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DTBE Evaluation Plan and Annual Report Example							Updated August 17, 2020
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PDF Versionpdf icon***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: Identify Factors Related to Patient Completion of Treatment for Latent Tuberculosis Infection**
**Planned Start Date: October 1, 2020 – Planned Completion Date: August 1, 2021**
**Part A: Evaluation Plan***(Please update as necessary when submitting annual report*.)Background, Rationale, & Expected Outcome*Please provide a background, purpose or rationale (what activity or program component are you evaluating, and why have you chosen that particular activity or program component to evaluate) and expected outcome of your project.*
**Background and Rationale:**
**Scenario:** Completing treatment among patients with latent tuberculosis infection (LTBI) is needed to prevent development of active tuberculosis (TB) disease; and promote progress towards TB elimination. Despite these important goals, over the past 3 years our program has not been making progress towards meeting the 2025 national target of at least 93% of contacts to sputum acid-fast bacilli smear-positive TB patients newly diagnosed with LTBI completing treatment. While almost all patients with LTBI begin treatment, a third do not complete treatment. Understanding why this occurs will assist in designing interventions that promote completion of treatment among persons with LTBI.
**Long Term Goal:** Meet the 2025 National Performance Target (93%) of patients with newly diagnosed TB disease who complete treatment within 12 months among those who are eligible to complete treatment within 12 months.
**Expected Outcomes\Short Term Goals:**
Identify factors affecting success or failure to complete treatment among patients with LTBI. Using this information, the TB program will design and implement a plan that addresses these factors.On This Page
			Evaluation Plan DetailsEvaluation FindingsProgram FacilitatorsProgram ChallengesUse of FindingsDeliverablesObjectives*Please provide 1 or more objectives for each goal of the evaluation topic. Objectives should be Specific, Measurable, Achievable, Realistic, and Time-bound (SMART). Each objective must have at least 1 Evaluation Question.*
Identify facilitators, barriers, and potential solutions to barriers expressed by patients in complying with LTBI treatment during October 1, 2020–May 1, 2021.
Identify facilitators, barriers, and potential solutions to barriers expressed by public health staff in promoting completion of LTBI treatment during October 1, 2020–May 1, 2021.
Identify characteristics of patients succeeding or failing to comply with LTBI treatment during October 1, 2020–May 1, 2021.
Identify public health system factors that might be related to patients succeeding or failing to comply with LTBI treatment and possible solutions to barriers during October 1, 2020–May 1, 2021.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 the scope of work in your cooperative agreement with the Centers for Disease Control and Prevention (CDC).*
**Contact Investigations:**LTBI Completion of Treatment
**Examination of Immigrants and Refugees:** Completion of LTBI treatment among contacts of persons with LTBIEvaluation Plan Questions, Indicators, Analysis, & Timeline**Evaluation Question**
**Measure**
**Data Source**
**Method of Analysis**
**Target**
**Timeline/Persons Responsible***1.   Each evaluation question or activity must correspond to an objective*
*1.1 Each evaluation question should have its own deliverable*
*1.2 Having multiple deliverables per question is permissible*
*1.1. Each deliverable needs a data source*
*1.1 Each deliverable should have a way to be calculated or measured objectively*
*1.1. How will you know your deliverable was met?*
*1.1  What is your anticipated timeline and who is responsible for different aspects of the evaluation?*1.   What are facilitators, barriers, and potential solutions to barriers expressed by patients in complying with LTBI treatment?
75% of LTBI patients will identify facilitators, barriers, and potential solutions to barriers
Medical records of LTBI patients receiving treatment during November 1, 2020–May 1, 2021
Each patient will be asked by nursing staff about facilitators, barriers, and potential solutions to barriers during ≥2 treatment sessions
75% of all LTBI patients receiving treatment during November 1, 2020–May 1, 2021, will be asked to identify facilitators, barriers, and potential solutions to barriers to treatment
*Develop questions, a database for responses, and instruct nurses*: October 1–November 1, 2020
*Data collection*: November 1, 2020–May 1, 2021
*Analysis:* May 1–July 1, 20212.   What are facilitators, barriers, and potential solutions to barriers expressed by public health staff in promoting completion of LTBI treatment?
90% of health care staff identify and record facilitators, barriers, and potential solutions to barriers to patient adherence with LTBI treatment
Health care staff conducting examinations, administering medication, or overseeing directly observed treatment (DOT) or electronic DOT (eDOT) to LTBI patients November 1, 2020–May 1, 2021
Each health care staff member will complete a questionnaire regarding facilitators, barriers, and possible solutions to barriers during November 1, 2020–May 1, 2021
90% of health care staff will identify and record facilitators and barriers to providing treatment
*Develop questions, database for responses:* October 1-November 1, 2020
*Data collection:*November 1, 2020–May 31, 2021
*Analysis:* June 1–August 1, 20213.   What are patient characteristics among those succeeding or failing to comply with LTBI treatment?
Using the electronic surveillance system, review 50% of patients receiving treatment for LTBI November 1, 2020–May 1, 2021, and record treatment adherence and selected variables
Electronic surveillance system
The TB coordinator will conduct a review by using the electronic surveillance system for a random sample of 50% of eligible patients (patients receiving LTBI treatment during November 1, 2020–May 1, 2021)
75% of eligible patients will have variables extracted and recorded
*Select primary and secondary variables:* October 1–November 1, 2020
*Develop database to input abstracted data:* November 1–December 1, 2020
*Records review and abstraction:*
May 1–June 1, 2021
*Analysis:* June 1–July 1, 20214.   What public health system factors do clinic administrative and management staff express as affecting whether patients succeed or fail to complete LTBI treatment, and what solutions to possible barriers to LTBI treatment completion are expressed?
