Aggregate Reports for Tuberculosis Program Evaluation
The Aggregate Reports for Tuberculosis Program Evaluation (ARPEs) help to evaluate non-case finding and non-case holding TB prevention activities. In the United States, resources for tuberculosis control are available for going beyond curing cases by preventing them in the first place. Examples of prevention activities are contact tracing, targeted tuberculin testing, and treating latent tuberculosis infection (LTBI). While these activities accelerate tuberculosis elimination, they are labor intensive and offer mainly remote return for the investment. Therefore, careful evaluation of these activities is critical for assessing their validity. ARPEs are the national summary tools for confirming the merit of these activities.
The ARPEs are meant to capture data to serve as a program evaluation tool and should not be mistaken for surveillance data. Data collection may vary across jurisdictions; Data may not be directly comparable across jurisdictions. See additional data limitations as provided below.
ARPEs are the first steps for evaluating key activities for tuberculosis prevention: contact investigations, targeted testing, and treatment of LTBI. The reports do not, however, provide comprehensive insight into any of these activities, which should be evaluated in the context of local communities, tuberculosis programs, and epidemiology. In addition, the intrinsic limitations of the report have to be taken into account.
Aggregate data tend to conceal extreme ratios because diverse results are likely to converge on an overall average result, and in the calculation of indices, the result is a mean (i.e., simple average) instead of a median, which generally is a better representation of non-randomly distributed data. Analysis of aggregate data conceals variations among programs.
For ARPEs to have broad utility, they have to be relatively simple, yet the realities that they encompass, that is, contact investigations and targeted-testing projects, are extensively complex, with layers of details that are distributed over extended time periods. Because of this tension between simplicity and complexity, the reports fail to capture nuances. The simplistic approach to reporting is most obvious in the definitions, which fail to reflect many subtleties. Another source of limitations in the definitions is the need for consistency with other data systems, especially the national tuberculosis case surveillance RVCT system. Reporting by jurisdictions may be affected by inconsistent interpretation of instructions and application of definitions.
ARPEs were not designed for epidemiological study and analysis. The data definitions favor operational factors over epidemiological ones, and the data collection should not be subjected to the intensive quality control and review that is necessary for epidemiological studies, because this would be very inefficient. However, ARPEs can be used as a starting point for focused investigations using more stringent definitions and data collection.
With the many complex activities covered by the reports, and the number of steps required for data collection, opportunities for misinterpretations are numerous. Any extreme results in ARPEs should be checked for potential misconceptions/errors before searching for programmatic problems. Data do not reflect prioritization of contacts.
From jurisdiction to jurisdiction, and from site to site within a jurisdiction, inconsistencies of reporting are likely because of different contexts and different interpretations of instructions. The inconsistencies also can arise from intentional modifications of ARPEs instructions for meeting local needs.
The national summary of contact investigations can be obtained by contacting the DTBE General Line: (404) 639-8120 or submitting a request via email to: firstname.lastname@example.org.