Enabling the Public and Partners:Delivering the Message of TB

John BernardoPulmonary Center

Boston University School of Medicine

October 6, 2016

Objectives

Upon completion of this presentation, you will be able to:• Explain the significance of presenting TB

data effectively; and • Describe how educating the public and

partners about TB can advance the goal of TB elimination

Your Audience

The Public• Communities (groups) at-risk• The population at-large

Health Providers• Direct care• Public Health

Policy Makers• Jurisdictional, national

We ALL are partners

The Public: Communities

Understand priorities and needs of your people• Where does your message fit?

How do people get health information?• What medium is best for communication?• Whom do they trust?

Develop credibility Introduce your message

Personal Barriers to TB Prevention and Treatment Knowledge/beliefs about TB infection,

prevention, disease, transmission Perceived consequences about TB and its

prevention or treatment Social, clinical

Attitudes towards seeking treatment: Realities and conflicting priorities Fears Limited access to care Loss of income - inability to work

Meet Your Population Engage community

groups and events• Churches, CBO’s,

health fairs … Put a face to the

message

Focus Groups• Identify barriers

before you can devise strategies Existing health

beliefs; stigma Previous history

You just may develop a nose for this business!

Identify “gate-keepers”• Trust

Take advantage of preferred media:• Newspaper, TV,

radio, corner market, barber shop

You may be surprised at what you learn………

“…You are the white people in the white coats…in the white building…”

“Research is when you experiment on people who cannot tell on you…”

“My skin test means that my vaccine is working.”

“How come your medicine is the right one and mine isn’t?”

TB Prevention in the Homeless

Communities: at-risk

The Message:• Engage your people• Develop dialog, trust• Provide access - on their terms

The Outcome:• Access to reliable information, services• Better understanding of TB• Improved Public and Personal Health

Are YOU prepared for this?We are just getting word about a case of highly infectious tuberculosis that was just diagnosed at Jamaica High School! Parents are concerned!

The Public Perceptions about TB: TB??? What???

Develop plan for unexpected events• Identify responsible personnel, protocol• Anticipate: “High-Profile” notifications• Maintain contacts with media: Be available

Leverage data into a positive message• Provide accurate information: The TRUTH • Maintain control

Educate: Social Media; Marketing• NTCA/StopTB USA: Patient Forum• Facebook: TB Photovoice Rachel Orudno: TB Photovoice

The Public: at large

The Message:• Be pro-active

Opportunities to engage public Anticipate needs, events

• Provide reliable, timely information Improves awareness of the disease Reduces fears, stigmatization

The Outcome:• Recognition of Public Health, TB• Facilitates advocacy

Providers: Direct Care Competing priorities in clinical care Poor understanding of epidemiology of

TB in their population and area• Lack of information

Poor training – clinical and public health• Medical, nursing schools• Residency, fellowship programs

Lack of resources• Radiography, laboratory, outreach

They just don’t see it!

Direct Care Providers Identify providers to at-risk groups

• Where do people usually get care?

Engage health care systems• Define needs, resources, expertise

Develop education programs: Competence• Base it on Evidence – be Credible!!• Adapt educational strategy to need:

Academic Detailing in ED’s, Lunch didactic or workshop, …

Be a presence• Regular inservices/updates; service evaluations

Be available !!!

It always comes down to….

EDUCATION………

EDUCATION……..

EDUCATION………

… and knowing where to turn when you need help!

Providers: Public Health

TB is a victim of its own being• Unique in clinical and public health domains

Yet, TB Programs are being subsumed• “Program Integration”• Private Sector: “Everyone is insured”

Need to “Manage Up”• Educate Public Health decision makers• Inform and educate Legislators

Public Health

Maintain visibility• Interact with collaborating programs and

management to foster understanding of the unique needs of Public Health-TB: Politics

• Participate in Public events Health Promotions, World TB Day

Assure competence• Clinical, laboratory, and public health

Assure access to services• Remove barriers: social, behavioral, financial

Providers and Public Health

The Bottom Line:• We are the Safety Net• OUR PATIENTS’ NEEDS HAVE TO BE MET,

OR …

Community-Based TB Prevention, Boston

Health Centers are located in high risk communities

Community members may or may not access local Health Center

Providers may not be aware of TB risk around them

Providers and staff are not educated in TB

Other, more important things to do

Community-Based TB Prevention

Identify communities at-risk Engage local Health Center Conduct Needs Assessments

• Community• Health Center providers, staff

Educate• Community via trusted channels• Health Center – regular inservices

Develop program• One size does not fit all

Be available, friendly

Community-Based TB Prevention, Boston

Neighborhood Health Center BMC-TB Clinic

PPD + Evaluation- Chest Radiograph- Medical evaluation by Pulmonary MD, BUSM- Baseline LFT’s- TB/HIV education (HIV counseling/testing)- Follow-up appointment at NHC

Monthly follow-up at NHC- Assess adherence- Evaluate for side effects- Address other health care issues- Reinforce TB education- Dispense medications (DOPT if necessary)- Forward documentation to TB Program Monitor

- Monthly evaluations, provide medications- Completion of therapy for LTBI- Feedback to NHC- Education program for NHC staff

1996; TBAA, NHLBI HL-33035

Completion of Treatment for LTBIBMC vs NHC

n: BMC: 187; NHC:187

BMC NHCSite

0

20

40

60

80

Per C

ent C

o mpl

e tio

n

(73)

(136)

Barry Chin, Boston Globe, 10/15/2008

TB Is Where You Look For It!