Eyeing a Global Health Issue
Kay Libbus
Communicable diseases are a continuing public health concern, and tracking documented cases of contagious diseases, such as tuberculosis, is an important step in identifying and controlling outbreaks. The State of Missouri maintains registries that document communicable disease cases. But ensuring that all cases are registered properly is an ongoing challenge for public health workers.
Nursing Professor Kay Libbus recently examined the state’s registries for HIV and TB infection. She found a number of discrepancies. In some cases, individuals listed on the HIV registry as also having TB were nowhere to be found on the state TB registry. Libbus set out to verify whether these individuals actually did have positive TB diagnoses.
“The problem with missing names on the registries is that it makes it difficult to follow up and increases the risk of disease spread,” she says.
After accessing patient records, some of which were years old, Libbus found some cases in the HIV registry were simply miscoded, indicating a TB diagnosis when none actually existed. Regardless of the cause of the unclear registry records, the study piqued Libbus’ interest in addressing the screening and prevention of TB.
“Tuberculosis is a serious health concern, especially among those with a compromised immune system,” she says. “This is very much still a global health problem.”
Taking her interest to the next level, Libbus teamed up with Lynelle Phillips, a Missouri-based communicable disease specialist for the national Centers for Disease Control and Prevention. The pair examined TB case management in rural Missouri, identifying barriers to traditional care provided by rural public health nurses.
“TB is usually treated through a course of directly observed therapy, in which a nurse actually administers the treatment to the patient and observes the patient as he or she takes the medication. But that’s difficult in a remote area where nurses may have to travel long distances to see each patient,” Libbus explains.
Another important population that must be screened and treated to prevent the spread of TB resides on college campuses. Foreign-born students carry a higher risk of TB, and it’s important for student health centers to follow proper protocols in screening and administering treatment.
To address this concern, Libbus and Phillips created a set of guidelines that will be distributed to campus health centers nationwide. The project was funded by a $50,000 grant from the Heartland Tuberculosis Control Center, located at the University of Texas.
“Some colleges and universities have very good TB protocols,” Libbus says. “However, many do not, and there are no national recommendations to follow.” Libbus and Phillips outlined a recommended screening protocol and appropriate follow-up care. They plan to evaluate the success of the guidelines once they have been available for a couple of years.
In the meantime, Libbus is turning her attention to a potential national study of nurse case management of tuberculosis. She also has been exploring the transmission of Hepatitis B from mothers to infants.
“We still have to be aware of the risks of communicable disease,” she says. “We can’t afford not to be vigilant.”