TB Notes Newsletter

No. 3, 2010

NEWS FROM THE 2010 NATIONAL TB CONFERENCE

The 2010 National TB Conference was held in Atlanta from June 21 through June 24. Following are reports from some of the presentations and events of the meeting.

History of the National TB Nurse Coalition

On June 21, the National TB Nurse Coalition (NTNC) held its annual meeting. Brenda Ashkar, who served as first president of the national TB nurses group, gave the keynote address at the NTNC meeting. Below is a slightly edited version of her remarks.

When asked to provide the history of the NTNC, I began by thinking about why TB nurses needed an organization in the first place.  In the early 1980s, I was the nurse in charge of one of the largest TB programs in the United States (Los Angeles County), but I was essentially isolated.  California did not have a state TB nursing consultant.  If I called CDC with a question, I talked to the Duty Officer, but often this did not give me the nursing perspective. Nurses need to talk to other nurses!  Then in 1984 I met Carol Pozsik at CDC’s TB Today! Course in Atlanta (precursor of the Program Managers Course) and — this is no exaggeration — my life and career changed.

Carol Pozsik was the new TB Controller for South Carolina. She had joined the American Thoracic Society (ATS) and had become a member of its Scientific Assembly on Microbiology, Tuberculosis, and Pulmonary Infection (SAMTPI) Program Committee. She subsequently invited other TB nurses to take part in TB programs at upcoming ATS meetings.

In 1986, only four TB nurses attended the ATS meeting in Kansas City. A number of nurses had submitted posters, but were turned down by ATS because their posters were deemed not scientific enough.  Several TB nurses spoke about this to Mr. John Seggerson, then Chief of the Field Services Branch in CDC’s TB division.  John promised to look into this, and asked two nurses in the division, Mary Hutton, Nurse Epidemiologist, and Tina Schein, Nurse Researcher, to assist. John also received approval to hold a National TB Conference the next year and assured the nursing group that state and big city nurse consultants would be invited.

This was the spark we needed. Our first meeting was held in New Orleans in May 1987 in conjunction with the ATS meeting and the National TB Conference.  More than 80 nurses attended; our theme was “A Nursing Network to Improve TB Control.” We agreed to reconvene at the next ATS meeting, and we also proposed the idea for holding an evening poster session designed specifically for sharing program-oriented success stories in TB control. This would give nurses a reason to come to the meeting.  A poster being accepted to the session would generate permission to come!

In June 1987, Kay Herd and Sue Etkind, TB nurses in Massachusetts, contacted Mary Hutton at CDC with thanks for the May meeting and the opportunity to meet with other TB nurses.  They talked of the significance of the meeting, proposals, and ideas discussed as well as the dynamic leadership potential in evidence.  Their strong feeling was that we must continue to foster and formalize the nursing network, and that members of the group could provide each other with much information and support.  They envisioned a more structured organization and urged a working committee to meet later in the year.

At the second nurses’ meeting, held at the 1988 ATS meeting in Las Vegas, we were calling ourselves the TB Nurses Special Interest Group.  The highlight of the 1988 meeting was the first CDC poster forum. This was very successful, with more than 150 posters presented. The forum did exactly what was intended by allowing nurses from throughout the United States to come together and share their ideas and achievements.

The Advisory Committee [now Council] for the Elimination of Tuberculosis (ACET) was formed in 1987, with Carol Pozsik as the nursing representative. During these early years of the nurses group, Carol traveled throughout the United States to speak on behalf of the committee and DTBE’s newly approved TB elimination plan. She spoke with nurses throughout the country.  They had so many questions about TB care, and they wanted standards.

In November 1988, Carol communicated with Dr. Dixie Snider, then Director of the TB division, about the need for nursing standards, orientation plans, staffing standards, nursing policies and procedures, nursing practice standards, sample standing orders, and quality assurance measures such as nursing audits.  She informed him that in many states there were inadequate or no standards, reminding him that TB cannot be eliminated without quality assurance.  Carol had contacted other nurses, and they were interested in joining her in the development of a comprehensive nursing standards document that could be a model for the entire country.  She asked for CDC’s endorsement and the assistance of the TB nurse consultants there.  Carol also contacted the Executive Director of ATS in March 1989 to ask for her assistance in funding a committee to pursue the project of writing patient care standards.

