HomePerformance monitoring will be achieved by completing reports on the indicators presented here, according to the formulas provided in Table 2. Program performance indicators for the immediate past calendar year should be reported in February or March of the current year, except for treatment outcomes of all patients diagnosed with TB disease in the previous calendar year, which can be reported only a full year after. Annual program performance reports should be discussed with appropriate local public health representatives and community partners to ensure accountability, determine whether and how actions should be changed to improve outcomes and contextualize the information in a culturally-safe manner.35 Program managers (leads) are best positioned to implement change. This makes it crucial that program managers oversee the process and develop a mechanism to properly engage stakeholder groups.36 Annual summary reports should be published online to promote transparency and contribute to benchmarking efforts across the country.
Implementation of this program performance monitoring framework includes the completion of annual reports (to assess local performance over time) that are consistent across jurisdictions (to assess relative performance). Timely completion and sharing of these reports will help minimize delays in making program improvements. TB programs should allocate adequate human resources for data collection and validation to monitor these indicators. Validation should be performed in close collaboration with the physician/nursing leads and relevant community partners.
Table 2. Calculating and presenting TB program performance indicators.
| Goal of Elimination | |
|---|---|
| How to calculate performance for reporting | |
| 1.0 | Numerator: Number of TB cases who are notified in the jurisdiction between January 1 and December 31, inclusive. Denominator: Total mid-year population estimate. Formula: #of annual incident TB casesMid−year population estimate*100,00#of annual incident TB casesMid−year population estimate *100,00 In addition, calculate the necessary annual rate of decline to achieve pre-elimination within the jurisdiction (see below) where “years of difference” is the period between the year of reporting and 2035 and the target of 1 is the numerator. Annual%Change=1(pre−elimination target,per100,000population by2035crude rate per100,000population in year of reportingYears of difference−1*100Annual%Change=1(pre−elimination target,per100,000population by 2035crude rate per100,000population in year of reporting Years of difference−1*100 |
| Objectives for examination of immigrants and refugees | |
| 2.0 | Numerator: Number of Immigration, Refugees, and Citizenship Canada (IRCC) referrals dating from July 1 of the preceding year whose first appointment by a physician or designated public health specialist was achieved within six months of the date the referral was received. Denominator: Total number of IRCC referrals to the public health authority in the jurisdiction between July 1 and June 30. Formula: #of clients referred by IRCC for medical surveillance assessed within a period£180daysTotal#of clients referred by IRCC for medical surveillance within the previous12months*100#of clients referred by IRCC for medical surveillance assessed within a period£ 180 daysTotal#of clients referred by IRCC for medical surveillance within the previous 12 months*100 |
| Objectives for case management and treatment | |
| 3.0 | Numerator: Number of TB cases notified between January 1 and December 31 whose human immunodeficiency virus (HIV) status is known at the commencement of treatment. Denominator: Total number of TB cases treated. Formula: {#of annual incident TB casee with known HIV test results#annual incident TB case treated with>1anti−TB durg}*100{#of annual incident TB casee with known HIV test results#annual incident TB case treated with> 1 anti−TB durg}*100 HIV results include the following possibilities HIV-positive: medical documentation of a positive HIV test at any point in time. HIV-negative: medical documentation of a negative HIV test no more than 90 days before the start date of treatment for TB. |
| 3.1 | Numerator: Number of smear-positive (S), pulmonary TB (PTB) cases notified between January 1 and December 31 who initiate treatment within 72 hours of a positive nucleic acid amplification test (NAAT). Denominator: Total number of smear-positive, pulmonary TB cases. Formula: #of S+PTB case who initiate treatment within72hours of a positive NAATTotal#of S+PTB cases*100#of S+PTB case who initiate treatment within 72 hours of a positive NAATTotal#of S+PTB cases*100 |
| 3.2 | Numerator: Number of eligible smear-positive (S), rifampin-susceptible (by nucleic acid amplification test (NAAT)) pulmonary TB (PTB) cases notified between January 1 and December 31 who start four anti-TB drugs. Denominator: Total number of eligible TB cases treated. Exclusions: Patients judged to be at high risk for hepatoxicity, gout, and/or have a history of overt exposure to a source case who is known to have had drug resistant TB (any first-line anti-TB drug), and patients who have been previously treated will not count in the numerator or denominator. Formula: #of rifampin−susceptible(by NAAT)S+PTB cases who initiate4anti−TB drugs#of eligible S+PTB cases*100#of rifampin−susceptible(by NAAT)S+PTB cases who initiate 4 anti−TB drugs#of eligible S+PTB cases*100 |
