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No. 3, 2006
TUBERCULOSIS EPIDEMIOLOGIC STUDIES CONSORTIUM
TBESC Task Order 6 (TO6) Update: Regional
Capacity Building in Low-Incidence Areas
Background. The TB Epidemiologic Studies Consortium Task
Order 6 (TO6) focuses on developing and implementing regional tools
for TB control and elimination in low-incidence areas. TO6 is being
implemented through the Francis J. Curry National Tuberculosis
Center of the University of California, San Francisco. Previous work
identified the needs of four low-incidence states in the western
region of the United States: 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.
Process. Regional interventions were developed and
prioritized through a consensus process that involved the four
low-incidence states and many TO6 partners. The TB control programs
of Idaho, Montana, Utah, and Wyoming actively participated in the
development and implementation of a series of interventions.
Advisory groups (AGs), comprised of members of each state’s TB
control program and/or public health laboratory, national experts
associated with TO6 (the principal investigators, nurse consultants,
and CDC staff), and TO6 staff were routinely convened to make
decisions and communicate progress in each intervention area. For
example, the Policy and Planning Advisory Group was convened to
develop a TB Manual template to standardize practice and tailor
national guidelines to each state’s unique public health system. All
AGs were facilitated so that the issues of importance to each state
were raised and explored, and discussions were guided to ensure
interventions will benefit the region. Evaluation plans are being
introduced into each intervention to determine if objectives are
achieved, and, where applicable, if TB control practice improved.
Guidance of the evaluation components will also occur through an AG
process.
Interventions. The interventions, which are at various
stages of development or implementation, were designed to address
the TB control programs’ needs and include the following:
-
A customizable TB manual template that presents national TB
control guidelines for use in the field
-
Assessments of regional laboratory practice
-
Collaborative regional laboratory trainings
-
Case management and contact investigation trainings using a
collaborative model
-
A short audio course on the medical management of TB
-
Collaborative evaluation of a case management teleconference series
-
Regional clinical consultation
-
Tools for using genotyping and surveillance data to identify
potential region-wide outbreaks, and to inform strategic program
planning and program evaluation
-
An outbreak response plan template
-
A regional assessment of TB surveillance systems
-
A regional TB elimination plan
Some of the
interventions are completed or nearing completion. For example, the
TB Manual template will be available online this summer; the audio
course on medical management of TB has been completed and is
available online at http://www.nationaltbcenter.edu/med_mgmt/; a
final report of the evaluation of a case management teleconference
series in Idaho has been completed and was presented at the CDC
poster session at the ATS conference in May 2006 and at the NTCA
conference in June 2006; the regional assessment of TB surveillance
systems was completed. Regional laboratory trainings are currently
being developed in collaboration with the National Laboratory
Training Network. One laboratory survey has been completed and
presented in a variety of venues. A follow-up laboratory survey is
in progress. The case management/contact investigation training is
being developed to precede and complement Utah’s annual TB
conference held in Salt Lake City. A draft outbreak response
template is currently being evaluated in Idaho and will be finalized
by fall 2006. The regional TB elimination plan is currently being
developed. Additionally, the surveillance and genotyping
interventions are in early stages of development.
Outcomes. The regional
interventions were created in order to put the concept of
regionalization into practice and to assess whether tools created
and implemented in a low-incidence region provide added value to TB
elimination efforts. As these interventions are being evaluated, we
hope to determine effective practices for eliminating TB in a
low-incidence region.
—Submitted
by Lisa Pascopella
Francis J. Curry
National Tuberculosis Center
of the
University of California at San Francisco
and Charles
Daley
National Jewish
Medical and Research Center
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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