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U.S. Department of Health and Human Services

  

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TB Notes 1, 2002

International Notes

The Tuberculosis Coalition for Technical Assistance (TBCTA)

The TBCTA: As part of the global effort against TB, six organizations involved in TB control have formed a unique and free-standing partnership, the Tuberculosis Coalition for Technical Assistance (TBCTA). Each of the partner organizations has a TB-specific agenda as well as expertise and experience. Together, the partners of TBCTA form a formidable force that stimulates political commitment in the selected countries, and provides strategic direction and leadership, technical expertise, and related resources to the global effort to reduce the burden of TB. Examples of expertise and activities undertaken by the TBCTA include technical assistance, assessments, assistance with program and project development, training and workshops, supports for intracountry and intercountry meetings, program review missions, and consensus-building meetings.

Purpose: The purpose of the TBCTA is to (1) substantially improve and expand the capacity of the US Agency for International Development (USAID) to respond to the global TB epidemic by providing state-of-the-art, context-appropriate, technically sound and cost-effective consultation and technical assistance to high-incidence countries and USAID missions; and (2) complement and enlarge upon existing global TB control efforts, such as the Stop TB Initiative, the programs of the World Health Organization, and the activities of the individual TBCTA partners. The ultimate goal is to reduce the global burden of TB and its attendant mortality, thus significantly improving human health, well-being, and development, particularly among the poor.

The Partners: The World Health Organization (WHO), headquartered in Geneva, has a presence in virtually all developing countries as well as having responsibility for defining the international health policy for TB control. It provides technical assistance and advice to countries on policy formulation, project planning and implementation, and monitoring and evaluation of TB control activities. WHO maintains the global surveillance and monitoring of TB incidence, drug resistance, and status of TB control programs.

The International Union Against Tuberculosis and Lung Disease (IUATLD), a nongovernment organization (NGO) headquartered in Paris, is composed of constituent, organizational, and individual members. There are IUATLD regional organizations in North America, Latin America, Africa, Europe, Asia, and the Middle East. The IUATLD disseminates information on TB and lung disease; coordinates and assists the work of its members throughout the world; and maintains close links with WHO, other UN agencies, and government and nongovernment organizations in the health and development sector. The IUATLD's expertise and its activities are focused on the areas of technical assistance, education, and research.

The American Lung Association (ALA), based in New York City, is the oldest voluntary association in the United States, having been founded in 1904, and has 78 state and local organizations throughout the country. It is the U.S. constituent member to the IUATLD. Its mission is the prevention and control of lung disease and it works primarily through public education, public policy, and advocacy activities. The ALA works internationally solely in the areas of advocacy and in fostering the development of international protocols.

The American Thoracic Society (ATS), also based in New York City, was founded in 1905. It is a 14,000-member educational and scientific society and is the major U.S. medical professional organization with an interest in TB. The ATS has considerable experience in collaborating with the Centers for Disease Control and Prevention (CDC) in developing guidelines for TB prevention and control, which are used both in the United States and in other parts of the world. The ATS publishes a highly respected and widely read scientific journal. In addition, the Society conducts an annual international conference that attracts 15,000-16,000 attendees. The conference is a major forum for the presentation of new information about TB and its control, and provides an arena for TB training and education as well. Broad-range specific technical expertise is represented in the organization.

The Centers for Disease Control and Prevention (CDC), based in Atlanta, is one of the United States' federal public health agencies. It promotes health and quality of life by working to prevent and control disease, injury, and disability. Within CDC, the Division of Tuberculosis Elimination (DTBE) is responsible for domestic and international TB prevention and control activities. These activities are carried out along with other centers in the CDC and in collaboration with state and local health departments, academic and research institutions, and other partners such as ministries of health in foreign countries, and domestic and international NGOs. CDC provides technical assistance and consultation in a broad range of TB control areas.

The Royal Netherlands Tuberculosis Association (KNCV), based in The Hague, was established in 1903 as a unique public-private partnership. KNCV promotes effective and efficient TB control within national and international contexts and acts as an implementing agency for projects financed by the Dutch government and other Dutch international foundations. Since the 1980s, KNCV has contributed to the development and implementation of effective TB control programs in low-income countries. It also hosts the International Tuberculosis Surveillance Center (ITSC) and the Tuberculosis Surveillance Research Unit (TSRU); contributes to international policy development, especially within its collaboration with WHO and the IUATLD; and collaborates with numerous international organizations. KNCV has highly qualified staff in a wide variety of fields of experience and expertise, many of whom have years of experience working or living in developing countries.

In short, TBCTA is a unique coalition of partners who are collectively and individually well-positioned to mobilize political commitment and human and financial resources from a variety of sources, and to ensure the quality of the TB control efforts.