At the 1989 ATS meeting in Cincinnati, a TB nurses meeting was convened; 80 nurses registered. At this meeting, we developed outlines for a document on patient care standards.  The TB Nurses Special Interest Group gave a progress report to SAMTPI at the ATS meeting on the progress of the Patient Care Standards. The National TB Controllers meeting was held the next day.

In July 1989 the ATS sponsored the Patient Care Standards Committee, and we met in Atlanta to begin writing the Patient Care Standards Manual with the outlines provided by the TB Nurses Special Interest Group. In August 1990 the TB Patient Care Standards Committee met again in Atlanta, sponsored by ATS. Carol and I, as well as Dr. Larry Farer, Kay Lawton, and Tina Schein of CDC, attended the meeting.  We had completed six chapters at that point and planned to meet again in early 1991. In August 1991, Carol and Tina rented a house for a week at Myrtle Beach, South Carolina, and invited my daughter and me to join them.  There we spent half of each day writing and editing the Manual and the other half day relaxing. What a great way to finish a project!

Nurses active in TB control activities continued to meet as the TB Nurses Special Interest Group to network and solve problems during the ATS meetings in Anaheim in 1991, Miami in 1992, San Francisco in 1993, Boston in 1994, and at the CDC-sponsored National TB Controllers Workshops. In addition, the majority of the nurses attended business meetings and held joint programs with ATS/ SAMTPI.  I am grateful to say that this arm of ATS has always been extremely supportive of the TB nurses.

In 1994 CDC moved the National TB Controllers meeting to Atlanta and the nurses began discussions about formalizing the TB Nurses Special Interest Group. In January 1995, the TB nurse consultants from a majority of the states and large cities formally organized as the National TB Nurse Consultant Coalition (NTNCC).  After much discussion, we decided to be a section of the newly formed National TB Controllers Association (NTCA).  We felt that under the NTCA umbrella, we could be a collective voice for nurses working in TB control activities and provide counsel to TB Controllers, as well as develop standards for practice for PHNs.  I was elected the first president; Helen Gretz of Oklahoma, president-elect; and Jerry Lama of Chicago, secretary/ treasurer. A few months later we met and wrote by-laws. The first meeting of the NTNCC was held during the 1995 ATS meeting in Seattle.

NTNCC participated in the hiring of Walt Page, long-time TB controller and DTBE staffer, as the first Executive Director of NTCA. He began serving in this position in 1996, and under his direction, NTCA decided that its future meetings would be held in Atlanta and not at ATS. In August 1996, the membership chairman of NTNCC, Evelyn Lancaster, created the logo and membership brochures for both the NTCA and NTNCC.

One of the major accomplishments of NTNCC was the publication in 1997 of the manual, Tuberculosis Nursing: A Comprehensive Guide to Patient Care.  As of this writing, a second edition is nearing completion. On January 1, 2006, our organization formally changed its name to the National TB Nurse Coalition (NTNC) to be more inclusive of nurses who are not nurse consultants.

In the NTNC, TB nurses share ideas and knowledge with other TB nurses. What a confidence builder for nurses to know whom to call for help! Please join the NTCA and NTNC so your voice can be heard!

—By Brenda Ashkar, RN, MSN, PHN
Retired TB Nurse Consultant and first president of the NTNCC

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National TB Conference Poster Contest Winners

This year the National TB Conference held its fifth annual poster contest; 43 posters were developed and submitted by TB program staff from throughout the country, and were available for viewing during most of the meeting. A panel of judges reviewed and rated the posters on three criteria:

1. Relevance to TB control or elimination
   Topic provides information that can potentially be transferred to another program; addresses or identifies a high-priority area of a TB program or problematic area; provides strategy for better use of resources.
   
