlogoTuberculosis 1115 Waiver Project  

Project Manager:  Yolanda Cantu, M.P.H. | 210-949-2074  

Breathe Easy South Texas (BEST) is a project utilizing Texas 1115 Medicaid Waiver funds to expand screening for and treatment of Latent Tuberculosis Infection (LTBI) in high-risk populations in twenty South Texas counties. Twenty-five percent of these counties are classified as highest risk counties for TB by the Texas Department of State Health Services, based on an average TB rate greater than two times the Texas rate.

Target populations include the homeless, substance abusers, foreign born, diabetics, HIV infected, healthcare workers, and those living in congregate settings.  BEST is unique because it focuses much-needed attention on LTBI as a component of the Texas TB elimination strategy.  The BEST Model incorporates outreach and provider education with the specific aim of increasing screening and treatment for those with LTBI to reduce TB incidence.

Project strategies include outreach to and recruitment of providers to participate in the project, education of providers, access to TB experts for consultation, training, and guidance regarding testing with interferon gamma release assays (IGRAs) and treatment for LTBI through a 12 dose, 12 week treatment regimen administered by directly observed therapy (DOT) or other regimens as appropriate.


Founding project partners include the Texas Department of State Health Services Region 8, University Health System, University of Texas Health Science Center at San Antonio, and the City of San Antonio Metropolitan Health District.  This partnership has been responsible for planning and implementing activities to expand screening and treatment in a geographic area larger than 10 US states with county populations ranging from over 1.85 million to small rural counties of less than 810 residents.The partnership includes a growing network of urban, suburban, and rural medical providers who commit to screen, test, and treat populations at high risk for LTBI.


  • Project staff reached out to health care providers located in 20 counties

  • Physicians, nurse practitioners and physician assistants have joined the effort in San Antonio and surrounding counties

  • Many eligible providers now performing IGRA screening for the first time

  • Over 6000 individuals have been screened

  • Of those positive for Latent TB Infection, 90% have completed treatment.  

Impact on TB

BEST’s focus on high-risk populations has uncovered significant numbers of TB infections in need of treatment that otherwise may not have been detected.  The BEST Project will continue to expand activities in an effort to continue reducing TB in local communities and regionally.

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For Health Care Providers

Last updated February 24, 2021