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No. 2, 2006
HIGHLIGHTS FROM STATE AND LOCAL PROGRAMS
Third Annual Conference on TB in the U.S. Pacific
Islands: Meeting Highlights, Challenges,
and Solutions for Addressing the Disparities
Based on available surveillance data, the average tuberculosis
(TB) case rate in the U.S.-affiliated Pacific
Islands (USAPIs) is 51.1 per 100,000; this
is 10 times higher than the overall U.S. rate. The USAPIs include
the U.S. territories
of Guam and American Samoa, the Commonwealth
of the Northern Marianas Islands, and three U.S.-affiliated
nations: the Republic of Palau,
the Federated States of Micronesia, and the Republic
of the Marshall
Islands. The U.S.-affiliated nations have Compacts
of Free Association with the United States; under these compacts, the countries
are fully sovereign in domestic and foreign affairs, but give responsibility
for their health, education, defense, and other essential operations
to the United
States. As such, the USAPIs are among the recipients
of CDC cooperative agreement funding for TB control program activities.
These jurisdictions deal with many challenges such as highly mobile
populations, limited health care resources, variable economic and
social conditions, and locations separated by vast expanses of ocean.
The map of the USAPIs shown here has been superimposed on a map
of the United
States to illustrate the distances between
the islands. In addition, through agreements with the United States, USAPI citizens are able to immigrate
to the United
States without the usual overseas screening
for health conditions that is required of those permanently resettling
from other foreign countries. Given the disproportionately high
TB rates among USAPIs, the DTBE Field Services and Evaluation Branch
(FSEB) is working with partners to implement program and laboratory
improvements in this region.
From December 6 to 8, 2005, more than 80 nurses, laboratory technicians,
clinicians, and other public health officials gathered at what
has become an annual meeting to address the growing threat of TB
in the USAPI jurisdictions. This conference provides an invaluable
opportunity for those on the front lines to come together and formulate
strategies that will work in their communities. Meeting attendees
from CDC, the TB control programs in the USAPIs and the State of
Hawaii, the World Health Organization (WHO) Western Pacific Regional
Office, HHS Region 9, HHS Office of the Pacific, the State of California
Microbial Disease Laboratory, the University of Hawaii, and the
Pacific Island Health Officers Association gathered to review the
latest trends; conduct hands-on training in patient management,
surveillance, and TB laboratory quality assurance testing; and identify
solutions to the challenges of sustaining effective TB control programs
in the region. Among proposed solutions, an important factor will
be the maintenance of the WHO DOTS strategy and CDC enhancements,
such as high-quality laboratory testing and expert TB medical consultation.
Another major theme of the conference was the need for culturally
appropriate TB health education materials. This is especially important
in many of the Pacific Islands, where many islanders have
their own local language and a considerable proportion of the people
do not read. Mr. Terry Sasser, a resident of the Marshall Islands and founder
of the organization Mission Pacific, shared information about using
multimedia to empower communities. In many of the remote, isolated
communities in the Pacific
Islands, media tools such as locally produced videos provide a critical
means for outreach and empowerment. Mr. Sasser is currently collaborating
with DTBE and the Republic of the Marshall Islands National TB Program
to develop a video regarding TB for Marshallese communities.
Since TB is one of the most common opportunistic diseases for people
infected with HIV, the link between TB and HIV/AIDS was another
critical topic. While the numbers of HIV/TB-coinfected persons in
the region are low, DTBE will continue to work with USAPI TB programs
and HIV/AIDS organizations in the region to strengthen the availability
of HIV testing for TB patients. Conference materials are available
at www.pihoa.org/tb.
Prior to this year’s regional meeting (December 1–2), the San Francisco
Regional Training and Medical Consultation Center collaborated with
faculty from DTBE, the National Jewish Medical and Research Center,
the California Department of Health Services, and the Commonwealth
of the Northern Mariana Islands to provide training for approximately
40 clinicians and other medical professionals who treat TB patients
in this region. In collaboration with the University of Hawaii
School of Medicine and the Pacific Association for Clinical Training
(a HRSA-funded project), a training DVD was developed. Information
regarding this DVD can be obtained at http://pactraining.org.
For more information about TB control activities in the USAPIs,
please contact Subroto Banerji (404-639-8065 or zro7@cdc.gov)
or Andy Heetderks (404-639-8130 or ajh1@cdc.gov) in DTBE’s Field Services and Evaluation
Branch.
—Submitted by Maggie Kelly, Subroto Banerji,
Andy Heetderks, Gregory Andrews, and Zach Taylor
Div of TB Elimination
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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