   
2. Clarity of information
   Information is clearly written, using short sentences and bulleted points to enhance readability; adequate amount of information is provided to allow readers to understand project, but is not a complete journal article!
   
   
3. Graphic presentation
   Graphics are utilized to clearly present information (photographs to demonstrate or model, graphs and charts to display data); graphics are appealing to the viewer (not crowded, and colors are used appropriately).

The poster judges for this year were Wanda Walton, John Jereb, Mitch Yakrus, and Denise Garrett. A special thanks to them for their time and diligence.

This year the judges gave a first-place and a second-place award, and multiple third-place awards because of ties among the entrants.

The first-place award was given to
Margaret Patterson, Kentucky Department of Public Health, for her poster, “Investigation of Ongoing Transmission of M. tuberculosis Genotype Cluster – Jefferson County, Kentucky, 2000-2009.”

The second-place winner was
Adam Langer, Division of TB Elimination, for his poster, “Multistate Outbreak of Multidrug-Resistant TB Among Foreign-born Seafood Production Workers Identified by Genotype Cluster Investigation.”

Third-place awards were given to
Heidi Behm, RN, MPH, Oregon Department of Human Services, for her poster, “Where Are They Now? A Comprehensive Approach to Achieving a High Treatment Completion Rate in a Worksite TB Exposure in Washington County, Oregon.”

Wendy Cronin, PhD, Maryland Department of Health and Mental Hygiene, for her poster, “A Statistical Method to Prioritize M. tuberculosis Genotype Clusters for TB Control Programs’ Use in the United States.”

Julie Franks, Charles P. Felton National TB Center, for her poster, “Knowledge, Attitudes, and Beliefs About TB Testing Among Healthcare Workers Who Receive an Interferon-Gamma Release Assay as Part of Routine Employee TB Testing.”

Congratulations to the winners of this year’s competition, and thank you to all submitters for sharing your data, experiences, and excellent solutions!

—Submitted by Regina Bess
Div of TB Elimination

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Nuestra Casa – A Touring Project for TB Advocacy, Communication, and Social Mobilization

On June 23, over 150 people attended the grand opening of Nuestra Casa (Our Home), at CDC’s Global Health Odyssey museum. Attendees included participants from the 2010 National Tuberculosis (TB) Conference, CDC staff, and other invited guests. DTBE hosted the event to raise awareness about TB, which kills millions of people worldwide every year. Distinguished speakers included Dr. Kenneth Castro, Director of DTBE, whose comments inspired and motivated everyone to continue the fight to eliminate TB, and Miss Rachel Orduno, who shared her incredibly moving story about TB and led a call to action.

Nuestra Casa is a three-dimensional house that serves as a testimony to the lives of people affected by TB, their surroundings, and their messages of reality and hope. The exhibit provides museum visitors with an experiential learning opportunity by inviting them into the “home” of a person with TB. The house is filled with individual stories, photographs, and personal items, all contributed by persons affected by TB from the U.S.-Mexico border area. The exhibit reflects the need for social and political commitment to recognize the problem of TB, to increase the political will to improve TB disease prevention and control, and to reduce the stigma and discrimination experienced by persons affected by TB.

Included in the exhibit are a series of very powerful photographs and stories from the TB PhotoVoice project. The TB PhotoVoice project provides cameras to community members (survivors, caregivers, friends, and family) affected by TB. Participants take photographs to help them identify and improve their communities. The photographs represent what is happening in the participants’ lives and serve as a point for discussion about what can be done to change the present situation in regards to TB, stigma, education, and related issues. These unique photographs, and their accompanying narratives, give a face and voice to TB.

