Overview
The Massachusetts Department of Public Health (DPH) Bureau of Infectious Disease and Laboratory Sciences (BIDLS) takes an integrated approach to addressing HIV, viral hepatitis, STIs, TB, and other related infections of public health importance such as Mpox. This involves integrated policy approaches; centralized specimen collection; co-testing (for HIV, HCV, and syphilis); HIV, viral hepatitis, and STI disease surveillance and case management in a single data system; and an integrated infectious disease drug assistance program. For the SHIP, DPH is focusing on HIV, STIs and TB.
Check out the other topics in this priority area: HIV and STIs.
Goals
The Massachusetts Tuberculosis elimination plan includes various strategies to prevent, control, and eventually eliminate tuberculosis in the state. Some of the key strategies are:
1. Early detection: Enhancing early detection of TB infection and TB disease is critical to reducing transmission and improving outcomes. The state aims to achieve this by increasing awareness among clinicians and patients, promoting routine TB screening, and providing timely and accurate laboratory services.
2. Targeted testing: Scaling up TB testing and Latent Tuberculosis Infection (LTBI) management for persons at risk of progression to tuberculosis disease in primary care and congregate settings is important to prevent the spread of the disease and provide timely treatment for those affected. This includes domestic TB screening of newly arrived refugees and immigrants, providing follow-up care to those with class A and B conditions, and offering targeted testing to high-risk groups and contacts.
3. Treatment optimization: Optimizing TB treatment options and drug availability is essential to ensure patient compliance and eradicate TB infection, prevent transmission, and prevent the development of drug resistance. The state is committed to providing high-quality, culturally appropriate, patient-centered care that addresses social determinants of health to promote equitable access and treatment completion.
4. Epidemiologic Surveillance System: Maintaining an effective surveillance system is important in identifying affected communities, the geographic distribution of cases, comorbidities, and LTBI trends. This information provides a foundation for equitable, culturally appropriate interventions and helps track progress toward TB elimination.
5. Education and training: Providing audience-tailored TB education and training for public and private sector staff and patients is crucial to advancing the TB elimination plan. The state provides training opportunities to healthcare providers, local boards of health partners, and others involved in TB prevention and control to ensure they have the knowledge and skills to deliver high-quality care.
6. Program evaluation: Advancing an ongoing and systematic program evaluation to measure the impact and effectiveness of TB program activities to facilitate continuous improvement and ensure responsiveness to patient's needs. The state uses data to inform decision-making, identify areas for improvement, and monitor progress toward TB elimination.
7. Guidance and Technical Assistance: Escalating periodical review and update of applicable laws, regulations, and policies to ensure consistency with recommended medical and public health practices. The state issues guidance and technical assistance and offers outbreak response assistance to local health departments and healthcare providers to help better control TB infection and disease and provide better care for individuals affected by TB.
Data
Tuberculosis is a contagious disease that can spread through the air and affect different parts of the body. However, it is both preventable and curable. In Massachusetts, non-US-born individuals are more likely to be diagnosed with TB, with the top five countries of origin being Haiti, India, China, Vietnam, and Dominican Republic. Racial and ethnic disparities exist, with the lowest case rate among Other Non-Hispanic and US-born White Non-Hispanic residents, and highest rates among Asian Non-Hispanic residents. According to the Office of Minority Health, there are several factors that impact their health, including an increased risk of tuberculosis (TB) among Asian Americans. These risk factors include infrequent medical visits, language and cultural barriers, and lack of health insurance. Additionally, Asian Americans are more susceptible to specific health conditions such as cancer, heart disease, stroke, unintentional injuries, and diabetes. It's also worth mentioning that they have a higher prevalence of specific risk factors and conditions, such as chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, and liver disease.
It is crucial to have support systems in place for patients to ensure equitable access to treatment and improve health outcomes.
The latest data shows that the national TB case rate for 2023 stands at 2.9 per 100,000 residents. In Massachusetts, there were 224 residents diagnosed with tuberculosis (TB) disease (incidence rate 3.2 per 100,000 residents). The average number of TB cases increased to 176 in the following three years (2021-2023), still below the pre-pandemic five-year annual average of 194 cases. The increase in TB cases observed in 2023 is most likely attributable to factors such as increased healthcare-seeking behaviors and access, increased international travel and migration, and decreased respiratory illness precautions.
Community Engagement
Community engagement is crucial to the Massachusetts Tuberculosis elimination plan. The Department of Public Health TB program works closely with various stakeholders, including state and federal agencies, local governments, hospitals and federally qualified health centers, community and ethnic-based organizations, and resettlement agencies, to ensure that developed strategies are responsive to the needs of patients and their communities.
The Medical Advisory Committee for the Elimination of Tuberculosis (MACET) assists the Department in guiding the elimination of tuberculosis. MACET makes recommendations regarding policies, strategies, objectives, and priorities and reviews the extent to which progress has been made toward eliminating tuberculosis in the Commonwealth.
List of Partners
- Centers for Disease Control and Prevention-Division of TB Elimination
- Medical Advisory Committee for the Elimination of Tuberculosis
- Rutgers Global TB Institute
- Stop TB USA
- Massachusetts Office for Refugees and Immigrants
- Office of Refugee Resettlement
- National Tuberculosis Controllers Association