The Department of Public Health (DPH) Tuberculosis Control Program (TBCP) is responsible for the prevention and control of tuberculosis (TB) in the County of Los Angeles (LAC). LAC typically reports more TB cases than other reporting jurisdictions in the United States except for California, Texas, New York, and Florida. Reflecting the national trend for TB disease, the decline in TB cases in LAC has plateaued. In calendar year 2018 the annual case count of 529 showed an increase from the total of 510 reported in 2017. The TBCP has reviewed its National Tuberculosis Indicators Project (NTIP) indicators and has identified Known HIV Status, Contact Latent TB Infection (LTBI) Treatment Completion, Immigrant/Refugee Evaluation Completion, and Electronic Disease Notification (EDN) system reporting as indicators not meeting targets to focus strategies for improvement over the next 5 years.
To accomplish the priority activity of identifying individuals with suspected or confirmed TB disease and ensure standard and appropriate treatment regimens, the TBCP will continue to deliver technical assistance and medical consultation with both DPH and non-DPH partners to ensure the use of new lab technologies and standard diagnosis and treatment regimens, and to improve completeness and timeliness of reporting.
To expedite the diagnosis and treatment of person with LTBI, the TBCP will build on recent successes in contact investigation practices, including promoting access to IGRA and short course regimens. The TBCP will continue to partner with community providers, and endeavor to increase its relationships in the community to treat high-risk populations with LTBI such as new immigrants, status adjustors, people experiencing homelessness, and with immunosuppressive medical comorbidities. The TBCP will expand the use of short course treatment and incentives to improve evaluation and treatment completion among persons at highest risk of progression from LTBI to TB disease.
To enhance our ability to report cases in a timely manner and monitor TB trends, the TBCP will refine internal reporting procedures and work with DPH partners to improve completeness of reporting. Resources critical to monitor genotype clusters and outbreaks will be maintained, along with State and Federal partnerships to limit on-going transmission. The TBCP is transitioning with other LAC disease control programs to an integrated disease control surveillance data system, IRIS, which will improve case-level TB disease and LTBI reporting, case management, contact investigation, outbreak detection, and elimination activities.
The TBCP also must provide leadership in establishing and dissemination clear guidance for best practices in clinical diagnosis and treatment, case management, contact investigation, and infection prevention and control for TB for DPH and the community. Through a coalition of community partners and an advisory board to create an LA County TB Elimination Plan, the TBCP is expanding collaborations with partners to resource and engage in elimination activities, as reduction of cases in LAC is heavily dependent on scaling up treatment of LTBI in high risk populations. Taken together, the successful execution of these activities will accelerate LAC toward TB elimination.