Dalla Lana School of Public Health

Integrating Public Health and Clinical Care: The case of TB

Course Description:

Tuberculosis (TB) care and serves is a perfect example of integrating public health and clinical care. TB is a historically deadly disease having killed over 1/6 people in England in the 1900s. The Directly Observed Treatment Short-course (DOTS) has demonstrated as the most cost-effective treatment and control strategy in the 1970s, and then it has been promoted as the national strategies worldwide since the 1990s. TB is now a curable disease with effective treatment (i.e., cure rate over 90% for smear positive cases, and per case medication cost less than $10). Global TB incidence rate has fallen by an average of 1.5% per year since 2000, while TB death rate has dropped nearly half between 1990 and 2015. On the other side, TB remains a disease of poverty, and the NO 1 killers in infectious disease (1.4 million deaths and 10.4 million new cases in 2015), and growing threats from multi-drug resistant TB, and co-infections of HIV/TB and diabetes/TB. TB is a disease of poverty and heavily stigmatized in many cultures. This course will introduce TB from microbiological, clinical, public health and health policy perspectives. It will discuss TB pathology, epidemiology, diagnosis and treatment, TB programs, policies and practices both at local and global levels. We will also discuss social, ethical and health system issues of TB prevention and care.

Prerequisites:  Students should have completed either a quantitative or qualitative research method course, or with permission of one course director. This course is intended for Master students who have taken research method courses, or any year of PhD students. The course will allow maximum 20 students. Students should contact with the course director for enrollment.

Objectives:

The goal of this course is to provide students a solid understanding of the interactions of clinical and public health in the context of TB prevention and care. Both students from the Public Health Sciences (PHS) and Health Policy Management and Evaluation (HPME) are welcomed. Students will be exposed to different study skills relevant in TB prevention and care context, such as quantitative (e.g., epidemiological, and interventional) and qualitative (e.g., social science) studies, policy evaluations, operational research and spatial analysis (geographical information system, GIS). Students will have the opportunities to learn from each other’s expertise and insights. By the end of the study, students will acquire the skills to critically evaluate disease control programs at local or national levels.

Specifically, by the end of the course, students should

• Have a solid knowledge on the essential elements of public health approaches in disease control;
• Understand the historical evolution of TB prevention and care programs and policies in Canada;
• Understand ethical, social and health system issues in TB prevention and care and their interactions;

• Understand how different research skills can be applied in TB studies, such as cohort analysis, social science, trials, operational research, genotyping and GIS;

• Gain insights of TB prevention and care in various settings; and
• Be able to critique country TB prevention and care programs and design operational studies.

Course Director: Dr. Xiaolin Wei, Professor Division of Clinical Public Health, and Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health Venue: 155 College Street 416-978-2020 xiaolin.wei@utoronto.ca Course Co-instructor: Dr. Ross Upshur, Professor, Head, Division of Clinical Public Health, Dalla Lana School of Public Health 6th Floor, 155 College Street, 416-978-6459 ross.upshur@utoronto.ca Guest Speakers: Dr. Elizabeth Rea, Associate Medical Officer, Toronto Public Health Dr. Christopher Rutty, Adjunct Professor, DLSPH and President, Health Heritage Research Services Dr. Kamran Khan, Staff Physician, St. Michael’s Hospital and Associate Professor, IHPME Dr. Robyn Lee, PhD, Assistant Professor, Dalla Lana School of Public Health Dr. I.D. Rusen, Senior Vice President, Vital Strategies/International Union Against Tuberculosis and Lung Disease Dr. Barry Pakes, Assistant Professor and Program Director, DLSPH Dr. Firdosi R. Mehta, MD, Former WHO medical officer and Adjunct Professor, DLSPH

Sessions:     Sept 8- Nov 24, 2021, on Wednesday, 9:00am to 11:45 pm

 

Venue:           Online through Zoom

The course will have online synchronous held weekly during the day and time indicated in the timetable. Each session will have approximately 1 hour 15 minutes lecture, 10 minutes break, and 1 hours 20 minutes in class discussion or workshops. In case of two guest speakers, the time will be equally divided by the two parts, that each will have 1 hour and 15 minutes lecture and discussion, with 10 minutes break in between. Students will participate using Zoom videoconferencing tool posted in the syllabus and also in Quercus. Lectures will be recorded during synchronous class-time and made available to students for asynchronous review. Full class discussions and groupworks will not be recorded.

