The Florida Department of Health in Broward County (DOH-Broward) is one of 67 Public Health Departments under the governance of the integrated Florida Department of Health (DOH). Although DOH-Broward is a state agency, it maintains a very strong partnership with Broward County Government, which is formalized in a core contract. The main administrative campus is located in Fort Lauderdale, Florida, with additional facilities in geographically accessible locations. DOH-Broward is responsible for protecting, promoting, and improving the health of the county's 1.9 million residents and over 10 million annual visitors.
According to the U.S. Census population estimates for July 2021, Broward County is the 17th most populous in the United States, with over 1.94 million people and 9% of Florida's residents. 34.1% of residents are foreign-born. The population is increasingly diverse with significant growth among minority racial and ethnic groups. Among Broward residents, 63.1% identify as White; 30.2% Black or African American including many who immigrated from Haiti, Jamaica, and other parts of the Caribbean, as well as Central and South America. 31.1 % of the population identifies as Hispanic or Latino. 37.5% of the population speaks a language other than English in the home.
Tuberculosis (TB) is the leading cause of infectious disease death worldwide and is caused by the bacterium, Mycobacterium tuberculosis which attacks the lungs. TB may be transmitted to others when a person infected with the disease coughs, speaks, or sings. Most people with TB can be treated by taking medications according to their appropriate physician prescribed treatment regimen. Treating TB disease is of public health importance because it benefits not only the patient infected with TB but the community as a whole.
The DOH-Broward TB program serves individuals who have been diagnosed with TB, those who have been exposed to TB and are at risk of developing the disease, as well as those who are at high risk of contracting TB due to their age, underlying health conditions, or other factors. The TB program also serves vulnerable populations, such as homeless individuals, refugees, and individuals who inject drugs, as these groups are often at higher risk of TB infection. Additionally, the program may serve individuals from various ethnic and cultural backgrounds, as TB can affect people of all ages, races, and ethnicities.
The COVID-19 pandemic has had a significant impact on County Health Department Tuberculosis Programs. During the pandemic, the DOH-Broward TB program needed to shift resources and efforts toward the COVID 19 pandemic response, while maintaining existing standards of TB care. At DOH-Broward, much of the TB clinic was utilized for COVID 19 response activities, which affected TB screening, testing, and treatment. Recognizing this, the program implemented changes to their directly observed therapy (DOT) procedures and the way TB sputum samples were collected. This aided in continuing to provide services and support to individuals with TB as well as contacts during the pandemic, to prevent the spread of the disease. According to the Centers for Disease Control and Prevention (CDC), DOT is a key element of TB case management and entails a trained employee watching as the TB patient swallows their anti-TB medications. Video DOT and telemedicine visits were implemented in response to the pandemic. Also, a drive-through specimen collection process was created at DOH-Broward to quickly test specimens and reduce the amount of time TB clients spent in the TB clinic which reduced the possibility of exposure and potential transmission of COVID-19.
The overall goal of the aforementioned initiatives was to prevent the spread of TB disease in the community by ensuring that clients and close contacts continued to receive proper care and follow up, despite the increasing burden of the COVID 19 pandemic.
Both telemedicine and video DOT were used as tools in supporting a DOT program for TB. For example, telemedicine and video DOT made it possible for patients to receive their medication and have it monitored remotely, without having to come into a clinic or require a face-to-face visit. Additionally, telemedicine helped maintain communication between patients, the DOH-Broward Nursing Case Manager, and the Senior TB Physician. This allowed for an open line of communication that guided and supported patients in adhering to their treatment plan during the pandemic. TB staff received training on telemedicine and the video DOT software, Pexip, by the DOH central office Information Technology Department (IT) located in Tallahassee, Florida.
The drive-through TB specimen collection process was implemented among newly diagnosed TB clients during the pandemic and took place in the parking lot of the DOH-Broward Fort Lauderdale Health Center. When notified by a local hospital of a potential new TB case, DOH-Broward would contact the client, schedule a telemedicine appointment and subsequent appointment to provide a sputum specimen via the drive-through process in real-time. This ensured that the specimen was collected and processed quickly allowing for the proper treatment of their newly diagnosed TB disease. This also allowed for the Physician to do an initial face-to-face consultation which is considered the gold standard for newly diagnosed TB cases.
Additionally, for existing clients, sputum collection test kits were dropped off at each client's home by disease intervention specialists (DIS) staff and a follow-up timeframe was provided for pick-up of the specimen. The process prior to the COVID-19 pandemic, consisted of DIS staff only dropping off the specimen collection kits and clients would then bring the specimen to their in-person follow-up appointment for testing. This change in process ensured the specimens were collected in a timely manner and eliminated the need for clients to come into the clinic as their appointments took place via telemedicine.
Telemedicine, video DOT, and the drive-through specimen collection initiatives helped address health inequities by targeting barriers to adherence and access to care during the pandemic. Such barriers may have been, fear of exposure to COVID-19 for both staff and patients, accessibility to the Physician during all clinical visits, and ease of access to DIS for DOTs.
Florida Department of Health in Broward County website: https://broward.floridahealth.gov/