Policy Directive Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/ space space Principles for the Management of Tuberculosis in New South Wales space Document Number PD2014_050 Publication date 17-Dec-2014 Functional Sub group Clinical/ Patient Services - Infectious diseases Clinical/ Patient Services - Medical Treatment Population Health - Communicable Diseases Population Health - Infection Control Summary This policy directive outlines key principles of the management of tuberculosis in NSW, including the need for treatment to be provided under direct supervision, expert management of multi-drug resistant TB, HIV screening of all persons diagnosed with TB, and provision of TB services free of charge to the patient. Replaces Doc. No. Tuberculosis and Human Immunodeficiency Virus (HIV) Infection [PD2009_028] Tuberculosis - Principles for Management of people with Tuberculosis in NSW [PD2008_019] Tuberculosis - Management of Multi Drug Resistant Tuberculosis in NSW [PD2005_159] Tuberculosis Related Services - Charging [PD2008_018] Author Branch Health Protection Branch contact Health Protection 02 9391 9277 Applies to Local Health Districts, Board Governed Statutory Health Corporations, Chief Executive Governed Statutory Health Corporations, Specialty Network Governed Statutory Health Corporations, Affiliated Health Organisations, Public Health System Support Division, Community Health Centres, Government Medical Officers, Private Hospitals and Day Procedure Centres, Public Health Units, Public Hospitals Audience Chest Clinics, Medical, Nursing, Community Health, Local Health Districts Distributed to Public Health System, Divisions of General Practice, Government Medical Officers, Ministry of Health, Private Hospitals and Day Procedure Centres, Tertiary Education Institutes Review date 17-Dec-2019 Policy Manual Not applicable Director-General space File No. H14/99932 This Policy Directive may be varied, withdrawn or replaced at any time. Compliance with this directive is mandatory for NSW Health and is a conditionStatus ofActive subsidy for public health organisations. POLICY STATEMENT PRINCIPLES FOR THE PROVISION OF TUBERCULOSIS SERVICES IN NEW SOUTH WALES PURPOSE This policy sets out the mandatory principles for the provision of Tuberculosis (TB) services in New South Wales (NSW). TB Services are required to operate in accordance with this policy in conjunction with the current relevant guidelines for the prevention and control of tuberculosis in NSW, which reflect best practice for the clinical and public health management of TB. MANDATORY REQUIREMENTS All staff must adhere to these principles. All services related to the screening, care and management of people with active, latent, or suspected TB are available at no charge to patients within the NSW Public Health system. The treatment for people with active TB is to be administered by directly observed treatment. IMPLEMENTATION Chief Executives must ensure that: • The principles and requirements of this policy are applied, achieved and sustained • Relevant staff are made aware of their obligations in relation to the Policy Directive • Documented procedures are in place to support the Policy Directive. Clinicians: • Must comply with this Policy Directive. REVISION HISTORY Version Approved by Amendment notes PD2014_050 Deputy Secretary, Updated and combined policy. Replaces PD2008_019, December Population and PD2008_018, PD2009_028 and PD2005_159 2014 Public Health PD2008_019 Director-General Replaces PD2005_141 – updated April 2008 PD2008_018 Director-General Replaces PD2005_579 – updated December 2008 PD2008_028 Director-General Replaces PD2005_076 – updated May 2008 PD2005_159 Director-General Replaces Circular 99/75 – updated January 2005 PD2014_050 Issue date: December-2014 Page 1 of 2 POLICY STATEMENT ATTACHMENTS 1. Principles for the Provision of Tuberculosis Services in New South Wales: Procedures. PD2014_050 Issue date: December-2014 Page 2 of 2 Principles for the Provision of Tuberculosis Services in New South Wales PROCEDURES Issue date: December-2014 PD2014_050 Principles for the Provision of Tuberculosis Services in New South Wales PROCEDURES CONTENTS 1 BACKGROUND .................................................................................................................... 2 1.1 About this document ...................................................................................................... 2 1.2 Key definitions ............................................................................................................... 2 2 DIRECTLY OBSERVED TREATMENT................................................................................. 2 3 MANAGEMENT OF MULTI-DRUG RESISTANT TB ............................................................ 2 4 SCREENING FOR HIV INFECTION ..................................................................................... 3 5 CHARGING FOR TB RELATED SERVICES ........................................................................ 3 5.1 Provision of TB services free of charge to the patient .................................................... 3 5.1.1 Investigation ....................................................................................................... 3 5.1.2 Treatment and medication ................................................................................. 4 5.1.3 TB prevention .................................................................................................... 4 5.2 Circumstances where charging for TB services is permitted .......................................... 4 5.2.1 Occupational screening for students and new healthcare workers ..................... 4 5.2.2 Occupational screening for existing healthcare workers ..................................... 4 5.2.3 Occupational screening (other than healthcare workers) .................................... 4 5.2.4 Immigration detention ........................................................................................ 4 5.2.5 BCG vaccination ................................................................................................ 5 5.3 Referral to private providers .......................................................................................... 5 5.4 Medicare benefits .......................................................................................................... 5 PD2014_050 Issue date: December-2014 Contents page Principles for the Provision of Tuberculosis Services in New South Wales PROCEDURES 1 BACKGROUND 1.1 About this document Tuberculosis (TB) continues to be a disease of public health significance in Australia. Each year there are over 1300 cases of active TB notified in Australia and approximately 40% of these cases live in NSW. The clinical and public health management of patients with TB requires a collaborative approach. Treating physicians are responsible for the implementation of appropriate treatment strategies with the support of TB services. NSW TB services are delivered through a network of metropolitan and regional local health districts, in a range of environments, including; large metropolitan chest clinics and community health centres in regional and rural areas. Patients with suspected or confirmed TB should be referred to their local TB service. The TB service should review the case, develop a management plan with the treating physician and initiate appropriate public health actions. TB services are required to operate in accordance with the current NSW policies and guidelines for the prevention and control of TB, which reflect best practice for the clinical and public health management of TB. TB is a notifiable condition. Doctors, hospitals and laboratories are required to notify all cases of active TB to either their local chest clinic or public health unit, in accordance with the NSW Public Health Act 2010. 1.2 Key definitions TB is caused by bacterium from the Mycobacterium tuberculosis complex. The disease most commonly occurs in the lungs (pulmonary TB), although it can affect any region of the body (extrapulmonary TB). The pulmonary form is most infectious. 2 DIRECTLY OBSERVED TREATMENT Treatment for people with active TB should be administered by directly observed therapy (DOT), which means that a health professional observes the person take their medication and records the treatment that was administered. Supervised TB treatment is a supportive measure provided to minimise the risk of development of drug resistance or reactivation of disease attributable to non-adherence, as well as facilitating early detection and attention to side-effects of TB treatment. 3 MANAGEMENT OF MULTI-DRUG RESISTANT TB Multi-drug resistant TB (MDR-TB) is defined as disease caused by Mycobacterium tuberculosis bacilli that are resistant to isoniazid and rifampicin, with or without resistance to other first-line anti-tuberculous agents. MDR-TB represents an important public health concern for the effective control of TB. PD2014_050 Issue date: December-2014 Page 2 of 5 Principles for the Provision of Tuberculosis Services in New South Wales PROCEDURES In order to ensure best practice management of MDR-TB, an expert panel will be convened by Health Protection NSW to review all identified cases of MDR-TB in NSW. The expert panel will review and provide advice on the clinical and public health management and develop a case management plan for each case