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Example Program Evaluation Plan for State & Local TB Programs							Updated August 10, 2020
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PDF Version***Disclaimer:**The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program evaluation should be identified by state or local TB program officials in collaboration with other stakeholders. The example provided here is not intended to be applied directly to any specific TB program.***Program Evaluation Topic/Focus Area: Completion of Treatment for Tuberculosis Disease by Using Incentives and Enablers**Background*The purpose of this section is to provide background, purpose or rationale, and intended use of your evaluation results. What are the expected outcomes and impact, if successful?*
***Background and Rationale***
**Scenario:** In August 2020, a Tuberculosis (TB) prevention and control program of a county public health department implemented activities that address barriers and improve TB completion of treatment (COT) within 12 months among patients receiving clinic-based, directly observed therapy (DOT). TB patients who receive DOT at home (or other locations) have high completion rates; therefore, the focus of this evaluation is on patients who come to the clinic for DOT.
Activities included providing bus passes for TB patients so that they can get to the clinic for DOT, expanding clinic hours so that patients have more flexibility regarding when they must arrive for DOT, and rapidly following up to reschedule patients who miss a DOT visit. This process evaluation assesses the success of those activities.
**Goal:** Meet the 2025 National Performance Target (95%) of patients with newly diagnosed TB disease who complete treatment within 12 months among those who are eligible to complete treatment within 12 months.On This Page
			Evaluation Plan DetailsEvaluation Findings & ConclusionsProgram FacilitatorsProgram ChallengesUse of FindingsDeliverablesResourcesObjectives*Should be specific, measurable, attainable, realistic, and time-bound (SMART).*
By December 2021, decrease the percentage of TB patients with missed doses of in-clinic DOT from 10%/week to 5%/week.
By December 2021, increase the overall percentage of TB patients who complete treatment from 86% to 90%.Corresponding National TB Indicators Project Indicator*Program evaluation should ideally reflect the National Tuberculosis Indicator Project (**NTIP**).*
*Please specify the NTIP indicator addressed by this evaluation.*
*If the evaluation is not linked to an NTIP indicator, please provide an explanation regarding how the evaluation relates to your scope of work.*
**Corresponding NTIP indicator:** Completion of Therapy – the proportion of patients who completed treatment within 12 months among those for whom ≤12 months of treatment was indicated.Open All Close All
Evaluation Plan DetailsEvaluation Plan Details
**Evaluation Question**
**Measure**
**Data Source**
**Method of Analysis**
**Target**
**Timeline of Activities and Person
Responsible**Are bus passes, extended clinic hours, and follow-up telephone calls for missed directly observed therapy (DOT) effective ways to increase the number of patients who come to the clinic for DOT?
Proportion of patients who received bus passes
Number of patients who came to clinic during extended hours
Proportion of patients who rescheduled a same-day DOT when the scheduled DOT time is missed
Bus pass purchase receipts
Patient self-reported use of bus passes
Clinic DOT logs and schedule
Number of patients who used a bus pass out of the number of patients who received a bus pass
Number of patients who came during extended hours
Number of patients who rescheduled same-day DOT out of the total number of patients who missed their scheduled DOT time
90% of patients who received bus passes arrive at clinic by scheduled DOT time
At least 5 patients/week come to the clinic during extended hours
90% of patients who miss their scheduled DOT time are rescheduled
**August 2020–December 2021**
•   DOT outreach workers will supply bus passes to eligible patients
•   TB program manager will partner with sexually transmitted disease clinic to use their extra clinic hours for DOT patients
•   DOT outreach workers attempt to reschedule missed DOT visit
•   TB Program Evaluation Network (PEN) focal point and DOT outreach workers will develop and implement standard operating procedures for using incentives and enablers
•   TB PEN focal point and DOT outreach workers will develop and implement standard operating procedures for follow-up on patients who miss their scheduled DOT time.
**January–August 2021**
•   Epidemiologist and TB PEN focal point collect data weekly from clinic logs and bus pass records
•   Data are assessed and shared with the TB program manager
•   Areas not meeting the indicator are addressed (e.g., DOT worker not rescheduling same-day appointments or patients not showing up during extended clinic hours)Was the program able to increase completion of treatment among patients TB patients?
The proportion of TB patients eligible to complete treatment within 12 months who truly completed it within 12 months
National Tuberculosis Indicator Project (NTIP)
Local surveillance system data
Number of patients who completed treatment out of the number of patients eligible to complete treatment within 12 months
By December 2021, 90% of eligible patients complete treatment within 12 months
**January–December 2021**
•    Status of indicator is assessed during monthly meeting with clinic staff, TB program manager, epidemiologists, and PE focal points
•    Epidemiologist and PE focal points review, monitor, and present NTIP data related to each indicator
•    Clinic staff present successes and challenges in completing treatment among TB patientsEvaluation Findings & ConclusionsEvaluation Question and Related Findings
**Evaluation Question and Related Findings**
**Benchmark**
**Met or Not Met****Are bus passes, extended clinic hours, and follow-up telephone calls for missed appointments effective ways to increase the number of patients who come to the clinic for DOT?**• 9 of 12 (75%) patients who were given bus passes arrived at the clinic for DOT at their scheduled time.