Staff involved in clinic administration or management will participate in a structured meeting to discuss analyses and brainstorm about related health system factors affecting LTBI treatment completion and strategies for addressing those factors
Structured meeting
Clinic administrative and management staff will discuss perceived facilitators, barriers, and potential solutions to barriers to LTBI treatment completion
At least four staff involved in clinic administration or management will participate in the structured meeting
*Develop structured meeting questions:*
May 1–July 1, 2021
*Conduct meeting:*
July 1–15, 2021
*Write up meeting summary:*
July 15–August 1, 2021**Part B: Evaluation Findings and Conclusions***(This section should be updated with submission of the annual report, if new findings are available, when the evaluation is complete.)*Is this a final report of a completed evaluation or an interim report of an ongoing evaluation? Final

Open All Close All
Evaluation Findings**Evaluation Question or Indicator Outcomes***(Listed results are by evaluation question and per NTIP indicator, if appropriate.)*
**Benchmark****Met or Not Met***1.*What facilitators, barriers, and possible solutions to barriers were expressed by patients in complying with treatment for LTBI?
20 eligible patients; 19 interviewed
*Facilitators*
Being given a bus pass (expressed by 10 patients); later clinic hours (5 patients); Sunday clinic hours (2 patients)
*Barriers*
Cannot easily walk to the bus; clinic not open evenings
*Possible Solutions to Barriers*
eDOT; evening clinic hours
Met — 90% of patients asked about barriers and facilitators*2.*What facilitators, barriers, and possible solutions were expressed by public health staff in promoting completion of LTBI treatment?
10 eligible staff; 7 interviewed.
*Facilitators*
Calling patients who are late to remind them (4 nurses); having a regular schedule so that staff can develop a relationship with the patients (2 respondents)
*Barriers*
Constantly being assigned to different areas of the public health clinic so that staff do not develop a relationship with patients (3 respondents); too little time allotted for visits so that staff are unable to have a meaningful conversation with the patient receiving DOT (2 respondents)
*Possible Solutions to Barriers*
Nursing managers improve consistent assignment of staff, increase time allotted to visits by 5 minutes each, and development of prompting questions that can guide health care staff in identifying patients’ barriers to treatment completion
Not met — 70% of eligible staff interviewed instead of 90% because of staff turnover3. What are patient characteristics among those succeeding or failing to adhere with the LTBI treatment regimen?
20 eligible patients; all electronic records reviewed
*Characteristics of Adherent Patients (12 Patients)*
Ages 30–60 years; ability to speak English fluently; or being US-born
*Characteristics of Nonadherent Patients (8 Patients)*
Ages 20–30 years or ≥60 years; being male; not speaking English well; or being homeless for part of the treatment period
Met — all records reviewed4. What public health system factors do clinic administrative and management staff express as affecting whether patients succeed or fail to complete LTBI treatment, and what possible solutions to barriers are proposed?
*Successful Adherence*
Extended clinic hours
*Unsuccessful Adherence*
Lack of communication with local homeless shelters
*Possible Solutions to Barriers*
Extend clinic hours; develop association with homeless shelter staff
Met — 5 staff participated and provided feedback in structured meetingProgram Facilitators**What helped facilitate the completion of this evaluation?***(This is helpful for other programs who might want to try a similar evaluation.)*
Having a timeline and an example to follow
Attending monthly calls with the CDC program evaluation consultant
Organized and up-to-date electronic surveillance recordsProgram Challenges**What major challenges did you face during this evaluation?***(If you did not meet your benchmark, explain why here.)*
Not enough time was allotted for the records review and abstraction
Many variables were missing from the records
3 staff were unavailable for interviewUse of Findings**How did you use the findings?**
We held a meeting with health care staff and clinic management on August 12, 2021, during which we reviewed all of the findings and discussed facilitators, barriers, and possible solutions to barriers. We identified multiple strategies for addressing barriers and expanding facilitators, as follows:
Provide a bus pass for all eligible and interested patients (i.e., those expressing difficulty getting to the clinic)
Extend clinic hours from 5:00 to 6:00 pm each day
Develop and maintain a contact list of patients and a protocol or follow-up if they are ≥30 minutes late for an appointment
Decrease shifting of TB staff to other clinic areas during hours when the majority of DOT patients come to the clinic
Adopt use of culturally and linguistically appropriate materials and use of an alternative language telephone line or other interpreter service
Establish an association with nearby homeless shelter staffList of Deliverables & Dissemination Plan*Please provide a list of final deliverables and describe how you plan to disseminate to appropriate stakeholders.*
Include funding for bus passes in the next annual budget (September 2021)
Revise staffing structure so that the clinic can remain open an additional hour each day (Begins October 2021)
At next staff meeting, instruct nursing staff to maintain contact sheet for DOT patients and to call them if they are ≥30 minutes late.
Find and use TB materials in patients’ first language or develop materials in patients’ first language if none are found
Schedule meeting with director of nearby homeless shelters to discuss areas for collaboration
							
					
						Page last reviewed:  August 17, 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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