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Instructions:
x Submit the Annual Progress Report to TBContractReporting@dshs.state.tx.us.
x The deadline to submit the Annual Progress Report is April 21, 2017.
x Report activities that occurred from January 1 December 31, 2016.
x Substitute forms that replace this template will not be accepted.

I. INTRODUCTION
Name of Local Health Department / DSHS Health Service Region: Fort Bend County Clinical Health Services/ Rgn 6/5S
Name of person completing form: Patsy Landin RN Phone #: (281) 238-3547 Date: 02/22/17
Please describe below each position funded by TB federal and/or state funds in 2016.

B.1 Name, Functional title, % of % of Type of # of


Code: E=Existing or P=Proposed. Time Time Certification Months
Paid by Paid by or License, Vacant
Federal State i.e., RN or or NA
1 Patsy Landin, RN E:TB/HIV/STD Program Manager 100 RN 0
2 Dianne Dzoba RN E: TB/HIV/STD Case Manager 47 RN 0
3 Soonshim BeackRN E: TB/HIV/STD Case Manager 0 RN 0
4 Isabel Kenyon RN E: TB/HIV/STD Case Manager 0 RN 0
5 Jeanette Munoz LVN E: TB DOT/CI 50 LVN 0
6 Delores Ollie LPN E: TB DOT/CI 100 LPN 0
7
8
9
10
11
12
13
14
B.2 For each nurse indicate their name below and a brief # of cases # of cases
description of duties. Use additional space, if managed managed
needed. with with TB
confirmed / infection
suspected
1 Patsy Landin RN-manage public health services 0 0
2 Dianne Dzoba RN-provide public health services 64 154
3 Soonshim Beack RN-promote and provide public health services 57 217
4 Isabel Kenyon RN-promote and provide public health services 62 203
5 Jeanette Munoz LVN-promote and provide public health services 0 0
6 Delores Ollie LPN--promote and provide public health services 0 0
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8
9
10
11
12
13
14



    

II. 2016 Targeted Testing for Special Populations. Provide results of targeted testing
performed at specific sites by your program staff. List each site and provide requested data.
Note: Special population is defined as a child less than 5 years of age at diagnosis, a U.S.
born minority, homeless, foreign born, substance abuse, a border resident La Paz counties,
or a client of a DSHSfunded refugee resettlement program.
Please add additional sites, as needed.

0
Number of targeted testing activities your program conducted in 2016: ______

Site #1 Site #2 Site #3


II.A Targeted
testing site. Name: Name: Name:
Provide full name
and address (no Address: Address: Address:
acronyms)

Type of facility:

# of persons
evaluated:

# of persons
with a positive
IGRA or PPD
result:

# of persons with a
prior positive IGRA
or PPD result:

# of persons
identified with TB
infection:

% of persons
identified with TB
infection:

# of persons
identified with
active TB disease:

% of persons
identified with
active TB disease:

 
   

II.B
Correctional Site #1 Site #2 Site #3
targeted testing
site. Name: Name: Name:
Provide full name
and address (no
acronyms)
Address: Address: Address:
*Exclude Chapter 89
Jails

Add lines as
needed.

Number of correctional targeted testing 0


activities your program conducted in 2016: ______

Type of facility:

# of employees
and inmates
evaluated:

# of employees
with a positive
PPD or IGRA
result:



    
# of inmates
with a positive
PPD or IGRA
result:

Combined total
(employees and
inmates) with
positive
PPD/IGRA result:

# of employees
and inmates
with a prior
positive IGRA or
PPD result:

# of employees
and inmates
identified with TB
infection:

% of employees
and inmates
identified with TB
infection:

# of employees
and inmates
identified with
active TB disease:

% of employees
and inmates
identified with
active TB disease:

 

    

II.C List all facilities that received TB testing supplies from your program to conduct their
own screening. For example, list opioid treatment centers with nursing staff that performed
TB screenings using supplies your program provided. *Exclude sites where your TB
program staff performed TB screenings.

