2024 - California TB Elimination Heroes

Adama Dyoniziak, Executive Director, Champions for Health

For more than four years, Champions for Health has been an active partner in TB elimination strategies in high-risk communities in San Diego County. As the non-profit arm of the San Diego County Medical Society, Champions for Health’s purpose is to address the unanswered healthcare needs of low-income and uninsured San Diego County residents. In 2019, the County of San Diego TB program (County TB) approached Champions for Health to see if they could partner to pair their TB risk assessment activities with their flu shot clinics. They agreed and ensured the County had access to their clinic schedule and the locations that would have the most impact. When the TB Elimination Alliance (TEA) started up their mini-grant program, Champions for Health volunteered to lead the creation of the CARE TB program, partnering with the County of San Diego TB Program, CDPH TB Free California, and the Asian Pacific Health Foundation. As a result of three successful TEA mini-grant awards from 2020 to 2023, CARE TB has been able to complete more than 130 needs assessments, six focus groups, and three collaborative health fairs, partnering with Asian American and Pacific Islander organizations, local universities, as well as other health care agencies serving the diverse populations of San Diego County. In August 2023, Champions for Health received TEA funding for an in-person San Diego TB Prevention Education and Community Engagement Summit that will take place on March 22, 2024, just two days before World TB Day. The Summit will bring together providers and representatives from community-based organizations to learn more about TB prevention, share practices for engaging communities at risk, and develop a community action plan.

Dr. Marytere Carrasquillo-Navarro 

Butte County is in Northern California about 90 miles north of Sacramento. It is semi-rural with limited healthcare providers with the expertise and knowledge to treat TB. Dr. Marytere Carrasquillo-Navarro is one of a handful of community providers specializing in internal medicine and infectious diseases. She works at several federally qualified health center (FQHC) locations, primarily managing patients diagnosed with HIV. She is a compassionate and competent provider partnering with the public health department to treat and manage patients diagnosed with TB, with or without HIV coinfection, and plays a critical role in achieving the desired outcome for each patient. To provide the best care for her patients diagnosed with TB, Dr. Marytere Carrasquillo-Navarro has been willing to participate in case discussions with public health during her lunch hours to strategize solutions to meet patient needs. In collaboration with public health, she addresses the complexities of TB care in the context of chronic co-morbidities, mental health issues, socioeconomic barriers, and other challenges. Through her patience and commitment in addressing social and health inequities that each patient faces, she is contributing to advancing health equity in our community, one patient at a time. For all these reasons, Butte County Public Health would like to acknowledge and thank her for her commitment to TB care and she deserves to be recognized as a TB Elimination Hero.

East LA Health Center Group
Pharmacist Clinic for LTBI Treatment

The Pharmacist Clinic for LTBI Treatment is an embedded clinical pharmacist clinic in an adult primary care clinic. Primary care doctors identify and evaluate LTBI patients first in their clinics, then refer to the pharmacy clinic to supervise LTBI treatment. The pharmacist clinic offers more frequent and reliable access for follow up and support during treatment than possible in our busy primary care clinics. The clinic keeps standardized documentation of LTBI treatment completion for data monitoring in accordance with suggestions of the LA County DPH TB Control. Overall, this innovation offers a team-based approach to efficiently retain patients through the LTBI care cascade without placing undue burden directly on primary care providers alone.

Jose Eli Villanueva

Jose has enthusiastically supported San Diego County TB outreach activities as their video producer for the past eight years. Starting with the first version of the “What is TB?” video, Jose has produced numerous videos, including TB and LTBI patient testimonials, instructional videos for clients having a chest x-ray, providing a sputum collection, and using our video DOT recording application. He has worked patiently with our native language narrators to do voice-overs and translate some of these videos into Spanish, Vietnamese, Mandarin, Tagalog, and Russian. With the support of his office, the San Diego County Communications Office, he has also been able to produce videos on behalf of other California local health jurisdictions. In addition, many of his videos have been shared at the state and national levels, including the Centers for Disease Control and Prevention. From the San Diego County TB outreach and education team’s perspective, Jose has never had a bad day. He is always happy to hear an idea pitch and provide his professional opinion on how to make it into a quality educational video. We are forever grateful for his contributions to moving our TB outreach objectives forward.

    Mission Neighborhood Health Center

    As a community-based healthcare institution deeply committed to serving patients in San Francisco’s Mission district, MNHC has consistently demonstrated dedication, innovation, and resourcefulness in the fight against tuberculosis (TB) for many years. Over a decade ago, MNHC initiated a dedicated program of nurse follow-up for patients with positive TB tests. This initiative ensured that these individuals received comprehensive follow-up care, including diagnosis and preventive treatment. This proactive approach not only improved patient outcomes but also played a crucial role in preventing the spread of TB within the community.

