A Market-based Approach to Improving Passive Surveillance of Tuberculosis in Tarrant County

Purpose: To explore a new method of public health action to further domestic tuberculosis (TB) elimination efforts through cooperation with private healthcare partners in the Tarrant County, Texas public health catchment. U.S. efforts towards TB elimination have recently stalled. Research has shown that these efforts should be expanded to include latent TB infection (LTBI). However, limited resources, a vague mandate, and more make it difficult for public health to maintain consistent surveillance and treatment of LTBI. Therefore, a market-based approach is an attractive method for addressing this new focus. Understanding facilitators and barriers is paramount to developing such an approach. Experience from this limited context, a largely urban population of just over 2 million, will inform if and how a market-based approach can contribute to national TB control efforts. Methods: Interviews and focus group discussions with key individuals from the Tarrant County public health catchment were held beginning 5/19/2017 to explore (1) supporting research, (2) community partners serving at-risk populations, (3) facilitators and (4) barriers. Results: (1) Supportive evidence from epidemiology, economics, public health, private healthcare, etc. potential gross for local providers exceeding $7 million estimated 14.5% of Tarrant’s 2015 population are high risk (2) In Tarrant County, there is one federally qualified healthcare center organization that serves a significant portion of high risk individuals. (3) Facilitators include partner healthcare organizations, CDC support, provider advocates, etc. (4) Barriers include costs (real and perceived), changes to clinical and documentation practices, coding/billing, etc. Conclusions: There is a wealth of evidence to support the feasibility of such a project. Identification of the appropriate at-risk population(s) and their respective healthcare providers highlights community partners likely to be interested in such a project. Through the collection of appropriate resources, use of identified facilitators, and addressing of respective barriers, the project could be implemented at little to no direct cost to the private healthcare organization. Furthermore, the combination of these could yield an effective program that is financially lucrative, thereby meeting the goals of both public health and private healthcare.