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TB Notes Newsletter
No. 2, 2007
HIGHLIGHTS FROM STATE AND LOCAL PROGRAMS
Successful Collaborations
by New England TB Prevention and Control Programs
The 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 Plan
The 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:
- Engage in ongoing dialogue to promote regional
planning and policy development
- Increase education and training geared to
identified needs
- Actively use data from molecular genotyping of
Mycobacterium tuberculosis strains
- Use program evaluation to improve health
outcomes
- Intensify coordination of cross-jurisdictional
contact investigations
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.org
Another 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 Genotyping
Finally, 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,
New England Region TB Consultant, DTBE, and
Kathy Hursen, RN,
Director of Education and Training
Massachusetts Div of TB Prevention and Control
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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