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TB Notes NewsletterReturn to Main Menu - TB Notes 2, 2007No. 2, 2007HIGHLIGHTS FROM STATE AND LOCAL PROGRAMSSuccessful Collaborations by New England TB Prevention and Control ProgramsThe six New England tuberculosis (TB) control programs have recently created a mechanism for communicating, coordinating, and collaborating on specific issues related to TB prevention and control. As a consequence of increasing immigration from a wide diversity of countries, all of the New England states are greatly impacted by the changing epidemiology of TB reflected in the growing foreign-born population. Another common challenge for the New England TB programs is to maintain the low TB rates among traditional populations that are vulnerable to TB, especially the homeless and incarcerated, to prevent outbreaks and to hasten the decline of TB in these groups. These challenges come at a time when funding to local and state TB programs is declining. This article will detail examples of the collaboration that has resulted from this new partnership among public health departments. New England Region TB PlanThe New England region TB plan provides a framework for promoting regionalization as a means to improve and enhance TB prevention and control as part of the vision for TB elimination. The framework sets out the goals and objectives for effective collaboration between programs and partners in the region and identifies five key regional TB strategies:
CDC’s Division of Tuberculosis Elimination (DTBE) and state and local partners are supporting this effort to share experiences and resources. Starting in 2005, Dr. Mark Lobato, a DTBE medical officer, has been working with the New England TB programs to help develop a regional approach to capacity building. This is done through supporting existing programs and implementing new initiatives via systematic collaboration on priority areas. “Eliminating TB Case by Case”One success story has been the series of TB case presentations entitled “Eliminating TB Case by Case.” Several sources of evidence indicate that health providers have ongoing educational needs, including 1) a regional education needs assessment, and 2) studies, including one by CDC documenting nonadherence to national TB standards and guidelines by private providers. This highly successful TB case series was organized by a coordinating group from the New England TB Programs, the Northeastern Regional Training and Medical Consultation Center (RTMCC), and DTBE. Contributors to creating the series included Kathy Hursen, RN, director of education and training for the Massachusetts Division of TB Prevention and Control, the moderator for the series; Judy Proctor, RN (New Hampshire); Erin Howe, health educator for the Northeast RTMCC; and Mark Lobato (CDC). The web-based case series is designed to allow providers to present patients whose cases illustrate public health principles and practices. The objectives of the TB case series are to offer a forum for discussing the public health implications of infectious TB, describing the clinical management of TB, increasing awareness of national recommendations for TB diagnosis and treatment, and discussing options for ongoing patient care. To date, the six presentations have reached 60–80 nurses, physicians, health educators, and others. The inaugural presentation featured Robert Horsburgh, MD, from the Boston School of Public Health and the Boston Medical Center and formerly with CDC. Dr. Horsburgh, a local and national expert in TB and HIV treatment, skillfully drew participants into an active dialogue around the case, thereby laying the groundwork for future presentations. An upcoming presentation is planned with Dr. Marie Turner, medical director of the TB Treatment Unit at the Lemuel Shattuck Hospital in Boston. NewEnglandTB.orgAnother success has been the development of the regional TB website, NewEnglandTB.org. The intent of the website is to provide a means for building program capacity by sharing developed resources and materials, communicating experiences and successful strategies, and giving providers access to education and training resources and patient education materials. Developed by a regional team including Marilyn DelValle (MA) and Lisa Roy (NH), the TB programs are learning how to improve the website and promote its use by public health nurses and TB providers. Molecular TB GenotypingFinally, the TB programs are at the beginning stages of sharing molecular TB genotyping data to define the specific TB strains circulating in their states. In investigating infectious TB patients, state programs often communicate and collaborate with their neighboring states to prevent possible interstate TB transmission. By identifying the specific TB strains, the programs can define and quantify the extent of transmission across states lines. The first discussion among New England TB programs of a common cluster strain involving 25 patients in four states took place recently. Regina Grebla, an MPH intern from Columbia University, has started work on the creation of a shared database of genotyping results. The New England TB programs intend to continue and expand their collaborations. At a future NTCA meeting it is hoped that the regional experience can be shared with other TB programs. —Submitted by Mark Lobato, MD,
Last Reviewed: 05/18/2008 |
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Centers for Disease Control & Prevention |