As a special feature of Nuestra Casa, visitors could write comments about the exhibit on pieces of cloth and hang them on a clothesline located outside of the house. As many as 245 visitors did so, their comments expressing a range of reactions: how much empathy they felt for people with TB, how they were reminded of the homes of their relatives, and how thankful they were for what they had. Some visitors indicated how informative the exhibit was, and others expressed their desire to hold our political leaders accountable for this dreadful disease. The following quotes were selected to illustrate how moving and powerful our TB educational efforts can be:

“I am now rethinking my career path so that I can do research to contribute to the efforts to combat TB. Also, I want to go abroad so that I can actively help out.”

“I am going to med school one day. Five minutes in this house just convinced me I'm going to do Doctors without Borders for at least a year.”

“This exhibit inspired me to research TB on my own to better understand its causes, effects, and how it damages the body. Now I want to be a scientist and work for the Centers for Disease Control.”

“It’s a wakeup call. A lot of people need help. I'm going to start a fund raiser to help the people with TB.” (13 years old)

“It is a wonderful exhibit. It brings the main part of the team into the picture, allowing the health of the patient to have a voice and be heard.”

The organizations Project Concern International (PCI) and the Alliance of Border Collaboratives, in collaboration with the Mexico National Tuberculosis Program and with financing from USAID-Mexico, helped make the Nuestra Casa project a reality. Nuestra Casa was exhibited in South Africa and Mexico before arriving at CDC in June. Nuestra Casa was on exhibit at the CDC Global Health Odyssey until September 3, 2010.

Nuestra Casa is a reminder of who we are serving and how important it is to educate all people about TB.

—Reported by Peri Hopkins, MPH
and Cheryl Tryon
Div of TB Elimination

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Special Awards Presented at the National TB Conference

Several special awards were presented at the 2010 National TB Conference over the course of the meeting. These awards are special because they not only recognized the outstanding contributions of the award recipients themselves, but they also honored the distinguished careers and accomplishments of the TB experts for whom the awards were named.  These awards, which will be given annually, were presented this year for the first time.

On Tuesday, June 22, the first three awards were announced. The Advocacy Award is to be bestowed on an organization or individual who has rendered outstanding efforts and achievements in advocating for increased support of TB control and prevention efforts. Phil Griffin called Charles DeGraw, Louisiana TB controller, to the stage. As Charles came forward, Phil said, “Charles, this award is not being given to you – it is being named for you. This award will hereafter be called the Charles DeGraw Advocacy Award.” Mr. DeGraw, who gave a presentation at the conference on the importance of grassroots advocacy, is a tireless crusader for increased support for TB control. The Charles DeGraw Advocacy award was presented to Ms. Nuala Moore of the American Thoracic Society, Washington, DC.  Ms. Moore has been instrumental in advocating for TB funding and supportive legislation in Washington and in helping to guide the NTCA advocacy efforts.

The President's Award is given at the discretion of the NTCA President to acknowledge special accomplishments of an individual or organization who has contributed to the NTCA or the TB community in general. In presenting this award, Phil noted that there were many outstanding persons to whom he could have given this award, but that one person stood out – one person who preferred to remain behind the scenes, but who had been the “voice of reason” and had urged him to move on rather than be distracted by side issues. Phil then presented the NTCA President’s Award to Deborah (Deb) K. Sodt, RN, MPH, Minnesota Department of Health, St. Paul, MN.

Also on Tuesday, Michael K. Leonard, MD, President of the National Society of TB Clinicians, presented the William Stead TB Clinician Award. Dr. William Stead, long-time TB controller for Arkansas who died in 2004, was regarded during his lifetime as the outstanding TB clinician in the United States and perhaps worldwide. In the 1970s, he and colleagues developed short-course TB therapy, adopted worldwide as the definitive therapy for TB, and he made major contributions regarding TB in prisons and nursing homes. (TB Notes readers may recall that Dr. Kashef Ijaz, until recently the chief of DTBE’s Field Services and Evaluation Branch, worked with Dr. Stead at the Arkansas Dept. of Health.) This honor is bestowed upon a TB physician for outstanding patient care services. He presented this award to dedicated TB physician Barbara Seaworth, MD, a nationally recognized expert in the care of patients with MDR and XDR TB; she is with the Heartland National TB Center, San Antonio, TX.

