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TB Notes 2, 2007
Director's Letter
Highlights from State and Local Programs
  Successful Collaborations by New England TB Prevention and Control Programs
World TB Day 2007
  First Annual TB Awareness Walk
  TB and HIV Analogy
  From Us to You
Nursing Update
  Judy Gibson, BSN, MSN, Receives Chief Nurse Officer Award
TB Education and Training Network Updates
  Member Highlight
  Cultural Competency Workgroup: Special Topic Discussion on “The Culture of Substance Users”
Communications, Education, and Behavioral Studies Branch Update
  New Additions to
Clinical and Health Systems Research Branch Updates
  MDR TB and XDR TB Clinical Trials Design Working Group Formed
  The Long Road to a Shorter, Stronger, Safer Cure for TB – How to Get There Faster
International Research and Programs Branch Update
  Building the Capacity of Health Care Workers from the Former Soviet Union on TB/HIV Surveillance Activities
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  RVCT Revision
  10th Semiannual Meeting of the TB Epidemiologic Studies Consortium
New CDC Publications
Personnel Notes
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TB Notes Newsletter

No. 2, 2007


Successful Collaborations by New England TB Prevention and Control Programs

The six New England tuberculosis (TB) control programs have recently created a mechanism for communicating, coordinating, and collaborating on specific issues related to TB prevention and control. As a consequence of increasing immigration from a wide diversity of countries, all of the New England states are greatly impacted by the changing epidemiology of TB reflected in the growing foreign-born population. Another common challenge for the New England TB programs is to maintain the low TB rates among traditional populations that are vulnerable to TB, especially the homeless and incarcerated, to prevent outbreaks and to hasten the decline of TB in these groups. These challenges come at a time when funding to local and state TB programs is declining. This article will detail examples of the collaboration that has resulted from this new partnership among public health departments.

New England Region TB Plan

The New England region TB plan provides a framework for promoting regionalization as a means to improve and enhance TB prevention and control as part of the vision for TB elimination. The framework sets out the goals and objectives for effective collaboration between programs and partners in the region and identifies five key regional TB strategies:

  • Engage in ongoing dialogue to promote regional planning and policy development
  • Increase education and training geared to identified needs
  • Actively use data from molecular genotyping of Mycobacterium tuberculosis strains
  • Use program evaluation to improve health outcomes
  • Intensify coordination of cross-jurisdictional contact investigations

CDC’s Division of Tuberculosis Elimination (DTBE) and state and local partners are supporting this effort to share experiences and resources. Starting in 2005, Dr. Mark Lobato, a DTBE medical officer, has been working with the New England TB programs to help develop a regional approach to capacity building. This is done through supporting existing programs and implementing new initiatives via systematic collaboration on priority areas.

“Eliminating TB Case by Case”

One success story has been the series of TB case presentations entitled “Eliminating TB Case by Case.” Several sources of evidence indicate that health providers have ongoing educational needs, including 1) a regional education needs assessment, and 2) studies, including one by CDC documenting nonadherence to national TB standards and guidelines by private providers. This highly successful TB case series was organized by a coordinating group from the New England TB Programs, the Northeastern Center of Excellence (COE), and DTBE. Contributors to creating the series included Kathy Hursen, RN, director of education and training for the Massachusetts Division of TB Prevention and Control, the moderator for the series; Judy Proctor, RN (New Hampshire); Erin Howe, health educator for the Northeast COE; and Mark Lobato (CDC).

The web-based case series is designed to allow providers to present patients whose cases illustrate public health principles and practices. The objectives of the TB case series are to offer a forum for discussing the public health implications of infectious TB, describing the clinical management of TB, increasing awareness of national recommendations for TB diagnosis and treatment, and discussing options for ongoing patient care. To date, the six presentations have reached 60–80 nurses, physicians, health educators, and others. The inaugural presentation featured Robert Horsburgh, MD, from the Boston School of Public Health and the Boston Medical Center and formerly with CDC. Dr. Horsburgh, a local and national expert in TB and HIV treatment, skillfully drew participants into an active dialogue around the case, thereby laying the groundwork for future presentations. An upcoming presentation is planned with Dr. Marie Turner, medical director of the TB Treatment Unit at the Lemuel Shattuck Hospital in Boston.

Another success has been the development of the regional TB website, The intent of the website is to provide a means for building program capacity by sharing developed resources and materials, communicating experiences and successful strategies, and giving providers access to education and training resources and patient education materials. Developed by a regional team including Marilyn DelValle (MA) and Lisa Roy (NH), the TB programs are learning how to improve the website and promote its use by public health nurses and TB providers.

Molecular TB Genotyping

Finally, the TB programs are at the beginning stages of sharing molecular TB genotyping data to define the specific TB strains circulating in their states. In investigating infectious TB patients, state programs often communicate and collaborate with their neighboring states to prevent possible interstate TB transmission. By identifying the specific TB strains, the programs can define and quantify the extent of transmission across states lines. The first discussion among New England TB programs of a common cluster strain involving 25 patients in four states took place recently. Regina Grebla, an MPH intern from Columbia University, has started work on the creation of a shared database of genotyping results.

The New England TB programs intend to continue and expand their collaborations. At a future NTCA meeting it is hoped that the regional experience can be shared with other TB programs.

—Submitted by Mark Lobato, MD,
New England Region TB Consultant, DTBE, and
Kathy Hursen, RN,
Director of Education and Training
Massachusetts Div of TB Prevention and Control


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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