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TB Notes 1, 2002
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)
P.O. Box 146
2501 CC The Hague, The Netherlands
Reported by Charles Wells, MD
Division of TB Elimination
New U.S. Department of State Forms for Overseas
"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,
The rationale behind developing the additional worksheets
- 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
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