TB Notes Newsletter

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No. 3, 2009

Dear Colleague:

I join Dr. Kevin Fenton, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), in congratulating recent recipients of the NCHHSTP Director’s Recognition Award. The Global Perinatal Integration Working Group (GPIWG), which includes Heather Menzies, MD, MPH, of DTBE’s International Research and Programs Branch (IRPB), and Alyssa Finlay, MD, formerly with IRPB, received the NCHHSTP Director’s Recognition Award for August. Dr. Fenton cited the group’s “leadership in promoting integrated global maternal, newborn, and early child health (MNCH) services. GPIWG has worked collaboratively to develop a compendium of interventions and ‘best practices’ for MNCH integration as well as a series of operational research proposals.” Andy Heetderks of DTBE’s Field Services and Evaluation Branch was awarded the September NCHHSTP Director’s Recognition Award for his contributions to addressing multidrug-resistant (MDR) TB in the U.S.-affiliated Pacific Islands. Andy spent a tremendous amount of time and energy in efforts to secure medications for all infected patients and to ensure ongoing support of the program. In large part due to his efforts, 17 patients received life-saving treatment.

The Advisory Council for the Elimination of Tuberculosis (ACET) convened in Atlanta on July 14–15, 2009; a review of some presentations follows. Dr. Hazel Dean, Deputy Director of NCHHSTP, provided an update on Center activities. She reported that the President’s 2010 budget includes increased funding over last year’s funding level. However, most of it is for the domestic HIV/AIDS program, to focus on high-risk populations.

She also reported on NCHHSTP’s H1N1 influenza-related activities. Scientists in NCHHSTP have developed recommendations relative to the novel H1N1 flu for individuals infected with HIV; these recommendations can be found at the CDC website http://www.cdc.gov/h1n1flu/hiv_flu.htm . Providers who are treating TB patients coinfected with HIV will likely find the website useful.

In my update on DTBE activities, I reported the announcement of the 2010 TB Cooperative Agreement, for which submissions were due August 28, 2009. The competitive continuation will allow the use of unobligated funds.

I also reported on the newly revised Report of Verified Case of Tuberculosis (RVCT), which was introduced in January 2009. The form has been tremendously enhanced by this expansion. At the same time, completing the form has become more complex. To address this, a DTBE team has developed training materials that are being used to introduce and explain the new form. Please see the related article in this issue.

Dr. Drew Posey of CDC’s Division of Global Migration and Quarantine (DGMQ) provided an update on immigrant and refugee health issues. The 2007 TB Technical Instructions for TB Screening and Treatment have now been implemented in 24 countries. With thousands of Bhutanese refugees expected to resettle in the U.S. from Nepal, a team representing ACET and NTCA travelled to Nepal in August to evaluate the TB screening and treatment program there. He also shared the news of the recent Notice of Proposed Rulemaking that would remove HIV infection from the list of inadmissible conditions. CDC will review and respond to comments; a final rule will be issued in October 2009 at the earliest.

Dr. Randall Reves reported on A Call for Action on the Tuberculosis Elimination Plan for the United States, which was written by the Stop TB USA–convened TB Elimination Plan Committee. At this point it is superfluous to state that the goal of eliminating TB by 2010, called for in the 1989 Strategic Plan for the Elimination of Tuberculosis, will not be met. The Committee further concludes that an elimination date of 2035 mentioned in the Institute of Medicine’s 2000 report Ending Neglect (but only possible if new tools and strategies had been developed in the last decade resulting in 20% annual declines in TB rates) is also not attainable. Therefore, the Committee recommends a new timeline extending beyond 2035 be developed.

We heard updates from a number of workgroups. Several TB law–related resources have been developed by the Centers for Law and the Public’s Health (Centers), including a state “model act.” Regrettably, the Centers and CDC/NTCA concluded that they could not reach an agreement about required revisions to the model act, and a menu of options for states to consider is being developed. The Interferon-gamma release assay (IGRA) Guidelines workgroup recommends the publication of the revised IGRA guidelines with minor edits, recognizing that some areas will need further research in the future. The revised guidelines for controlling TB in foreign-born persons are currently undergoing further revision. And the BCG Workgroup, which is developing guidelines for preventing TB transmission to U.S. health care workers and volunteers working in countries with endemic drug-resistant TB, will recommend the use of BCG as one option among an array of preventive measures. The BCG Workgroup will continue collecting data and comments, and will request final guidance from ACET on the plan.

The Mycobacteriology Laboratory Branch (MLB) recently underwent external peer review, as required by CDC policy. As of September 1, 2009, MLB began offering the new service of molecular detection of drug resistance (while continuing to offer conventional testing). This process involves use of a DNA sequencing–based assay that will detect mutations associated with drug resistance. We also heard about the new MLB laboratory consultant positions. These consultants—Angela Starks, Frances Tyrrell, and Tracy Dalton—are providing advice and assistance to TB control programs in carrying out the lab component of TB cooperative agreements.

The two research consortia have both been undergoing recompetition. The TB Trials Consortium (TBTC) recompetition for its next 10-year cycle has recently concluded. A number of proposals were received, and awards were made in mid-September. More information on the new TBTC sites will be forthcoming soon. The TB Epidemiologic Studies Consortium (TBESC) in its original form conducted studies in a variety of research areas. The new TBESC will conduct research on one priority topic and carry out one major multisite protocol with a number of substudies; all sites will participate in the main study rather than competing with each other. New sites are expected to be selected by summer 2010.

A number of DTBE staff attended this year’s National HIV Prevention Conference, which was held August 23–26. This conference, held in Atlanta every other year, offers CDC staff a chance to learn about innovations in the HIV/AIDS arena and interact with our colleagues in that field. With the theme “Innovation and Action to End the Epidemic,” the conference featured some topics that have not been addressed at previous conferences, such as new approaches to understanding stigma and discrimination. In addition, several important speakers provided their experiences and perspectives. On August 23, Earvin "Magic" Johnson spoke at the opening plenary session. U.S. Secretary of Health and Human Services Kathleen Sebelius and CDC Director Thomas Frieden also spoke, presenting on August 24 in a special afternoon session. On August 25, Jeffrey Crowley, Director of the White House's Office of National AIDS Policy, held a special Town Hall Meeting to discuss plans for development of a national HIV/AIDS strategy. Finally, on August 26, distinguished members of Congress presented at the closing plenary session, "The Power and Politics of Prevention."

Kenneth G. Castro, MD