The Kansas Tuberculosis Control Program provides support to local public health agencies, private physicians, and health care facilities involved in the screening, diagnosis, and treatment of tuberculosis. The Program works to prevent transmission of TB through three strategies:
- by ensuring that infectious TB patients are appropriately treated until they are rendered and remain non-infectious;
- by ensuring that persons infected with TB who are not presently infectious remain non-infectious through the use of preventive drug therapy; and
- by creating a community of health care providers knowledgeable in the diagnosis and treatment of TB infection and disease through the provision of educational programs on TB across Kansas.
The Program provides medical consultation to health care providers, technical support to local health officials in conducting effective contact investigations, and free anti-tuberculosis medications to health professionals treating patients with TB infection or TB disease. The program also maintains surveillance on the incidence of TB in Kansas to identify populations at increased risk for the disease.
The Kansas Tuberculosis Program began in 1901 as one of the first public health programs in the state, when the Kansas Legislature first allocated funds "for the suppression of tuberculosis." The tuberculosis epidemic in the United States reached its peak during the 1940s, 50s and 60s. Treatment for tuberculosis in this era consisted of admitting patients to sanitariums, where they were kept outdoors and provided with medications. The patients frequently refused the medications.
The development of the drug Rifampin in the 1960s allowed for tuberculosis to be effectively managed for the first time. The U.S. tuberculosis death rate plummeted, as did the incidence rate. With Rifampin therapy, tuberculosis patients could lead normal lives.
During the 1970s, Americans began to believe that tuberculosis would be eradicated in the U.S., as had recently been the case with smallpox. Funding for tuberculosis prevention came to be regarded as less necessary and was reduced. Throughout the 1970s and early to mid-80s, Kansas Tuberculosis Program activities consisted primarily of collecting data on new cases, distributing medications to patients, preventatively treating their contacts, and little else.
The HIV/AIDS epidemic that had began in the early 1980s was continuing to grow, drawing great public concern. It was learned that many HIV patients were becoming infected with and dying of tuberculosis. Multi-drug resistant strains of tuberculosis also emerged and began to infect Americans in greater numbers. In 1988, federal funding for state tuberculosis prevention programs was increased in order to meet these new challenges.
The Kansas Tuberculosis Program made effective use of the new resources, in part by converting from paper to electronic information systems. Beginning in 1997 and 1998, HAWK, the statewide reportable disease surveillance data system, allowed the program to better meet steadily increasing demands.
The events of September 11, 2001 prompted a re-organization of the Kansas Department of Health and Environment, Bureau of Epidemiology and Disease Prevention that would have lasting effects. Due to these events and other unforeseen circumstances, the program director's position was shared with two other programs, including the Kansas Bioterrorism Program and the Kansas Immunization Program. Ultimately, all three programs were able to acquire individual, full-time directors.
Beginning in April 2002, the program became more proactive under its new leadership. A philosophical transformation took place, with renewed emphasis on accountability and active intervention and prevention. Innovative solutions for medication inventory management and record keeping were implemented. Knowledge, commitment, teamwork, sense of direction, fiscal responsibility and customer service are the hallmark values of today's Kansas Tuberculosis Program.
The Kansas Tuberculosis Program now provides medications for nearly 90 percent of Kansas cases, regardless of health insurance status. The incidence rate for tuberculosis in Kansas for 2000 was three cases per 100,000 persons - half the U.S. rate, and a mere fraction of the historic rate. However, the program is now seeing a rise in the number of cases. Despite severe state budgetary challenges, the Kansas Legislature has assured that the state will continue funding medications for program clients, regardless of cost.
Universal laboratory genotyping for tuberculosis strains became available in January 2004, allowing program staff to more effectively respond to outbreaks. Due to diligent tracking of co-morbidity data, the program is well positioned to adapt to changes in federal funding (slated to occur in 2005) that will link allocations to the acuity of cases. Most significantly, Kansas has already met Healthy People 2010 goals for the eradication of uncomplicated tuberculosis cases. The program is striving to meet goals for treatment of complicated cases.
By July 2008, the program plans to improve its registries for infection. Prophylaxis completion rates, particularly among case contacts, will also be improved. Local health department staff will be trained in a standardized case investigation protocol. Development of this protocol, an annual training and education plan, and Web-based reporting forms will be part of this effort. The five largest local health departments will submit all tuberculosis information electronically.
The Kansas Tuberculosis Program will also confront several unique challenges over the next five years. Increased involvement with local district attorneys is anticipated in order to convince these officials to make decisions that place the public health ahead of other considerations. As the Kansas population continues to diversify, the need for cultural competency skills in staff will become ever more crucial. Drug research is ongoing to produce medications with reduced side effects.
As public health enters the 21 st century, the Kansas Tuberculosis Program is poised to deliver services and interventions to further protect and enhance the health of Kansans.