| 3.3 | Numerator: Number of all culture positive (C), pulmonary TB (PTB) cases who have sputum submitted for acid fast bacillus (AFB) smear/culture, and a chest radiograph (CXR) within two weeks of the end of the initial phase of treatment. Denominator: Total number of culture-positive pulmonary TB cases who are alive and not transferred out at the end of the initial phase of treatment. Exclusions: Patients who die during the initial phase and/or transfer out of the jurisdiction before the end of the initial phase will not count in the numerator or denominator. Formula: #of C+PTB cases with AFB smear/culture and CXR with2weeks of the end of the initial phase#of eligibel C+PTB cases who initiated treatment,and are alive at the end of the initial phase*100#of C+PTB cases with AFB smear/culture and CXR with 2 weeks of the end of the initial phase#of eligibel C+PTB cases who initiated treatment,and are alive at the end of the initial phase*100 |
| 3.4 | Numerator: Number of annual incident TB cases notified in the preceding 12 months who were cured or completed treatment. Denominator: Total number of annual incident TB cases notified in the preceding 12 months who were alive at diagnosis, and who started ≥ one anti-TB drug. Exclusions: Patients with rifampin resistance, patients whose treatment was initiated in another Canadian jurisdiction (transferred in), and patients who have transferred out of country during treatment are excluded from the numerator and denominator. Formula: {#of notified cases in the preceding year(all forms)who were cured or completed treatment#of notified cases in the preceding year alive at diagnosis,who started>1anti−TB drug}*100{#of notified cases in the preceding year(all forms)who were cured or completed treatment#of notified cases in the preceding year alive at diagnosis,who started>1anti−TB drug}*100 |
| 3.5 | Does the TB program have dedicated social worker support? If yes, their performance should be monitored according to the objective needs of patients and clients in the jurisdiction (See section 5.3 for examples). If no, the program, under the direction of the program manager/lead, should define the objective needs of underserved patients and clients in the program to advocate for dedicate social worker support. |
| Objectives for contact management | |
| 4.0 | Numerator: Number of close (household and non-household) contacts of smear-positive (S) pulmonary TB (PTB) cases notified between January 1 and December 31 whose initial contact encounter was within 3 working days of the contact having been listed. Denominator: Total number of close contacts of annual incident smear-positive pulmonary TB cases. Formula: #of close contracts of S+PTB source case whose initial contact encounter occurs within3days#of close contacts of S+PTB source cases*100#of close contracts of S+PTB source case whose initial contact encounter occurs within 3 days#of close contacts of S+PTB source cases*100 |
| 4.1 | Numerator: Number of close (household and non-household) contacts of smear-positive (S) pulmonary TB (PTB) cases notified between January 1 and December 31 who are completely assessed*. Denominator: Total number of close contacts of annual incident smear-positive, pulmonary TB cases. Formula: #of completely assessed close contacts of S+PTB source cases#of close contacts of S+PTB source cases*100#of completely assessed close contacts of S+PTB source cases#of close contacts of S+PTB source cases*100 * A complete assessment consists of: Testing for LTBI as indicated, a medical evaluation and CXR if indicated, plus sputum exams if needed (For more details, see Chapter 4). |
| 4.2 | Numerator: Number of close (household and non-household) contacts of smear-positive pulmonary TB cases notified between January 1 and December 31 eligible for TB preventive therapy (TPT) who initiate treatment, Denominator: Total number of close contacts of annual incident smear-positive pulmonary TB cases, who are eligible for TPT. Formula: {#of close contacts of S+PTB source case eligible for TPT who initiate#of close contacts of S+PTB source eligibel for TPT}*100{#of close contacts of S+PTB source case eligible for TPT who initiate#of close contacts of S+PTB source eligibel for TPT}*100 |
| 4.3 | Numerator: Number of close (household and non-household) contacts of smear-positive (S) pulmonary TB (PTB) cases notified between January 1 and December 31 eligible for TB preventive therapy (TPT) who initiated and complete treatment Denominator: Total number of close contacts of annual incident smear-positive pulmonary TB cases, eligible for TPT who initiated treatment of latent TB infection. Formula: #of close contacts of S+PTB source cases who completed TPT#of close contacts of S+PTB source cases who initiated TPT*100 |
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