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TB Notes 1, 2000
Introduction
Where We've Been and Where We're Going: Perspectives from CDC's Partners in TB Control
Changes I've Seen
TB Control in New York City: A Recent History
Not by DOT Alone
Baltimore at the New Millennium
From Crickets to Condoms and Beyond
The Denver TB Program: Opportunity, Creativity, Persistence, and Luck
National Jewish: The 100-Year War Against TB
Earthquakes, Population Growth, and TB in Los Angeles County
TB in Alaska
CDC and the American Lung Association/ American Thoracic Society: an Enduring Public/Private Partnership
The Unusual Suspects
The Model TB Prevention and Control Centers: History and Purpose
My Perspective on TB Control over the Past Two to Three Decades
History of the IUATLD
Thoughts about the Future of TB Control in the United States
Where We've Been and Where We're Going: Perspectives from CDC
Early History of the CDC TB Division, 1944-1985
CDC Funding for TB Prevention and Control
Managed Care and TB Control - A New Era
Early Research Activities of the TB Control Division
The First TB Drug Clinical Trials
Current TB Drug Trials: The Tuberculosis Trials Consortium (TBTC)
TB Communications and Education
TB Control in the Information Age
Field Services Activities
TB's Public Health Heroes
Infection Control Issues
A Decade of Notable TB Outbreaks: A Selected Review
International Activities
The Role of CDC's Division of Quarantine in the Fight Against TB in the U.S.
The STOP TB Initiative, A Global Partnership
Seize the Moment - Personal Reflections
 
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This is an archived document. The links are no longer being updated.

TB Notes 1, 2000

The Model TB Prevention and Control Centers: History and Purpose

by Elizabeth J. Stoller, MPH
Former Director, Francis J. Curry National TB Center
and Russ Havlak
Former Assoc. Dir. for Special Projects, DTBE

On January 22-23, 1992, a conference on multidrug-resistant TB (MDR TB) was held at CDC in Atlanta. Part of the strategy outlined in the resulting National Action Plan to Combat Multidrug-Resistant Tuberculosis was to establish centers of excellence for treating difficult-to-manage TB cases, especially MDR TB cases. The Plan also called for developing a cadre of health-care professionals with expertise in the management of TB and MDR TB through training. In 1993, the CDC Division of TB Elimination released a request for proposals for Model TB Prevention and Control Centers as a competitive supplement to the Surveillance, Prevention, and Control/Elimination cooperative agreements. The federal funds appropriated to support emergency TB grants were targeted to the 13 states and cities that had reported the largest numbers of TB cases in 1992.

Model TB Centers were to be located in high-incidence urban areas. The recipient health department was required to utilize a current, or establish a new, relationship with a school of medicine or public health for Center operation. The Centers were to provide

  1. Comprehensive, coordinated state-of-the-art diagnostic, treatment, prevention, and patient education services for TB cases, suspects, contacts, and recipients of preventive therapy (treatment for latent TB infection);
  2. Innovative approaches for ensuring adherence with drug therapy and for carrying out other prevention and control activities; and
  3. Training for all levels of health care workers providing TB screening, prevention, and control services within the targeted area.

Three sites were selected for Model Center awards: Newark, NJ, New York City, NY, and San Francisco, CA.

The New Jersey National Tuberculosis Center is located at the University of Medicine and Dentistry of New Jersey, serving Newark and Essex County. The New York City operation is located at the Harlem Hospital Center, and serves Central and East Harlem. The San Francisco Center is operated by the TB control program of the San Francisco Department of Public Health, and includes the surrounding Bay Area counties as the target area.

The programmatic emphasis of each Center was designed to address the needs of each respective target area. New Jersey developed an integrated approach to managing high-risk urban populations through interdisciplinary teams and a nurse case management model, telephone information services for health care professionals and the general public, and a comprehensive training program. The Harlem Center featured enhanced clinical services, a clinic-based DOT model, and training of house-staff and community physicians. The San Francisco program was designed to replicate local successful program components in surrounding jurisdictions in the target area, as well as offer enhanced regional surveillance, laboratory and institutional "hazard evaluation" services, clinical and epidemiologic consultation services, and a comprehensive training program.

In 1997, Kenneth Castro, MD, Director, Division of TB Elimination, CDC, called a meeting of the Model Center principals to discuss a change in programmatic emphasis for the Centers. While the expectation was that activities would continue, efforts should be made to "capture" the outcome of each major effort in some sort of enduring product. This would allow other TB Control programs in the nation to make use of the strategies and tools developed, tested and/or perfected by each of the Centers. The Centers were asked to redesign their programs in accordance with the new directive and submit proposals with exhibits organized under three headings: State-of-the-Art Care, Training, and Innovative Activities. Effective January 1998, the Centers shifted into "product" mode. In less than 2 years, the Centers have developed and disseminated the following innovative program products:

Image 1: The Model TB Centers have developed and disseminated a number of innovative program products.

Harlem:

  • Six case studies to be used for training physicians in clinical management of TB infection and disease
  • Improving Treatment Completion for Latent Tuberculosis Infection among Health Care Workers, a guide for employee health services and chest clinics
  • Tuberculosis Training for International Medical Graduates, a guide for residency program directors, health administrators and TB control programs
  • Social Support Services for Tuberculosis Clients, a guide to help providers establish and enhance social support services

New Jersey:

  • A TB School Nurse Handbook
  • Guidelines for a School-Based Directly-Observed Therapy Program
  • Tuberculosis Preventive Therapy Database for patient tracking and outcome evaluation
  • TB drug treatment pocket card for clinicians
  • Standardized patient scenarios

San Francisco:

  • A series of guidelines on institutional infection control measures
  • A videotape on engineering methods for institutional M. tuberculosis prevention
  • A CD-ROM on patient management
  • A searchable database of TB training and education resources from throughout the US and international programs
  • A software program (TB Info) for real-time program data analysis

The three Centers have undertaken several collaborative efforts, including the development of a national strategic plan on tuberculosis training and education; a national satellite broadcast series for health care providers; and print-based educational materials for civil surgeons and panel physicians. Collectively, the Centers have provided training to tens of thousands of health care providers and the public health workforce, and consultation to providers from a broad range of practice settings.

The Centers continue to operate in response to the needs of the programs in their respective target areas and, with guidance from the CDC, the National TB Controllers Association (NTCA), and the National TB Nurse Consultant Coalition (NTNCC), increasingly in response to the needs of the nation. These Centers are designed to meet your program needs: be sure to contact them for assistance or for resources.

Francis J. Curry National Tuberculosis Center (San Francisco)
Web address: www.nationaltbcenter.edu
Telephone: 415/502-4600

Charles P. Felton National Tuberculosis Center at Harlem Hospital (New York)
Web address: www.harlemtbcenter.org
Telephone: 212/939-8254

New Jersey Medical School National Tuberculosis Center (Newark):
Web address: www.umdnj.edu/ntbc
Telephone: 973/972-3270

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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