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No. 1, 2007

Highlights From State and Local Programs

Maine’s Contact Investigation Course for Public Health Nurses: A Model for Regional Collaboration

The Northeastern Regional Training and Medical Consultation Center (RTMCC) is one of four regional centers providing training, technical assistance, and medical consultation to health care professionals throughout the northeastern United States. Health educators working with the Northeastern RTMCC are assigned to provide training or technical assistance to TB programs in their project areas. This process began with a lengthy needs assessment to develop stronger relationships with TB program staff and TB public health and clinical service providers throughout the region.

One unique example of this collaboration is a contact investigation course planned for public health nurses in the state of Maine. Individuals from the Northeastern RTMCC, the TB Prevention and Control programs in Massachusetts and Maine, and the Maine Public Health Nursing Program began with a series of conference calls to better understand the educational needs of Maine’s public health nurses. This process included an informal survey of the target audience by Maine’s public health nursing consultant, as well as input from Maine’s TB program director. Key topics identified for the course included contact investigation, working with individuals using drugs or alcohol, harm reduction, and working with immigrant and refugee populations. Particular emphasis was placed on developing a course that was customized to the needs of Maine’s public health nurses and that included presenters from the state of Maine.

The course agenda prioritized the psychosocial impact of TB on marginalized populations (such as new arrivals to the United States and persons who are drug or alcohol users or are homeless) as integral to public health education. The training program spurred several lively discussions, debates, and sharing of experiences between conference participants on these topics. The opportunity for public health nurses to learn about and discuss these issues can ultimately lead to better community partnerships and more successful contact investigations.

Challenges encountered during the process of planning for this course included the large geographic size of the state of Maine, diverse populations throughout the state, public health nurses’ travel and coverage constraints, and varying educational needs of urban and rural parts of the state. The organizing group decided to conduct the training via interactive video conferencing (ITV) from a central location in Augusta. Six remote sites were chosen for participation throughout the state (Rockland, Caribou, Machias, Portland, Lewiston, and Bangor). The ITV system allowed each of the remote sites to view the presentations held in Augusta, and the home site could view the people at each of the remote sites. The group also decided to hold the conference on two consecutive days, repeating the same program each day with three distinct remote sites. This satellite configuration was chosen to maximize the participation of Maine’s public health nurses by minimizing the need to travel. Binders with educational materials and other handouts were mailed ahead to each conference site, and presentation slide sets were sent by e-mail.

Unique collaborations led by Maine’s TB program staff contributed to the success of the conference. Maine’s TB Controller and Massachusetts’ Director of TB Education and Training, with input from the Maine Public Health Nursing Program, prepared two case presentations based on TB cases occurring in Maine and their respective contact investigations. A Public Health Nursing Consultant from Maine specializing in education and training moderated the conference program and encouraged participation from each of the remote sites. Maine’s TB Nursing Consultant served as the ITV system expert and organized the logistics on the ground. Individuals from the Northeastern RTMCC coordinated conference planning calls, compiled binders and conference materials, and helped secure presenters from outside the state of Maine. A Nurse Psychologist from Massachusetts spoke about building relationships with TB patients, how to avoid burnout, and ways to practice harm reduction in TB case management and contact investigation activities. Other presenters included Maine’s TB program Medical Director, the Director of Maine’s Office of Multicultural Affairs, and the Director of Maine’s Office of Minority Health.

Lessons learned from this conference:

• Nearby states have experts, materials, or ideas that they can share with one another. Frequently they are not provided with the opportunity to discover their commonalities and share resources.
• Planning for training programs can be successfully directed by TB program staff and based on the needs of the training audience in the project area. Customized training programs geared towards the needs of a specific audience are efficient ways of providing training.
• Collaboration between state programs and the Northeastern RTMCC provide new possibilities for accessing training and education resources. This cooperation forms a connection between federal and state TB efforts to improve services, access to resources, and ultimately TB control.

While it may take longer to develop training programs that utilize rich local resources and are customized to meet the specific needs of their audiences, these programs strengthen local resources and connections and may better meet the needs of training participants. Overall, the Contact Investigation Course for Maine’s public health nurses can serve as a valuable model for collaboration across states and regions.

—Submitted by Erin Howe, Northeastern RTMCC,
for the Maine CI Course Collaborative Team

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Washington State TB Program Hosts Regional Meetings

On August 23, 2006, representatives of TBESC Task Order 6, “Regional Capacity-Building in Low-Incidence Areas,” met in Bremerton, Washington, for an annual review and update. Participants included state TB program staff from Montana, Utah, Wyoming and Idaho; CDC DTBE staff; and Francis J. Curry National Tuberculosis Center staff. The presentation given by Dr. Christine Hahn, Idaho Health Officer, included a discussion of an outbreak among epi-linked and genotype-linked homeless persons; the outbreak involved the states of Idaho, Washington, Oregon, and Montana. This outbreak serves as a good case study for the TB Outbreak Advisory Group within Task Order 6.