Schedule for 2021:

 

Day	Date	Topic	Format	Instructor(s)
1	Sept 8, 2021	Introduction of TB pathology, transmission, epidemiology and global TB program strategies	Lecture and discussions	Xiaolin Wei Ross Upshur
2	Sept 15, 2021	Community management of TB: case finding, contact tracing, DOT and patient support	Lecture and discussion	Xiaolin Wei Elisabeth Rea
3	Sept 22, 2021	Historical aspects of TB program in Canada and US, and the implications to public health approaches	Lecture and discussions	Christopher Rutty
4	Sept 29, 2021	TB program studies and operational research	Case studies and discussions	Xiaolin Wei
5	Oct 6, 2021	Social and ethical issues	Lecture and discussions	Ross Upshur
6	Oct 13, 2021	Clinical aspects: TB diagnosis, treatment, clinical evaluations, and latent TB Combining genomics with epidemiology to resolve TB transmission dynamics	Lecture and discussion	Kamran Khan Robyn Lee
7	Oct 20, 2021	TB in low burden countries: working towards TB elimination in Canada Short Critique due at 9am Oct 20	Lecture and group work	Elizabeth Rea Barry Pakes
8	Oct 27, 2021	TB programs in high burden countries: India and Indonesia	Lecture and group work	Firdosi R. Mehta
9	Nov 3, 2021	TB programs in low HIV prevalent but high TB burden countries: China and Hong Kong SAR	Lecture and group work	Xiaolin Wei
10	Nov 10, 2021	Health system strengthening in TB programs	Lecture and discussions	Xiaolin Wei
11	Nov 17, 2021	Research on shortened MDR-TB regimens: progress and challenges	Case study	I.D. Rusen
12	Nov 24, 2021	Student Presentations Due		Xiaolin Wei Ross Upshur
13		Individual essay is due at 9pm, 5 Dec

Evaluation:

Grades will be based on four parts: participation (10%), a short critique (20%), a group presentation (20%) and an individual essay (50%).

1. Participation (10 marks, 10% of total):

Students are expected to participate through the online connection at least 80% of the lectures and actively engaged in the class discussions in each session to get the full marks of participation. Absence from a session without notice and approval from a course director will result in an automatic deduction of 2 marks (2%). Participation includes preparation (from full prepared to little evidence of reading), interaction (from actively engage in to no participation in discussions with others), and quality of comments (relevance of comments to session topics).

Participation Rubric was based on a publication by Adam Chapnick, “A Participation Rubric”, The Teaching Professor. March 2005, p4.

http://www46.homepage.villanova.edu/john.immerwahr/TP101/lects/participation%20matrix0001.pdf

2. Mid-term short critique (20 marks, 20%)

Students will write a short critique (1000 words maximum) to one research paper (NOT including readings on guidelines, training manuals, reviews or case studies) in the course reading list. Detailed guidance can be reached at: Allyson Skene, The Writing Centre, UT Scarborough

https://www.utsc.utoronto.ca/twc/sites/utsc.utoronto.ca.twc/files/resource-files/CritReview.pdf

Grading will be based on overview of the topic (5 marks), list of key points (8 marks), balanced comments (3 marks), and logic and clarity (4 marks).

Due at 11:59pm, Oct 20, 2021

3. Presentation (20 marks, 20%)

Students will be required to describe and critique the TB prevention and care program of a place. This can be a province (e.g., Manitoba) or a country (e.g., Uganda, Indonesia), but cannot be a number of countries or a country/region whose TB prgram profiles have been given in sessions. Students will form small groups (2-5 per group). The group will choose a place with common interests. The group should make a 15-minute presentation based on: the country’s health system, TB epidemic and control program, and major challenges. Presentations will be graded based on its clarity, organization, use of research evidences, relevance, and time management. Points will be given based on 1) content score (14 marks): background regarding health system and economy, TB history and epidemic, major challenge of TB program, and use of evidence and adequate discussion of findings; and 2) presentation score (6 marks): clarity, organization, logic, visual layout, and time management. Any overdue of 3 minutes exceeding the 15-minute limit will result in 2 marks (2%) deducted.

Presentation date: 24 Nov, 2021

4. Individual essays (50 marks, 50%)

Students will be required to write an individual essay (min. 1500 words, max 3000 words for Masters) based either on their group work or a place that the student is particularly interested in. The study should 1) to critically review a country/ province’s health system (5 marks), TB program and its history based on the best available information from national statistics and literature (12 marks); then identify the major challenges of its current TB prevention and care program (5 marks); pick up one challenge and conduct a detailed analysis regarding its scale, possible reasons and any suggested solutions using published literature (18 marks). Another 10 marks will be allocation for presentation of the essay regarding organization, logic flow and clarity.

Due at 11:59pm, Dec 5, 2021

Late assignment policy: Points will be deducted for handing in assignments late, unless permission is obtained from a course director ahead of time (2marks or 2% deducted per calendar day). Assignments that submitted 7 calendar days after the deadline will not be considered.