Expanding the Partnership: The TBCTA aims to contribute to the objective of accelerating directly observed treatment, short-course (DOTS) expansion in line with the Amsterdam Declaration through the current six-member coalition and through an expansion of the partnership, especially in high-burden countries and through their national programs for TB control. The issue of expansion of the partnership is twofold: (1) Each of the current six members of the TBCTA can make arrangements with other partners to implement activities described in this proposal. In order to keep the management transparent, the TBCTA has decided that the Coalition member is the one responsible to the Coalition for the proper implementation. In all cases, the TBCTA will strive to strengthen and expand in-country organization and human and programmatic capacity in order to achieve sustainable development. (2) Other donors or agencies can apply to the TBCTA to implement activities on their behalf. For example, ACDI-CIDA (the Canadian International Development Agency) and DFID (the UK's Department for International Development) have already approached the Coalition regarding this possibility. When other donor/agency funding becomes a reality, the Coalition will take every precaution to ensure that the separate management and administration of the different donor resources will be safeguarded. The vast experience of the Coalition members in dealing with various donors in the past guarantees this process.

The TBCTA envisions expanding to other professional societies, public and private organizations, and/or universities. This includes both organizations already involved in TB control at country level and newcomers with the interest and motivation to join the effort. Specifically, this expansion could include organizations involved in advocacy and lobbying. If so, such efforts would complement the USAID resources and build on the experience and system established by the Coalition in contributing to DOTS expansion.

For more information about the TBCTA, readers can contact the following individuals: Dr. Peter Gondrie, Ms. Elsbeth Gosens, or Ms. Clara Habraken
Royal Netherlands TB Association (KNCV)
Riouswstraat 7
P.O. Box 146
2501 CC The Hague, The Netherlands
Telephone: 31-70-358-7222
FAX: 31-70-358-4004

Reported by Charles Wells, MD
Division of TB Elimination


New U.S. Department of State Forms for Overseas Health Assessment

"Out with the old and in with the new" is a common saying, but it has never been more aptly used than for the overseas health assessment document, Optional Form-157 (OF-157). The U.S. Department of State has been responsible for updating the information on the OF-157 since 1949. The most recent OF-157, last updated in 1986, became outdated in 1990 when the Immigration and Nationality Act (INA) was amended. In collaboration with the Department of State, the Immigration and Naturalization Service, state TB controllers, and overseas U.S. embassy-assigned examining physicians (panel physicians), CDC's Division of TB Elimination and Division of Global Migration and Quarantine (DQ) developed four new forms. These are the DS-2053 (replacing the OF-157) and three accompanying worksheets (DS-3024, DS-3025, DS-3026). All four will now be used during the overseas migration health assessment.

These four new medical forms will be completed by the panel physicians or the International Organization for Migration physicians for immigrant and refugee applicants, respectively. The DS-2053 is a summary of the three worksheets and contains serologic results. This form has been updated to be in compliance with all the changes in immigration law. It has check boxes for easier recording and collection of data, more space for panel physicians to use to write comments, larger boxes for recording laboratory findings, and a space to show if vaccination entry requirements have been met or waived.

The DS-2053 is designed to be used with the chest x-ray and classification worksheet (DS-3024), vaccination worksheet (DS-3025), and medical history and physical examination worksheet (DS-3026) to provide additional essential health information to the U.S. embassies, the receiving health departments and providers, and DQ.

The rationale behind developing the additional worksheets was twofold:

  • The worksheets will provide more detailed and specific information about the results of the overseas health assessment; this is needed by receiving health departments to provide adequate care and follow-up.
  • The worksheets can also function as a quality assessment tool through which DQ can monitor compliance of panel physicians with the regulations and Technical Instructions for the overseas examination (developed by DQ).

The new chest x-ray worksheet (DS-3024) is of most interest to the TB control programs. It provides additional information about how the panel physician determined the classification for a TB condition in the immigrant or refugee applicant. It is designed as a self-guided algorithm to help the panel physician determine the following:

  • The need for a chest radiograph,
  • The classification of findings on the chest radiograph (whether suggestive of active or inactive TB),
  • The need for sputum smears (based on chest radiograph findings and clinical signs and symptoms), and
  • The final TB classification of the applicant.

The chest x-ray and classification worksheet will therefore provide a method for determining how the physician arrived at the TB classification in order to help DQ identify inadequacies in the classification process.

On March 28, 2001, the Department of State notified the consular officials at U.S. embassies of the new forms. The time frame for implementation has been left to the discretion of the individual U.S. embassies. By late fall of 2001, most countries were using these forms to report the results of overseas health assessments.

The forms are available at the Consular Sections of U.S. embassies. Detailed instructions for their use are available at: http://www.cdc.gov/ncidod/dq/dsforms/. The next revision of the forms is anticipated to be in 2004, after further essential input from TB controllers.

Submitted by Mary Naughton, MD, MPH,
TB Medical Officer,
and Susan T. Cookson, MD
Division of Global Migration and Quarantine

 


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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