IUATLD - North American Region, Chicago, IL. March 2001

Bower BL, El-Sadr W. Distilling Key Information From LTBI Guidelines: Strategy For Successful Implementation By Frontline Providers

Introduction: 10-15 million people in the US have latent TB infection (LTBI), and about 10% of them will develop TB disease. Identifying those with LTBI and ensuring completion of treatment are national TB control priorities. Appropriate implementation of new CDC/ATS guidelines is essential. A suitable format for specific provider groups is needed.

Methods: Four key decisions emerged among tasks that clinicians undertake in managing LTBI: 1) who to test, 2) who to treat, 3) which treatment regimen to use, and 4) monitoring treatment until completion. Key information from guidelines was distilled in a simple, user-friendly form. Expert review of content and presentation was obtained. A plan for dissemination and evaluation was developed and implemented.

Results: Three pocket reference cards were designed for identifying and treating LTBI among adults, women during pregnancy/postpartum period, and children/adolescents. Pre-tests identified physicians' preference for an action-oriented, durable, pocket-sized card, and these were modified accordingly. To date, 30,000 cards have been distributed. Early evaluation results indicate a positive response. 88% agree that the cards address a key TB control issue, 92% agree all essential information is included, and format and presentation are easy to use.

Conclusions: The three pocket reference cards demonstrate how detailed guidelines can be condensed into an easy-to-use and practical format. By providing information needed at key decision-making steps, these cards are useful and effective tools. Developing specific tools that are appropriate for broad clinician types is necessary to expand partnership in TB control efforts.