On Wednesday, June 23, several more awards were presented. Phil first announced an award for laboratory staff, hereafter to be known as the Ed Desmond Award, named for distinguished laboratorian Edward Desmond, PhD,Chief, Mycobacteriology and Mycology Section, California Department of Public Health. His laboratory, as one of two labs providing genotyping services for all U.S. TB control programs, performs strain typing of Mycobacterium tuberculosis complex cultures for the western half of the United States. Dr. Desmond's laboratory also performs molecular beacons testing on acid-fast, smear-positive sputum samples and cultures to detect M. tuberculosis and drug resistance. This award is bestowed on a TB laboratorian for outstanding tuberculosis laboratory services. This was awarded to Dr. Desmond’s colleague Shou-Yean (Grace) Lin, MS, of the California Department of Health, Richmond, CA.

For the second award presentation on Wednesday, another long-time TB professional was honored with the naming and presenting of the Carol Pozsik TB Nurse Award. This award is bestowed on a tuberculosis nurse for outstanding services as selected by the National TB Nurse Coalition.  As noted by Brenda Ashkar in her earlier remarks, Carol’s influence and impact on TB nursing have been huge in scope and impact. She brought nurses together, organized and publicized their contributions, and helped them find their collective voice. Like her colleague Charles DeGraw, she has been a long-time TB control leader and advocate, and serves as the current NTCA Executive Director. Kathy Kolaski, NTNC President, gave the award to Ms. Laurie Hickstein, BSN, of the Southern Nevada Health District, North Las Vegas, NV, who has worked for a decade in the health district’s TB treatment and control clinic.

Next, the Dixie Snider Award was given. Dr. Dixie Snider, who retired from CDC in 2006 as CDC’s chief science officer, served CDC for more than 33 years. From 1985 to 1993, Dr. Snider served as Director of the TB Division. During that time, he was responsible for the establishment of the Advisory Council for the Elimination of Tuberculosis (ACET), and for the development of the 1989 Strategic Plan for the Elimination of Tuberculosis in the United States. He gained support for the plan by building coalitions with various groups and through extensive collaboration with key partners. Thus, this honor is bestowed on a CDC employee who has rendered outstanding support, through partnership, to the state- or local-level TB community in the interest of TB control and prevention program improvement. Phil presented this award to Angela Starks, PhD, of DTBE’s Mycobacteriology Laboratory Branch, Atlanta.

The fourth award presented on Wednesday was the Robert Koch TB Researcher Award, which is bestowed on a tuberculosis researcher for outstanding contributions. As readers know, on March 24, 1882, Koch announced to a medical group in Berlin that he had isolated, and grown, the organism responsible for tuberculosis. Years later, this date was chosen by the World Health Organization as the date on which World TB Day would be observed. In 1905, Koch won the Nobel Prize for his investigation and discoveries in relation to TB. Wendy Cronin, PhD, of the Maryland Department of Health, Baltimore, MD, was honored as the recipient of this award.

On Thursday, June 24, the last official day of the 2010 National Tuberculosis Conference, Phil presented the last award. The TB Controller of the Year, NTCA's highest award, is given for meritorious service and achievement at the state, regional, or national level in recognition of contributions related to the improvement of tuberculosis control and prevention leading toward elimination. This important award was presented to Mr. Mike Holcombe, MPPA, Division Director, Office of TB and Refugee Health, of the Mississippi State Department of Health, Jackson, MS.  Mr. Holcombe was the President of NTCA for the first 2 years of the organization and has continued to contribute tirelessly to the organization and to the TB community.  He was an early and passionate proponent of DOT, helping to lead the charge to make it the gold standard of care.  Mr. Holcombe has also been very instrumental in the creation of these annual awards of excellence.

Thanks to Phil Griffin for his help with this article, and for all his substantive contributions as immediate past president of NTCA!

—Reported by Ann Lanner
Div of TB Elimination

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