Goal 90% Not Met• 5 of 5 patients (100%) who expressed the need for extended clinic hours arrived at the clinic for DOT during extended
hours; 6 additional patients who had not previously expressed this concern also used extended clinic hours for DOT.
Goal 95% Met• 7 of 8 (88%) patients who missed DOT visits at the clinic were rescheduled by DOT workers the same day, and 1 (12%)
patient who did not answer the telephone was not rescheduled and treatment will be extended accordingly.
Goal 90% Not Met**Was the program able to increase completion of treatment among TB patients?**• Although we did not reach the 2025 target of 95% completion of treatment within 12 months for eligible patients, the
proportion who completed treatment increased from 86% to 90% in 2021 (among patients who could have completed
treatment during the year of the evaluation).
Goal 90% MetProgram Facilitators***What helped facilitate completion of this evaluation?***
Optimal relationship with sexually transmitted disease (STD) clinic.
Flexibility in rescheduling appointments and multiple contact numbers for patients (in case one number did not work).
Weekly and monthly data review and follow-up from epidemiologist, program evaluation staff, and the TB program manager.
Financial support from the state health department for incentives and enablers.Program Challenges***What major challenges did you face during this evaluation? If you did not meet your benchmark, please explain why.***
Extracting information from clinic logs was time consuming and it was difficult to find information.
Although we knew how many bus passes were provided and to whom they were provided, there was no way to track how many bus passes were actually used (sometimes the DOT worker did not ask the patient if they used a bus pass that was provided by the clinic).
Difficulty remembering to follow up with patients (DOT worker), no patient contact information, and patient not answering the telephone or being unreachable.
DOT workers are already busy, and it took a lot of time to do follow up for missed appointments.
Long-term use of free bus passes will be difficult due to the expense and lack of resources.Use of Findings***How did you use the findings from this program evaluation?***
Findings from this evaluation were used to
Negotiate with STD clinic manager to increase extended STD clinic hours for DOT patients. Cross-trained volunteer STD outreach workers to perform and record DOT.
Provide training to DOT workers regarding using an appointment log or patient checklist to keep track of appointments.
Brainstorm ways to help remind DOT workers when a patient is >30 minutes late or does not appear (e.g., put reminders on telephone calendar or cell phone alarm or check appointment log every hour).
Justify cost of bus passes to help patients arrive at the clinic for DOT and alternative schedules for DOT workers who participate in extended STD clinic hours.Deliverables, Products & Dissemination Plan***Please provide a list of final deliverables and describe how you plan to disseminate to stakeholders.***
Share information during staff meetings, budget meetings, and cohort review meetings.
Sustain line item for bus passes in each annual budget.
Check-in quarterly with STD clinic manager to discuss any problems related to shared clinic hours.
Adjust DOT worker schedules to accommodate extra clinic hours.
Add contact sheet for missed or late appointments and reschedules to electronic scheduling system.
Revise the standard operating procedures for use of incentives and enablers and follow-up for missed appointments based on lessons learned during the evaluation period.ResourcesSelf-Study Modules on TB,  Module 6 – Managing Tuberculosis Patients and Improving Adherence [PDF – 4 MB]
							
					
						Page last reviewed:  August 10, 2020					Content source: 	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention homeTuberculosisBasic TB Factsplus iconHow TB SpreadsLatent TB Infection and TB DiseaseSigns & SymptomsTB Risk FactorsExposure to TBTB PreventionVaccinesTB & HIV CoinfectionTB and DiabetesTB TermsPersonal StoriesTesting & Diagnosisplus iconWho Should be TestedTesting for TB InfectionTesting in BCG-Vaccinated PersonsTB Screening and Testing of Health Care PersonnelTesting During PregnancyDiagnosing latent TB infection and TB diseaseTreatmentplus iconDeciding When to Treat Latent TB InfectionTreatment Regimens for Latent TB Infection (LTBI)Treatment for TB DiseaseAdverse EventsTB Treatment of Persons Living with HIVTB Treatment and PregnancyTB Treatment for ChildrenFrequently Asked QuestionsDrug-Resistant TBResearchplus iconTB Epidemiologic Studies Consortiumplus iconResearch ProjectsPublicationsTB Trials Consortiumplus iconStudy DescriptionsBackgroundBehavioral & Social Science ResearchHealth Care Settingsplus iconTB Infection Control in Health Care