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TB Notes Newsletter

No. 2, 2005

Updates from the Surveillance, Epidemiology, and Outbreak Investigations Branch

Update on the Tuberculosis Biotechnology Engagement Program in the Republics of Armenia and Georgia, Spring 2005

The Biotechnology Engagement Program (BTEP) is an initiative of the U.S. Department of Health and Human Services (HHS), Office of Global Health Affairs (OGHA), designed to empower biodefense scientists from nations of the former Soviet Union to work on important public health problems in their home countries. The rationale for the program is that engaging these scientists on important public health efforts that lead to meaningful and productive outcomes will help deter them from bioweapons development. Congress appropriates funding for the program to the State Department; the State Department then allocates this funding among programs in HHS. The program provides up to 36 months of financial support and encourages collaboration between former Soviet Union biodefense scientists and U.S. experts in areas of strengthening surveillance and operational research that address urgent public health concerns.

In the two former Soviet Union republics of Armenia and Georgia, the incidence and prevalence of TB are thought to be significantly underreported, in part because of two independent reporting systems in each country. However, it is apparent that morbidity and mortality have increased remarkably since they gained independence. According to their own official statistics, the Republic of Armenia experienced a 3-fold increase in TB morbidity, from 282 TB cases reported in 1991 (14 of these cases were in children) to 896 in 2001 (38 of these cases were in children). The sharp rise in TB in children is of grave concern and indicates significant ongoing transmission of TB in Armenia. However, the TB hospital data show an even greater increase, from 724 cases reported in 1991 to 1343 in 2001. Concomitant with this increase in absolute numbers of TB cases in the past 10 years was a dramatic drop in the population from approximately 3.8 million in 1991 to 2.5 million in 2001, owing largely to emigration to other countries (e.g., Russia and the United States).

Despite this drop, the 1991 demographic data are still used to calculate the official Armenian Ministry of Health (AMOH) TB incidence and prevalence rates, which are understated. Further, anecdotally, the rise in multidrug-resistant M. tuberculosis (MDR TB) may have reached significant levels, but the data are lacking. Officials do know that 20% to 25% of all M. tuberculosis isolates are resistant to at least one antibiotic. The exact levels of MDR TB are difficult to ascertain because of an inadequate system of laboratory information at the Armenian National TB Reference Laboratory. AMOH officials attribute rising drug-resistant TB to poor compliance and follow-up of diagnosed TB patients and the increasing incidence of TB in the prison system.

Republics of Armenia and Georgia TB BTEP
In collaboration with Armenian and Georgian Ministry of Health colleagues, CDC staff have developed a TB BTEP project titled “Development of Multidrug-Resistant Tuberculosis Surveillance and National TB Program Evaluations, Republics of Armenia and Georgia.”  Awarded 3 years of funding by the Department of State and the HHS OGHA effective October 2004, this project consists of nine tasks designed to both empower local public health officials and build capacity in program evaluation and management, operations research, surveillance, epidemiology, data management, and health economics. It is also consistent with the more-encompassing public health TB reform efforts in both countries. Armenian and Georgian TB public health officials aim to develop TB programs that highlight public health decentralization and integration into local health department information systems. Finally, the BTEP project provides significant added value to existing public health prevention and control activities, while not detracting from ongoing activities.

Planned Armenia and Georgia TB BTEP Tasks

  1. Describe the current system for TB surveillance in Armenia and Georgia
  2. Conduct a formal evaluation of the TB surveillance systems in Armenia and Georgia
  3. Conduct operational research to clarify uncertainty regarding TB incidence (reported and unreported) in Armenia and Georgia
  4. Gain a better understanding of the burden of undetected TB cases
  5. Determine private-sector use of TB medications
  6. Evaluate data management systems at peripheral and national levels
  7. Measure the magnitude of MDR TB in Armenia and Georgia
  8. Evaluate a TB patient population group called “chronics.” Data from the evaluation will be used to change a public health policy that is ineffective and wasteful of resources
  9. Provide training to Armenian and Georgian national TB control staff, both in country as well as in the United States, in epidemiology, biostatistics, TB prevention and control, TB medical management, scientific writing, and advocacy.