    In recent years, MNHC has continued to expand its efforts in TB elimination through the equitable implementation and expansion of Interferon-Gamma Release Assay (IGRA) testing. Beginning with patients with HIV and Persons Experiencing Homelessness (PEH), they have worked tirelessly to extend these vital services to all patients, recognizing the importance of reaching the large number of their patients who are non-US born. By promoting access and prioritizing early detection and intervention, MNHC has demonstrated a commitment to equitable healthcare access and TB elimination. MNHC’s successful competition for a Tuberculosis Elimination Alliance (TEA) grant exemplifies their proactive approach to addressing TB at the community level. Through this grant, they have been able to expand outreach and education initiatives directly to community members served by the clinic, reaching individuals in various community and clinic-based settings. This comprehensive approach to TB awareness and education not only empowers individuals with knowledge but also fosters a supportive environment for TB prevention and care within the community. Leadership and staff throughout the organization including the CMO, CEO, providers, nursing, lab, patient outreach-education and operational staff have engaged in and supported TB elimination efforts for the community that they serve. MHNC’s tireless dedication, equity-focused clinical strategies, and multifaceted TB elimination efforts make them truly deserving of the 2024 California TB Elimination Heroes award. Their commitment to TB elimination and their significant contributions to the health and well-being of the community they serve exemplify the highest standards of equity in healthcare. MNHC is a local leader in the fight against TB, inspiring others to join in the collective effort towards a TB-free California.

    Dr. Sunita Lohiya

    Dr. Sunita Lohiya has partnered with the Orange County Health Care Agency (OCHCA) and the California TB Control Branch on a CDC-funded, multi-site Civil Surgeon Project. The project’s main goals are: 1) to improve reporting of persons applying to adjust their immigration status (“status adjusters”) who are diagnosed with LTBI; and 2) to expand efforts to encourage status adjusters with LTBI to seek treatment for LTBI, thus preventing future cases of active TB. Dr. Lohiya has led California as one of the top three reporters of status adjusters with LTBI in the state, and reported 72% of all status adjusters with LTBI in Orange County in 2023. Her clinic, Royal Medical Group (RMG), improved reporting of treatment referral to patients with LTBI by 85% in the last six months of 2023, compared to the first six months. Dr. Lohiya has been an engaged partner in promoting LTBI treatment among status adjusters. Her clinic has adopted materials specially designed for status adjusters with LTBI, including a brochure, poster, list of low-cost clinics offering LTBI treatment, and a treatment referral form signed by Dr. Lohiya and given to the patient. Along with her clinic’s medical assistants, Lilian Trejo and Eva Garcia, Dr. Lohiya has been generous and thoughtful with her time and input to the Civil Surgeon Project, and increasing the time spent with each patient in an already busy clinic. While it is too early in the project to assess how many patients have started LTBI treatment, referral information given to patients from RMG has increased to nearly 100% as of 2023. Several treatment forms have already been returned to OCHCA from patients and their treating physicians during the project period, compared to zero prior to the project start. Dr. Lohiya is an extremely experienced and accomplished physician. She has practiced family and occupational medicine in Santa Ana for nearly 40 years, and became a civil surgeon in 1987. She has co-authored two dozen publications, many focused on hepatitis B transmission. Her clinic is very popular, with some patients traveling hundreds of miles to see her. Recently, she presented her experience as a civil surgeon encouraging LTBI treatment at a Curry International Training Center training for civil surgeons in California. She is an enthusiastic partner and leader in our work to eliminate TB in California.

    Mayra Aviña

    Mayra Aviña is a Family Nurse Practitioner at Napa County’s only FQHC, CommuniCare+Ole. Mayra provides high quality healthcare to underserved communities in both Napa and Solano County and is a true asset to Napa County’s TB Control efforts. Mayra is a bicultural and native Spanish speaker raised in Napa, California. Prior to receiving her degree, she worked at CommuniCare+OLE for 8 years in a variety of roles including, collaborating with outreach to execute farm worker health fairs, track health disease data, and played a vital role in implementing the medical record system eCW. Her passion to serve her community motivated her to return to her hometown after school to provide healthcare to patients of all ages and cultural backgrounds. Along with her family medicine caseload, she manages and cares for majority of the LTBI patients within the health center.  

    Napa County is considered a rural county with comparably lower TB rates to our neighboring bay area counties. Due to lower rates, our Public Health Division is not staffed or funded for a TB clinic. Our TB control team greatly relies on support through community partners. A large portion of this partnership is through Mayra’s dedicated work at Ole. On numerous occasions she has personally taken initiative with evaluating, following, and treating patients with LTBI and active TB. Most recently she has revitalized Napa County’s only LTBI clinic, projected restart of this year.  LTBI clinic sessions lead by Mayra will be offered in both English and Spanish. At these sessions, health care providers and workers will provide TB education, complete assessments, lab draws, prescribe antibiotics, allow patients to voice their concerns, and ask questions. Having a bilingual provider to walk patients through their treatment journey is crucial and makes long lasting, positive impact for patients’ adherence to medication, follow-up, and return for future medical needs. 

    Napa County’s TB Control would not be able to accomplish the work we do without the collaboration and partnership with incredible providers such as Mayra. Napa County looks forward to our continued collaboration and support of Mayra’s invaluable work. We feel it necessary her steadfast and determined TB work be recognized by the larger TB community!

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