Tuberculosis Standard Operating Procedure
The TB Control Program has developed a standard operating procedure (SOP) for local public health agencies to assist in education and case management. This document is intended to provide a framework of how to investigate and treat cases of latent TB infection and active TB disease in Iowa and represent the policies and procedures of the Iowa Department of Public Health TB Control Program.
Local Public Health SOP
Directly Observed Therapy (DOT)
The Iowa TB Control Program provides incentive funding to LPHAs to perform DOT for suspected/confirmed cases of TB disease. Clinical benefits of DOT include significant reductions in disease relapse, treatment failure, and development of multidrug-resistant TB (MDR-TB). A cost benefits analysis demonstrates it cost $2,500 to treat drug susceptible TB and $250,000 to treat MDR-TB.
There is limited availability for DOT incentive funding for LTBI with high-risk patients (HIV+ individuals, children less than 5 years of age, MDR/XDR-TB contacts).
It is the expectation that health departments that accept incentive funding for DOT will perform DOT with the patient until treatment completion. Regardless of availability of incentive funding, DOT remains the standard of care. The CDC, IDSA, WHO, and ATS recommend all healthcare providers implement DOT on each active case of TB.
While there is no incentive funding for extrapulmonary cases of TB disease, DOT is still strongly recommended for the same clinical reasons listed above.
Contact the TB Program Manager at 515-281-7504 to discuss DOT reimbursement.
LPHAs in Iowa are responsible for conducting investigations of infectious TB. The TB Control Program Manager and Nurse Consultant will provide direct consultation to LPHAs on each case of infectious TB. Consultation consists of:
- When to initiate a contact investigation
- Assigning priorities to contacts
- Diagnostic and public health evaluation of contacts
- When to expand a contact investigation
- Data management of contact investigations
IDSS is the reporting system utilized by IDPH. Once the TB controller has initiated TB case in IDSS the LPHA will be notified and the “TB Contacts” tab will be available for completion.
TB Control Program Forms (TB Disease)
- Adult Patient information Sheet for Treatment of Active Disease
- Child Patient Information Sheet for Treatment of Active Disease
- DOT Tracking Log
- Suspected/Active TB Patient Intake Form
TB Control Program Forms (LTBI)
State Hygienic Lab at the University of Iowa
The State Hygienic Lab (SHL), formerly known as the University Hygienic Lab (UHL), serves as the main lab for the Iowa TB Control Program. The TB Control Program requests that clinicians who suspect a patient has TB utilize the SHL for rapid identification of M. tuberculosis complex isolates using rapid method such as DNA probe, nucleic acid amplification or HPLC.
- reporting of AFB smear results to health-care providers within 1 day;
- reporting of culture identification of M. tuberculosis complex within 21 days;
- reporting of drug-susceptibility test results within 30 days; and
- reporting of all positive test results to the specimen submitter within 1 working day from the date of report.
Lab results are directly communicated to the Iowa TB Control Program allowing for timely consultation with clinicians and local public health agencies.