Tasks 1 and 2
Of the nine tasks, Tasks 1 and 2 are to describe and evaluate the current TB surveillance system in Armenia, respectively. These tasks began last fall and provide a more complete understanding of the TB situation in these countries.  Tasks 1 and 2 are now completed, and copies of these reports are available upon request.

The Armenia and Georgia TB BTEP project has several unique aspects. In addition to empowerment, the program activities support ongoing TB reform activities in both countries. The project also adds value to existing nongovernmental organization support of TB reform efforts. Further, it builds capacity among local collaborators through learn-as you-do efforts as well as through formal classroom training both in country and in the United States.

The BTEP website can be accessed at

Team Members of the TB Biotechnology Engagement Program, Republic of Armenia, 2004

Team Members of the TB Biotechnology Engagement Program, Republic of Armenia, 2004

Submitted by Sylvera Demas, M.P.H., and
Scott J.N. McNabb, Ph.D., M.S.
Div of TB Elimination
(Dr. McNabb is one of the U.S. scientists participating in BTEP)


DTBE Helps the U.S. Government Delegation Prepare for the 2005 WHO Executive Board Meeting in Geneva: A Rotation in the Senior Executive Service Candidate Development Program

Background and Purpose
Each year, the Secretary of HHS – as a member of the World Health Organization Executive Board (WHO/EB) – makes an informed, evidence-based U.S. government (USG) policy and technical response to the varied health positions posed on global health by the WHO Secretariat. These varied global public health issues range from childhood immunization to prevention and control of infectious diseases (e.g., TB, HIV/AIDS, malaria), to aspects of bioterrorism and epidemic response (e.g., International Health Regulations), to infant and young child nutrition.

One of the many challenges in international health policy development is the requirement to cover a wide range of complex scientific and technical areas. This challenge brings together a diverse group of as many as 30 to 40 experts from across HHS and other USG agencies. These individuals may approach a given health issue with different viewpoints, but collectively must find consensus in order to develop a comprehensive USG policy position. To gather and craft the responses involves a dynamic, coalition-building process across HHS and sister agencies. These policy positions must then be integrated within the wider range of important elements: policy, public health import, scientific merit, and public health research. Finally, these positions must be cleared and receive proper approvals within the USG. The process produces a result that, while detailed and complex, also must be capable of being effectively communicated to high-level decision makers of developing and developed countries. The most recent WHO/EB meeting occurred in Geneva, Switzerland, in January 2005.   

Dr. Scott McNabb of DTBE’S Surveillance, Epidemiology, and Outbreak Investigations Branch is one of five CDC staff in the 26-member 2004 Health and Human Services (HHS) Senior Executive Service (SES) Candidate Development Program (CDP) (see photo below). Program participants were competitively chosen from among 325 applicants across all HHS agencies. As one element of his 18-month executive formation, Scott performed two rotations. The first occurred under the mentorship of Ms. Mary Lou Valdez from December 2004 through March 2005 in Washington, DC, in the Office of Global Health Affairs, Office of the Secretary, HHS. It was during this rotation that Scott led the effort to gather, craft, and clear the varied public health positions for the USG delegation to the WHO/EB (headed by Dr. William Steiger). His second rotation, occurring May through June 2005, is in the Office of Strategy and Innovation (OSI), Office of the Director, CDC, under the mentorships of Drs. Janet Collins and Brad Perkins. Through the various elements of the SES CDP such as briefings on departmental priorities and initiatives and two executive-level departmental assignments, candidates gain high-level skills that can be applied to the accomplishment of program goals.

Members of the 2004 HHS SES CDP

While the SES candidates are the primary beneficiaries of this program, the SES CDP is also beneficial to the participants’ agencies; thus CDC and DTBE will undoubtedly gain from Scott’s experience.

Submitted by Scott McNabb, PhD, MS
Div of TB Elimination


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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