Add lines as needed.

Number of facilities receiving TB testing supplies from your program


in 2016: ______
1

Congregate Targeted Screening


Setting TB Testing supplies
Name of site. Provide full Full Address (no Risk Monthly state
name (no acronyms) acronyms or P.O. box) Assessment Reports funded?
Done (Y/N) Submitted? (Y/N)
Y/N
Fort Bend County Sheriff's Office 1410 Williams Way Blvd.
Richmond, Texas 77469 Y Y Y

 

    

III. Large Contact Investigations (CI) in Congregate Settings, 2016. Provide


names and dates of each congregate setting in which 50 or more persons were screened
in a CI.

Examples of congregate settings sites include: schools, universities, day care centers,
hospitals, homeless shelters, jails, long term care facilities, etc.

Add sites on a separate sheet as needed.

Number of contacts investigations in congregate 0


settings where 50 or more persons were screened in 2016: ______

Name of site. Site #1 Name: Site #2 Name: Site #3 Name:


Provide full name
(no acronyms)

Address of site:
Include city and
county

CI date:
(initial screening
date at the site)

Type of site:

Was TB Branch
Epidemiology team
notified prior to
initiating first round
screening?

Was an incident
report form
submitted?

 
   
Total # of
persons
evaluated:

# of persons
with a positive
IGRA or PPD
result:

# of persons with a
prior positive IGRA
or PPD result:

# of persons
identified with TB
infection:

% of persons
identified with TB
infection:

# of persons
identified with
active TB disease:

% of persons
identified with
active TB disease:



    

IV. Surveillance, Reporting and Case Management in Correctional Facilities


(Texas Health and Safety Code Chapter 89). List all Chapter 89 jails in your
jurisdiction.

Add lines as needed.

1
Number of jails in your jurisdiction: ______

# of Monthly Annual
Name of Jail Address Reports Correctional
Reviewed and Tuberculosis
Submitted to Screening Plan
Central Office Submitted
(Yes/No)

Fort Bend County Sheriff 1410 Williams Way Blvd.


Department Richmond, Texas 77469 12 Yes

1.Do you facilitate discharge planning for inmates with confirmed or suspected TB disease?
Yes No
2. Do you followup to ensure continuity of care is provided for inmates with confirmed or
suspected TB after release or transfer from a correctional facility? Yes No
3.Check all contact investigation activities you perform for correctional facilities:
Plan and oversee contact investigations
Interview TB cases and suspects
Conduct TB testing and screening
4 . Who monitors and oversees TB prevention and care in correctional facilities in your agency?
(e.g. Reviews Monthly Correctional TB Reports and Correctional TB Screening Plans)
Employee Name: Isabel Kenyon
________________________________________________
RN

Title: TB/HIV/
_______________________Phone
STD Case Manager #: 281-344-6110
___________________________
Email Address: Isabel.kenyon@fortbendcountytx.gov
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

    

V. Please list hospitals, providers, schools, homeless shelters, or other groups for
which your jurisdiction provided TB education.
Add additional sites on a separate sheet as needed.

Briefly state what type of education was provided using the questions below as a guide.
As an example, did the jurisdiction identify when to report active or suspected cases of
TB, where to report, and how to report? Were educational materials left? Did the
education involve more in depth TB education, such as when isolation is needed? Was the
Texas Notifiable Condition list at
https://www.dshs.state.tx.us/idcu/investigation/conditions/ provided including a 24/7
telephone number to report notifiable conditions?

Please list the number of educational activities conducted in 2016: ______

Educational Site. Site #1 Name Site #2 Name Site #3 Name


Provide full name Ken Lubritz DDS Austin High School The Goddard School
no acronyms.

