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Tuberculosis Epidemiologic Studies Consortium (TBESC)
Task Order 6: Regional capacity-building in low-incidence areas
Task Order 6 focuses on developing, implementing, and evaluating
regional tools for TB control and elimination in low-incidence
areas. The study is being implemented through the Francis J. Curry
National Tuberculosis Center of the University of California, San
Francisco (UCSF), and involves collaboration with Principal
Investigators from Denver (Chuck Daley, Randall Reves) and Seattle
(Charlie Nolan), and with the state TB control programs in Idaho,
Montana, Utah, and Wyoming. Each of these states has differing TB
epidemiology and TB control program structure but they share the
common challenge associated with maintaining TB control program and
clinical expertise in the context of low TB incidence and few
resources. Task Order 6 has developed regional interventions that
were prioritized through a consensus process that involved the four
low-incidence states as well as the many TO 6 partners.
Sites
Utah, Montana, Wyoming, Idaho.
Study Objectives
- 1. Conduct a programmatic needs assessment of TB programs in
selected low incidence states (Utah, Montana, Wyoming, Idaho)
- Develop and implement regionally-based interventions that
address identified priority needs using the program needs
assessment.
- Evaluate the interventions to determine which are most
effective in improving program performance and accelerating
progress towards TB elimination.
- Based on the evaluation, develop a model of best practices
that be replicated in other low incidence areas. This model will
be developed using a regional approach that takes into account
the individual states’ needs.
Study Design
A public health intervention design was used. Program needs were
assessed through self-administered and interview surveys of state
public health staff involved in TB control. Decisions to identify
priority interventions, and the implementation of these, were made
in close collaboration with all stakeholders. Evaluation plans were
created and followed using the CDC Framework for Public Health
Evaluation.
Study Progress
Task Order 6 has completed the following regional interventions:
short audio course on the medical management of TB; a regional
outbreak response plan template; regional assessment of TB
surveillance systems; surveys of laboratory mycobacteriology
practice and reporting; trainings for laboratorians performing
mycobacteriology services; trainings, modified for low-incidence
settings, for local field-staff, in case management and contact
investigation; and a customizable TB manual template that is a
“how-to” guide for public health practitioners. A regional TB
elimination plan is being developed to describe the core
requirements of staff and resources necessary to perform TB control
activities and move towards TB elimination in a low-incidence area.
Additionally, a regional surveillance intervention is being
implemented to answer the question: What are the programmatic
improvements that result from routine review of genotyping and
epidemiological data across the region? This intervention involves
the implementation of a regional coordinator role, and tools for
using genotyping and surveillance data to identify potential
region-wide outbreaks and to inform strategic program planning and
program evaluation. Evaluation of the TB manual template is
underway; a baseline survey was conducted in ID and MT to determine
the TB information-seeking practices of local public health
practitioners, and their confidence in using the information to
perform TB control and patient management activities. The TB manual
template was customized to create a state-specific manual in the
states of MT and ID. A follow-up survey will be implemented six
months post-dissemination of these state-specific manuals. A
manuscript has been submitted.
Last Modified: 07/25/2007
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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