On August 24–25, the Rocky Mountain Fifth Annual Regional Meeting was also held in Bremerton, WA, in the Kitsap Government Building. This meeting was attended by 46 participants from Wyoming, Utah, Montana, Idaho, Oregon, Alaska, and Washington. Attendees included staff of local health departments, state corrections, Immigration and Customs Enforcement (ICE), and Division of Quarantine at Seattle-Tacoma International Airport. The 2-day regional meeting was hosted by Dr. Scott Lindquist, Kitsap County Health Officer and Department of Health TB Medical Consultant. Dr. Lindquist and Dr. Diana Schneider from the Division of Immigration Health Services, Washington, DC, gave a presentation on continuity of TB therapy for ICE detainees as well as an overview of the migration stream into Washington and the role of the civil surgeon screening. Updates on genotyping were presented by Lorena Jeske, WA State TB Nurse Consultant, Dr. Christine Hahn, Idaho Health Officer, and Denise Ingman, Montana TB Control Officer. Tom Stuebner, Director of the Francis J. Curry National Tuberculosis Center, reviewed the outcome of the 2005 Training and Education needs assessment for the western region of the United States; the top three training topics indicated by respondents included multidrug-resistant TB (MDR TB); legal issues related to TB; and pediatric TB.  Dr. Kim Thorburn, Health Officer for the Spokane County Health District, and Karen Crouse, Spokane County Lab Director, described the QuantiFERON-TB Gold in vitro diagnostic test and the process of implementing this assay in a public health laboratory. TB Program Managers Cristie Chesler (Utah) and Kim Field (Washington) compared and contrasted the cohort review processes as practiced in their respective states. Dr. Masa Narita, Medical Director of the Seattle and King County Public Health TB Program, gave a presentation on TB outbreaks in a school, among methamphetamine users, and in university settings. Phil Talboy, DTBE Deputy Director, provided an overview of 2006 appropriations for TB prevention and control and laboratory cooperative agreements. Maureen Wilce, DTBE, provided an update on the national initiative for TB program evaluation.

On August 25, participants gathered for a half day to hear more topics of interest and plan the location and content of the 2007 annual regional meeting. Lorena Jeske discussed Washington State’s process of gathering data for the Aggregate Reports for Tuberculosis Program Evaluation (ARPE). One of the most popular presentations among the regional attendees was the application of videophones as an adjunct to directly observed therapy (DOT) home visits; this was given by Donna Allis, Snohomish County Communicable Disease Supervisor, and Peggy Cooley, Tacoma Pierce County Health Department TB Case Manager. Dr. Christine Hahn stated, “This is a cost-effective tool to provide DOT, and I will be planning implementation with Idaho public health programs.” Carol Pozsik, CEO of the National TB Controllers Association (NTCA), reviewed the work of the NTCA board and members. Carol invited all participants to become members of NTCA.

Kim Field facilitated the discussion on the meeting evaluation, and staff of the Oregon State Department of Health volunteered to sponsor the 2007 regional meeting in Portland, Oregon.

—Reported by Kim Field
 Washington State TB Program Manager
Washington Department of Health

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Midwest TB Controllers’ Meeting

The Midwest TB Controllers’ meeting was held in Des Moines, Iowa, October 4–5, 2006. TB Program Managers and Nurse Consultants attended from Nebraska, Iowa, Illinois, Missouri, Kansas, Wisconsin, South Dakota, Minnesota, and Indiana. The National TB Controllers Association (NTCA) was represented by Carol Pozsik, and CDC attendees consisted of Dawn Tuckey, Program Consultant, DTBE; Phil Talboy, Deputy Director, DTBE; Patrick Moonan, Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB), National Genotyping Program, DTBE; and Kai Young, Field Services and Evaluation Branch (FSEB), Evaluation Team, DTBE. Heartland National TB Center staff also were present.

On Oct. 4, Dr. Patrick Moonan (DTBE), Phil Griffin (Kansas), Mike Arbise (Illinois), and Lynelle Phillips (Missouri) facilitated a workgroup discussion concerning the interstate use of genotyping data. We then heard presentations from staff of each state TB program, each of whom gave a detailed case study or investigation or a description of a project of interest. The presenters spoke on the following topics:

• Minnesota: First XDR TB case
• Nebraska: New TB medication distribution system
• Iowa: TB outbreak overview
• Kansas: TB outbreak in a prison
• Wisconsin: Web-based communicable disease reporting and patient management system
• Missouri: DHSS communicable disease website
• South Dakota: MDR TB cases

CDC staff presented a review of the budget, and NTCA Executive Director Carol Pozsik presented an update on advocacy activities. All presentations were interactive and generated robust discussion among the participants.

On Oct. 5, the Heartland Center sponsored a TB Update, which featured several university case studies by Dr. Douglas Hornick of the University of Iowa as well as updates on MDR and XDR TB by Dr. Timothy Aksamit (Mayo Clinic, Minnesota). 

In recognition of the four new member states, the name of this association will change to the Upper Midwest TB Association, and will include the following states:  Illinois, Iowa, Indiana, Kansas, Minnesota, Nebraska, Missouri, North Dakota, South Dakota, and Wisconsin. The next meeting is planned for the first week in October or the last week in September of 2007.  The meeting will be held in Illinois.

—Submitted by Allan Lynch
Program Manager
TB Control and Refugee Health
Iowa Department of Public Health

Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

 
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