Address of 2500 Fondren Rd. 3434 Pheasant Creek Drive 21024 W Bellfort, Richmond, TX
site/provider. Houston, Texas 77063 Sugar Land, Texas 77479 77406
Fort Bend County Fort Bend County
Include city and Harris County
county

Date education
was provided. 05/12/16 10/05/16 10/10/16

What type of Literature Literature Literature


education was Oral presentation Oral presentation
provided? Brief
description only.

Did the education Yes Yes Yes


identify when to
report TB disease
or infection?

 

    
Did the education Yes/Local Health Yes/Local Health Department Yes/Local Health Departmment
describe where to Department
report? If so,
where?

Did the education No. Yes-Fort Bend County Yes-Fort Bend County
include a 24/7 Clinical Health Services Clinical Health Services
Number provided which number provided which
phone number to includes a number to call includes a number to
report an event or after hours. call after hours.
staff contact
information? Be
specific.

Was the education The education Site visit was made to Yes-Case manager's
more in depth and provided was establish 3HP dosing at direct number and Fort
clarification school. Teaching was Bend County Clinical
describe what between TB disease provided and supplies Health Services number
constitutes an and TB infection; left for nurse. provided which includes
and when a patient
active case or TB with disease is no
Educational material left
with school nurse.
a number to call after
hours.
infection? Please longer contagious.
discuss briefly. Pamphlets 'Get the
Facts, Q&A about TB
and TB at a Glance
were mailed to
physician.

Did the education Yes Yes Yes


describe when
isolation is
necessary?

Describe the Physician School nurse School director and


group(s) or assistant
provider(s) that
received
information:

 
   

VI. Discuss efforts to conduct provider/infectious disease


practitioner/methadone center education in 2016. Has this education produced
better communication between the TB Program and the provider? Has this education
improved reporting or TB outcomes? Add sites on separate sheets as needed.

1
Please list the number of these educational activities conducted in 2016: ______

Educational Site #1 Site #2 Site #3


Site Infectious Diseases

Full name of Access Health


400 Austin Street
site/provider Richmond, Texas 77469
and address:

Date education
was provided:

10/25/16

Outcome(s): Education pamphlet faxed to


office after telephone
conference with physicians'
assistant.
Handout specific to patient's
current circumstances.


   

VII. TB program testing standards. Check the appropriate boxes.


Do you use IGRA as the standard method to screen for TB?
Yes No
What type of IGRA test does your program currently use?
QuantiFERON TB Gold InTube (QFTGIT) T SPOT TB (TSpot) %RWK

None
What laboratory do you use for IGRA testing?
State Laboratory (Austin)
Oxford Diagnostic Laboratory
Other (Specify)
Name:
Address:
Phone #:

Do you offer tuberculin skin testing for persons aged four and older?
Yes No

VIII. Protected health information (PHI). List all staff that send PHI and indicate
whether they have a Texas Public Health Information Network (PHIN) account. For example,
staff who sends RVCTs, jail or targeted testing monthly reports, incident reports, patient
referrals, TB 400s, TB Expert consultations, Cohort Review Presentation forms or lists of
counted cases and contact investigation reports.

Name Title PHIIN account


established? (Y/N)

Patsy Landin TB/HIV/STD Program Manager Y

Dianne Dzoba TB/HIV/STD Case Manager Y

Soonshim Beack TB/HIV/STD Case Manager Y

Isabel Kenyon TB/HIV/STD Case Manager Y

Jeanette Munoz DOT/CI Nurse Y



    

IX. TB services. In accordance with your overall TB funding, list program


activities/services not performed; those services/activities performed well; and those
performed in a minimal manner in 2016. Add separate sheets as needed.

