The purpose of the Montana Tuberculosis Program Manual is to provide guidance and current recommendations in the best public health and medical practices for the prevention and control of tuberculosis in the State of Montana.

The Montana Tuberculosis Program Manual was written for use by public health departments, including county, tribal, and Indian Health Services jurisdictions. In addition, the manual is targeted for providers and organizations providing care to high-risk groups or populations, e.g. migrant clinics, correctional facilities. Providers will find current recommendations for treatment of disease, infection of latent TB infection, reporting, etc. Other health-care facilities, including hospitals, clinics, and long-term care facilities will also find the manual useful.

The Montana Tuberculosis Program Manual was specifically written for public health personnel and public health partners (public health nurses, nurse case managers, outreach workers, private providers, and infection control staff). Any private provider with a patient with suspect tuberculosis will find current recommendations for diagnosis, treatment, and public health requirements for TB.

The manual is divided into sections such as diagnosis, treatment, case management, contact investigation, laboratory services, etc. Each section’s introduction describes the purpose and importance of practices in that section for tuberculosis prevention and control and lists relevant Montana forms that are required or recommended to use. In the body of each section, sources of recommendations are referenced in numbered notes and listed at the end of each section.

Because of the complexity of tasks, the sections on diagnosis, treatment, case management and contact investigation each offer a Quick Start Check List that outlines the essential tasks and references key instructions and forms for the tasks. Refer to these quick start check lists to start and follow through diagnosis, case management tasks, treatment, and contact investigations.

References and resources are listed at the end of each section. They include (among others) the Centers for Disease Control (CDC); Montana Statute and Administrative Rules; the Francis J. Curry National TB Center; the New Jersey Medical School National TB Center; the California Department of Health Services (CDHS), the California Tuberculosis Controllers Association (CTCA); the Washington State Department of Health; and the Colorado Department of Public Health and Environment, Tuberculosis Manual.

The manual is based on the best medical/public health practices as outlined by Centers for Disease Control and Prevention (CDC). Its information is provided at a more general, national and programmatic level. For example, recommended regimens and dosages are provided at a national level by the CDC and apply to all patients, regardless of where they are treated. However, responsibilities and detailed clinical protocols for patient care may vary across jurisdictions. For example, outreach workers may be responsible for directly observed therapy tasks in some jurisdictions, but nurses may handle them in other jurisdictions. In Montana, some local jurisdictions provide all treatment of TB disease using directly observed therapy, while other jurisdictions still make that determination on a case-by-case basis. If available, your local nursing protocols provide more detailed clinical instructions for patient care practices.

The manual will be updated when CDC publishes new guidelines or when Montana law or administrative rules change. Alerts will appear on the manual web page when changes/updates have been made. This is one of the advantages to online information: it can be easily and quickly updated and is immediately available.

Two-step testing

a. Information and questions on two-step testing can be obtained from the Core Curriculum on Tuberculosis or by contacting the state TB Program manager Ryan Weight by phone (406) 444-0274, fax (406) 444-0272, or email ryan.weight@mt.gov 

Defining infectious TB and non-infectious TB
b. Information and questions on defining infectious TB and non-infectious TB can be obtained from the Core Curriculum on Tuberculosis or by contacting the state TB Program manager Ryan Weight by phone (406) 444-0274, fax (406) 444-0272, or email ryan.weight@mt.gov 

Answering questions for facilities about infection control
c. Information and questions about infection control can be obtained from the Core Curriculum on Tuberculosis and the CDC’s “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005” (MMWR 2005; 54 [No. RR-17, 1-141]; or by contacting the state TB Program manager Ryan Weight by phone (406) 444-0274, fax (406) 444-0272, or email ryan.weight@mt.gov