Integrating Public Health and Clinical Care: The case of TB

Sessions:       Sept 11- Nov 27, 2019, on Wednesday, 9:15am to 12:00 pm

Venue:          HS 614

Schedule for 2019:

Day	Date	Topic	Format	Instructor(s)
1	Sept 11, 2019	Introduction of TB pathology, transmission, epidemiology and global TB program strategies	Lecture and discussions	Ross Upshur Xiaolin Wei
2	Sept 18, 2019	Community management of TB: case finding, contact tracing, DOT and patient support	Lecture and discussion	Xiaolin Wei Elisabeth Rea
3	Sept 25, 2019	Historical aspects of TB program in Canada and US, and the implications to public health approaches	Lecture and discussions	Christopher Rutty
4	Oct 2, 2019	TB program studies and operational research	Case studies and discussions	Xiaolin Wei
5	Oct 9, 2019	Social and ethical issues	Lecture and discussions	Ross Upshur
6	Oct 16, 2019	Clinical aspects: TB diagnosis, treatment, clinical evaluations, and latent TB Diagnosis critical – the laboratory role in the identification of tuberculosis infection and disease Short Critique due at 9am Oct 18	Lecture and discussion	Kamran Khan Frances Jamieson
7	Oct 23, 2019	TB in low burden countries: working towards TB elimination in Canada	Lecture and group work	Elizabeth Rea Barry Pakes
8	Oct 30, 2019	TB programs in high burden countries: India and Indonesia	Lecture and group work	Firdosi R. Mehta
9	Nov 6, 2019	TB programs in low HIV prevalent but high TB burden countries: China and Hong Kong SAR	Lecture and group work	Xiaolin Wei
10	Nov 13, 2019	Health system strengthening in TB programs	Lecture and discussions	Xiaolin Wei
11	Nov 20, 2019	Research on shortened MDR-TB regimens: progress and challenges	Case study	I.D. Rusen
12	Nov 27, 2019	Student Presentations Due
13		Individual essay is due at 9pm, 9 Dec

 

 

 

Course Directors: Dr. Xiaolin Wei, Associate 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 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. Frances Jamieson, Medical microbiologist, Public Health Ontario, Associate Professor, Dept. of Laboratory Medicine and Pathobiology 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

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.

 

 

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 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 9am, Oct 16, 2019

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: 27 Nov, 2019

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 essay has two parts. In Part 1, the study should 1) to critically review a country/ province’s TB program and its history based on the best available information from national statistics and literature (15 marks), and identify the major challenges of its current TB prevention and care program (10 marks). Then the student need to 2) propose reasonable solutions regarding public health measures and/or policy changes that may restructure/reform its TB prevention and care (5 marks). In Part 2, the study should briefly design a feasible operational study to understand deeper of one particular unknown area or to explore solutions regarding the particular area of TB program in the setting. (20 marks)

PhD students will have the same evaluation schemes. However, they will be expected to make more rigorous research design regarding their operational studies (Part 2). Maximum words of the essay for PhD students are 4000.

Due at 9pm, Dec 9, 2019

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.