Services/activities not Services/activities Services/activities performed


performed performed well in a minimal manner

2.Cases and suspected cases, of TB 3. Newly-reported suspected cases of TB 1. Newly-reported TB cases shall have an
under treatment shall be placed on disease shall be started in timely manner HIV test performed (unless they are known
timely and appropriate Directly on the recommended initial 4-drug HIV-positive, or if the client refuses) and
Observed Therapy (DOT). regimen. Goal 93.4% Score 96.2% shall have positive or negative HIV test
G l 91 6% S 70% lt t d t DSHS di t th
9. Newly-reported TB clients with a 4. Newly-reported TB clients that are older 6. Newly diagnosed TB cases that are
positive AFB sputum-smear result than 12-years-old and that have a pleural eligible* to complete treatment within 12
shall have at least three contacts or respiratory site of disease shall have months shall complete therapy within 365
identified as part of the contact sputum AFB-culture results reported to days or less. Goal 87% Score 87.5%
investigation that must be pursued for DSHS according to the time lines for
13. For Class B immigrants and 5. Newly-reported cases of TB with
refugees with abnormal chest x-rays Acid-fast Bacillis (AFB) positive sputum
read overseas consistent with TB, culture results will have documented
increase the proportion who initiate conversion to sputum culture-negative
medical evaluation within 30 days of within 60 days of initiation of treatment
16. For Class B immigrants and 7. Increase the proportion of
refugees with abnormal chest x-rays culture-confirmed TB cases with a
read oversees as consistent with TB genotyping result reported. Goal 94.2%
and who are diagnosed with TB Score 100%
i f ti (TBI d i l ti i th
8. TB cases with initial cultures positive for
Mycobacterium tuberculosis complex shall
be tested for drug susceptibility and have
those results documented in their medical
record Goal 97 8% Score 100%
10. Newly-identified contacts, identified
through the contact investigation, that are
associated with a sputum AFB
smear-positive TB case shall be evaluated
for TB infection and disease
14. For Class B immigrants and refugees
with abnormal chest x-rays read overseas
as consistent with TB, increase the
proportion who initiate and complete
evaluation within 90 days of arrival. Goal
15. For Class B immigrants and refugees
with abnormal chest x-rays read oversees
as consistent with TB and who are
diagnosed with TB infection (TBI during
evaluation in the US, increase the

 

    

X. Describe barriers that affected your delivery of services, if any. State the issue
and describe potential alternatives. If there are no barriers, write None below. Add
separate sheets as needed.

 TB cases and suspect reports are not received in a timely manner and some physicians are choosing to wait to start patients
2.
on anti TB therapy pending culture results especially if they believe culture will produce non-mycobacteria result.
Our Case Managers contact the physicians and discuss the rationale for the "wait and see" approach versus placing the patient
on therapy and providing educational material for their use and referring the MD to expert consultation with Heartland or UT Tyler.

9. Suspect/Cases will not disclose contacts-some patients believe their "business will get out there; some believe TB is a
shameful disease and they will be ostracized by their culture.
Education about the disease and how contact investigation is conducted is the best we can provide to the patients, although
differences in language is often a barrier in communicating with patients.
Our Cases Managers and DOT/CI nurses use language translator apps on their cell phones for simple translations and search
TB sites on line for TB information in foreign languages.

15.One finding with Class B Immigrants and refugees is that they do not always arrive to the address listed on the form. Our Case
Managers have found they arrive in another state entirely. Another finding is, that quite a few immigrants/refugees list Catholic
Charities as their residence but they do not reside there at all. We then have to locate their actual residence which delays
complying with the 30 days of arrival compliance. We are learning as we go along. We know to contact Catholic Charities now as
soon as we get an immigrant/refugee with that address to cut down on the location time.

16.The number of immigrants/refugees who complete treatment has been hard to comply with due to the fluid movement of this
population. Once they arrive, employment is found and they resettle at a different address without notifying us so that their
medical records can be forwarded and treatment continued to completion. Oftentimes, once the patient is evaluated and started
on therapy, it is difficult to get the family member or sponsor to return with the client for refills due to the family/sponsor being
busy with work, etc. Communication is paramount with their family/sponsor.

 

    


XI. Provide an overview of your health department and describe the populations
served. How did this affect your planning for the delivery of services? Add separate sheets
as needed.

