TB Notes Newsletter
No. 1, 2006
New Association of Public Health Laboratories
(APHL) TB Steering Committee Formed
Following the publication of the 2004 APHL TB Task Force report,
“The Future of TB Laboratory Services, A Framework for Integration,
Collaboration, and Leadership,” the association will begin
implementing the report recommendations. Heading this endeavor is
a new APHL TB Steering Committee. The committee is a joint venture
with APHL members, CDC staff, a National TB Controllers Association
(NTCA) representative, and laboratorians from the clinical sector.
It will also be tasked with reviewing other important TB laboratory
and cross-cutting programmatic issues.
There are three benchmarks that the Steering Committee will be
tasked with implementing. Benchmark one suggests that an ongoing
assessment of available TB laboratory services is needed to determine
the current status and capacity of services and to identify unmet
needs, obstacles to obtaining laboratory services, and opportunities
for improvement. Benchmark two addresses the need for an assessment
of the true costs of providing TB laboratory services. The third
and final benchmark involves the development of a strategic plan
for implementing and maintaining a systems approach for TB control.
The Committee met at APHL headquarters on November 21 and 22, 2005,
to strategize a plan of action for implementing these benchmarks.
—Submitted by APHL TB Steering Committee:
Nancy Warren, Chair, PA; John Bernardo, NTCA; Edward Desmond, CA;
Wendy Gross, VA Medical Ctr, CT; Bruce Hanna, NY Univ School of
Medicine; Nancy Hooper, MD; Ken Jost, TX; Anthony Tran, APHL;
David Warshauer, WI; Michael Iademarco, John Ridderhof, and Tom
Laboratory Issues from the Northeastern TB Controllers
The Northeastern TB Controllers Meeting was held on September
26 and 27, 2005, at the New York State Department of Health, Albany,
New York. The Northeast Regional Training and Medical Consultation
Center in New Jersey serves the following states and cities: Maine,
New Hampshire, Vermont, Rhode Island, Massachusetts, Connecticut,
New Jersey, New York, Delaware, Maryland, Pennsylvania, West Virginia,
Ohio, Indiana, Michigan, New York City, Philadelphia, Baltimore,
Detroit, and Washington, DC. For the first time, TB laboratory partners
from each of these jurisdictions were invited to attend the meeting.
Day one of the meeting included separate morning breakout sessions
for the TB controllers and laboratorians, allowing them to discuss
issues of significance in their particular realm. During the laboratory
session, there were several key issues noted by the laboratory participants:
- A discussion regarding funding brought to light the fact that
laboratories do not feel that they are seen as equal partners
in TB prevention and control. Federal guidelines (i.e., Healthy
People 2010) are now requiring faster turnaround times by laboratories
in identifying and reporting TB. However, to meet these shorter
turnaround times, the laboratories must use more sophisticated
and expensive diagnostic tools such as the Mycobacterium Tuberculosis
Direct (MTD) assays and QuantiFERON-TB Gold (QFT-G). In addition,
the costs of liquid media, probes, and reagents increase each
year, as do workforce salaries and benefits. TB funding has remained
level since 1995, and this lack of increased funding results in
the decreased ability to keep pace with laboratory requirements.
Flat funding affords less buying power for the laboratories.
- Each year the TB Laboratory Upgrade component of the Cooperative
Agreement requests laboratories to fill in a “true needs”
budget assessment, but no additional funds for meeting these needs
had been provided until FY 2005. However, the laboratories that
received less funding in FY 2005 as a result of the funding formula
did receive a slight increase to help make up for this shortfall.
Several laboratory panel members also felt disconnected with CDC
in terms of support and guidance during the Cooperative Agreement
writing process. Still others felt that the goals CDC set are unrealistic
without the promise of more financial support. These funding issues
must be dealt with at the federal and state level in order for change
to occur. The APHL TB Steering Committee has been addressing TB
funding issues and will continue to be committed to helping the
TB laboratory find equality of funding.
- A proposal was made that TB training and education for the
performance of laboratory assays could be supported by the TB
Regional Training and Medical Consultation Centers (RTMCCs), since
they receive a large share of the total TB funding.
The afternoon session consisted of a joint roundtable session
with both program and laboratory members. The roundtable discussion
focused on the QFT-G assay, including issues surrounding funding,
transportation of specimens, and cost, which is estimated to be
$35 per test. While laboratorians agree that the QTF-G data look
encouraging, the aforementioned questions still need to be answered
before implementation can take place. New York State is currently
the only jurisdiction in the region performing the QFT-G assay;
however, this is only done on Department of Corrections patients.
This specialized population was chosen in order to address the specimen
stability problem. Inmates are transported from the prison to a
site closer to the laboratory where blood is drawn and samples can
be processed immediately.
Day two of the meeting was packed with plenary sessions on TB
contact investigation guidelines, program evaluation plans, the
role of the National TB Controllers Association (NTCA), implementation
of QFT and real-time genotyping, surveillance in low-incidence populations,
and the investigation of an M. bovis cluster in New York
The overall sentiment from participants was positive towards the
first joint meeting of TB controllers and laboratorians in the Northeast
region. Attendees felt that the meeting provided a good forum for
sharing information from their respective jurisdictions and learning
from others. In general, TB controllers and their laboratory partners
have worked hard to establish good working relationships. Joint
meetings afford all parties involved the opportunity to work together
to improve funding, understand the limitations of new procedures,
and address the obstacles encountered in new testing methods. This
speaks to the need for collaborative education for both groups,
in order to improve communication and maximize the use of resources.
Hopefully future meetings with more time for discussion will help
alleviate some of these issues.
For questions about APHL or the APHL TB Steering Committee, please
contact Anthony Tran, HIV, STD, and TB program manager, at email@example.com
or at (240) 485-2783.
—Submitted by Anthony Tran, MPH, MT(ASCP)
Association of Public Health Laboratories
On behalf of the APHL TB Steering Committee