Wednesday, April 2, 2025
4/2/2025
TB Control and Elimination in the State of Hawai'i - Project Abstract Summary The Hawai’i Dept of Health (DOH) Tuberculosis Control Branch (TBB) oversees programmatic activities and clinical services for tuberculosis (TB) control and elimination mandated by the Hawai’i Administrative Rule (HAR) Chapter 11-164.2 and the Hawai’i Revised Statutes (HRS) §325-71 to §325-78 “Tuberculosis”. TBB coordinates these activities and services with the assistance of the Public Health Nursing (PHN) Branch. Both the TB Branch and the PHN Branch are within the Communicable Disease and Public Health Nursing Division (see DOH Organizational Charts Attachments E, F, and G). These coordinated efforts are centralized within the Dept of Health because there are no separate county or local departments of health. Hawai’i Revised Statutes HAR Chapter 11-164.2 requires school employees and students, healthcare workers, residents of group homes, and workers in certain positions to undergo TB screening for a TB Clearance as part of the state’s TB control efforts. These control efforts, undertaken by TBB, include: 1. Screening to diagnose TB: a) risk assessment; b) skin testing (TST); c) IGRA testing (Quantiferon is the only IGRA available in Hawai’i); d) sputum testing; and e) chest X-ray. 2. Treatment of latent TB infection (LTBI) and active TB disease; 3. Contact investigation to diagnose and treat those exposed to TB disease; 4. Training and education of healthcare partners; 5. Disseminating TB related data to state and federal stakeholders. TBB monitors its performance of the National TB Indicators Project (NTIP) and shares these results at quarterly meetings. There are 12 indicators and 25 elements of these indicators; TBB meets or is within points of meeting the performance targets of 14 elements; TBB achieved 100% in three elements. During the 2020-2024 Cooperative Agreement (COAG) grant period, TBB was able to focus on NTIP #11: Examination of Immigrants and Refugees. With grant support, TBB now meets three of the four elements of NTIP #11. We were able to identify some of the barriers for B immigrants to initiate LTBI treatment, e.g. having to take more time off from work to return to the TB clinic for treatment counseling. As a result, measures are being implemented to make it more time efficient for B immigrants to undergo TB evaluation and start treatment. TBB is applying for continued federal funding under the new Tuberculosis Elimination and Laboratory Cooperative Agreement (CDC-RFA-PS-25-0003) to continue to improve its performance in achieving short-term, intermediate, and long-term outcomes towards TB elimination. TBB has identified specific areas for further improvement, particularly NTIP Objective #3: Contact Investigation. With continued funding for the grant period 2025-2029, TBB will focus its efforts to meet national performance targets by identifying barriers, which TB contacts encounter, to completing TB evaluation, initiating and completing LTBI treatment (see Project Narrative: Applicant Evaluation Performance Measurement Plan). TBB plans to do outreach to organizations representing the Pacific Islander communities to gain a better understanding of any cultural barriers, which may be affecting our contact investigation (CI) efforts. With this information, TBB will formulate a local CI training to be able to address these barriers. TBB’s goal is to actively reduce known health disparities through efforts such as: 1) targeted testing; 2) initiating and completing treatment of populations identified to have a disproportionately higher incidence of LTBI and TB disease, such as the immigrant populations from Asia (the Philippines, China, and Vietnam) and the migrant populations from the Pacific (Marshall Islands and Micronesia/Chuuk); and 3) initiating and completing treatment of populations at higher risk of progressing to TB disease due to comorbid illnesses, such as diabetes and chronic/end stage kidney disease.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).