 Bend County Clinical Health Services TB department is comprised of one program manager, three case managers, two
Fort
DOT/CI licensed nurses and three lay persons trained to provide DOT.
The program manager compiles the information and submits all the reports that are due to DSHS, reports to clinical director
daily program activity report, monthly data and narrative report, bi-weekly team lead meetings are attended by program manager.
Vouchers are checked for accuracy for DOT providers as well as mileage reimbursement for staff nurses. Annual evaluations are
performed by program manager.

The Case Managers work with TB suspects,cases, LTBI, B1,B2 clients scheduled and unscheduled. TB chest clinic is held the
first and third Wednesday of each month. It varies from one to five patients being seen and six to fifteen records being reviewed.
Each Case Manager is working eight to twelve suspect/cases and fifteen to twenty LTBI's at one time. Medications are ordered by
each nurse for their patient and monitored for refills to reduce waste. They are assigned additional tasks such as jail reports,
ordering TB/STD supplies, ITEAMS inventory, daily Program Activity Report and continuous patient education. Assistance is
provided to the licensed nurses with DOT and Contact Investigation. Sputum specimens, labs and Chest x-rays are collected and
done at designated times, results monitored and reported as required.
They also work with the STD/HIV program whereas they test for syphilis and HIV, treat for gonorrhea, chlamydia and syphilis by
referral from private physicians and DSHS and distribute condoms,along with education on risk reduction.

The licensed staff perform contact investigations whether it be internal or external from other jurisdictions, flight investigations,
etc. They provide DOT to our active cases, suspects, 3HP, window therapy, etc. They also collect the information and put
together our education and disaster packets for our patients. They archive our files and enter our LTBI patient information in
TWICES. They monitor our medication that has expired and assemble it for destruction by our pharmacist. The DOT nurse is
responsible for ordering medications for the patient she is providing services to.

The DOT lay trained people provide medication packets to our patients and inform the Case Manager of any adverse events as
needed or changes in patients residence, schedule changes,etc.

The TB program is comprised of one Spanish speaking Program Manager and one Spanish speaking Case Manager. Foreign
language apps are utilized on the nurses personal phones to communicate with non-English speaking patients.

United States Census Bureau QUICK FACTS Fort Bend County Populations Served
Population-estimates July 1, 2016 (741,237)
Race and Hispanic Origin
White alone, percent, July 1, 2015, (56.8%)
Black or African American alone, percent, July 1, 2015, (20.9%)
American Indian and Alaska Native alone, percent, July 1, 2015, (0.6%)
Asian alone, percent, July 1, 2015, (19.5%)
Native Hawaiian and Other Pacific Islander alone, percent, July 1, 2015,(0.1%)
Hispanic or Latino, percent, July 1, 2015, (24.1%)
White alone, not Hispanic or Latino, percent, July 1, 2015, (34.6%)
Education
High school graduate or higher, percent of persons age 25 years+, 2011-2015(88.9%)
Bachelor's degree or higher, percent of persons age 25 years+, 2011-2015(43.7%)
Income and Poverty
Median household income (in 2015 dollars), 2011-2015($89,152)
Per capita income in past 12 months (in 2015 dollars), 2011-2015 ($36,962)
Language other than English spoken at home, percent of persons age 5 years+, 2011-2015(38.2%)
Health
With a disability, under age 65 years, percent, 2011-2015 (5.5%)
Persons without health insurance, under age 65 years, percent (12.8%)

Our TB program serves all people within the parameters allotted by DSHS. . We receive the person at face value and evaluate
their needs. The majority of our patient's are uninsured and are referred to other agencies to supplement their needs, i.e. Social
Services, Helping Hands, Access Health,etc. We examine ourselves for any unidentified prejudices toward cultures different than
our own being as that we are serving a bigger population of foreign born people

 

    

XII. Unusual events or significant accomplishments in 2016. Please describe. Add


lines as needed.



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