SettingsResources for TB Screening and Testing of Health Care Personnelplus iconFrequently Asked QuestionsTB in Specific Populationsplus iconHealth DisparitiesAsian PersonsBlack or African American PersonsHispanic or Latino PersonsChildrenPregnancyCorrectional FacilitiesPeople Experiencing HomelessnessInternational TravelersLaboratory Informationplus iconDrug Susceptibility TestingFalse-Positive Investigation ToolkitInterim Laboratory Biosafety Guidance for XDR  tuberculosis strainsModel Performance Evaluation Program (MPEP)Rapid Molecular Testing to Detect Drug-Resistant TB in the USplus iconExecutive SummaryIntroductionBackground on Tests for Molecular Detection of DRGeneral Considerations and Principles for a Molecular DR Testing ServicePossible Scenarios and Scope of Testing for a Molecular DR Testing ServiceResearch NeedsGeneral Recommendations of the Expert PanelCommunication Plan for the ReportRecommendationsReferencesPanel Members and CDC ParticipantsAppendix 1Appendix 2Appendix 3The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TBplus iconGeneral ConsiderationsGeneral Recommendations of the Expert PanelRecommendations to ACET, CDC, DTBEData & Statisticsplus iconTB Incidence in the United StatesReported TB in the US, 2022 Surveillance Reportplus iconNational DataReporting Area DataRisk FactorsDemographicsTB Treatment and Case OutcomesDrug-Resistant TBMolecular SurveillanceTuberculosis in the United States, 2022 (Slide Set)Archived Surveillance Reports and Slide Sets2021 State and City ReportArchived State and City ReportsProfessional Resources & Toolsplus iconTools for Healthcare ProvidersResources for TB Programsplus iconStrengthening Civil Surgeons’ Capacity to Improve LTBI Surveillance and Outcomes Among Status AdjustersNotice of Funding Opportunity (NOFO)Program EvaluationTB Centers of ExcellenceTB Elimination AllianceTB Genotypingplus iconConventional TB GenotypingWhole Genome SequencingTB GIMSAnalytic ToolsLatent Tuberculosis Infection ResourcesPublications & Productsplus iconPatient and Public MaterialsFact SheetsGuidelinesplus iconControl & EliminationDrug-Resistant TBInfection Control & PreventionLaboratory & GenotypingTB & HIVTB in Specific PopulationsTesting & DiagnosisTreatmentVaccines & ImmunizationsArchived TB GuidelinesGuides & Toolkitsplus iconAggregate ReportsCDC TB Surveillance TrainingCore CurriculumEffective TB Interviewing for Contact InvestigationEthnographic GuidesFalse-Positive Investigation ToolkitForging Partnerships to Eliminate TuberculosisGuide to Application of GenotypingLTBI: A Guide for Primary Health Care ProvidersMantoux Tuberculin Skin Testing ProductsReport of Verified Case of Tuberculosis (RVCT)Self-Study ModulesTB Contact Investigation Interviewing Skills CourseTB eDOT ToolkitUnderstanding the TB Cohort Review ProcessNewslettersplus iconTB Notes, No. 4, 2023TB Notes, No. 3, 2023TB Notes. No. 2, 2023TB Notes. No. 1, 2023TB Notes, No. 4, 2022TB Notes, No. 3, 2022TB Notes, No. 2, 2022TB Notes, No. 1, 2022TB Notes, No. 4, 2021TB Notes, No. 3, 2021TB Notes, No. 2, 2021TB Notes, No. 1, 2021Pamphlets, Brochures, Bookletsplus iconQuestions and AnswersPatient Education SeriesTuberculosis - Get the FactsTuberculosis - The Connection between TB and HIV12-Dose Regimen for Latent TB Infection-Patient Education BrochurePostersplus iconMantoux Tuberculin Skin Test Wall ChartWorld TB DayThink TBStop TBTake on TBReports & Articlesplus iconDTBE Authored Journal ArticlesTuberculosis Laboratory Aggregate ReportsSlide Setsplus iconIntroduction to TuberculosisEpidemiology of Tuberculosis Among Non-U.S.​–Born Persons in the United States, 1993–2016Self-Study Modules on Tuberculosis, 1-5 Slide SetsThe Tuberculosis (TB) in Correctional Settingsplus iconFacilitator GuideIntroduction to TB GenotypingEpidemiology of Tuberculosis in Correctional Facilities, United States, 1993-2017Prevention and Control of Tuberculosis in Correctional and Detention FacilitiesGuidelines for Preventing the Transmission of M. TB in Health care SettingsInvestigation of Contacts of Persons with Infectious TBEpidemiology of Pediatric Tuberculosis in the United StatesTargeted Tuberculosis Testing and Treatment of Latent Tuberculosis InfectionElectronic Tools & ResourcesWeb-Based Courses & Webinarsplus iconTB 101 for Health Care WorkersContent SyndicationInfographicsplus iconSocial Media GraphicsCustomizable Take on TB Infographic with InstructionsEventsWorld TB Dayplus iconU.S. TB ChampionsHistoryFeaturesplus iconTB Risk FactorsTreating Latent TB Infection with Short-Course RegimensWorld Tuberculosis (TB) Day 2021World Tuberculosis (TB) Day 2020Linksplus iconState TB Control OfficesAbout Usplus iconMission Statement and Activitiesplus iconDTBE Strategic PlanNational TB Program ObjectivesOrganization ChartAdvisory Groupsplus iconFederal TB Task Force


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