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TB Notes 3, 2000
Hightlights from State and Local Programs
San Antonio Program Managers
As part of the National Statewide Training Initiative, the Francis
J. Curry National Tuberculosis Center and the Texas Department of
Health Tuberculosis Elimination Division collaborated to develop
and provide training May 16-18, 2000, at the Texas Center for Infectious
Disease in San Antonio. The training was attended by individuals
who are TB program managers or TB supervisory personnel in the local
or regional programs in Texas. Applications were received from 51
people, but the training could only accommodate 40. The applicants
chosen were those with the greatest program responsibility.
This course was the result of an extensive TB training and education
needs assessment process conducted by the Francis J. Curry National
TB Center and the Texas Department of Health. The needs assessment
process included conference calls; a review of Texas TB epidemiology;
a written survey completed by TB program managers; site visits to
seven local programs, one regional program, and the Texas Department
of Health TB Education Center (the training component of the Texas
Department of Health TB Program); and attendance at a program managers’
meeting. Based on the training and education needs identified, the
planning group decided to target the training activity to TB program
managers and others with significant supervisory responsibility
for TB program activities. It was felt that these individuals would
have the greatest opportunity to provide further training and education
and implement program improvements. The site chosen for the joint
training event was the Texas Center for Infectious Disease in San
Antonio, which houses the Texas TB Education Center. The participation
of the TB Education Center staff was intended to build capacity
at the Center by sharing the expertise of the Curry Center in organizing
and presenting such extensive training events.
The course included sections on case management for private sector
patients, quality assurance, the treatment of latent TB infection,
targeted screening programs, contact investigation, the use of data
to plan and evaluate TB programs, and community outreach and training.
Training methods included lecture, case studies, small group exercises,
and panels. The faculty members were TB experts from California
and Texas and experienced TB program managers from Texas. The faculty
from California included Brenda Ashkar (Los Angeles), Mona Bernstein
(Curry Center), Effie Gournis (San Francisco), and Karen Smith (Santa
Clara County). Texas faculty included Ed Graviss (Baylor Medical
School), Barbara Seaworth (TB Education Center), and Jeff Taylor
(Texas Department of Health) in addition to 14 Texas TB program
managers who served on panels that highlighted their experiences
in providing various aspects of TB program activities. There was
also a lunch presentation on working with migrants given by Del
Garcia and John Byrd of the Migrant Clinicians Network.
In addition to an on-site evaluation survey, participants were
asked to develop two problem statements addressing actual issues
in their program area and a plan to implement the techniques and
concepts of the course in resolving those problems. A survey will
be sent out at 6 and 12 months to evaluate whether the course has
been beneficial to the participants in improving the aspects of
their programs that they identified in their problem statements.
Please contact Ann Tyree (512-458-7447 or firstname.lastname@example.org)
or Mona Bernstein (415-502-7905 or ) for more information.
—Submitted by Ann Tyree
Texas Department of Health
Formation of Kansas TB Control
With great enthusiasm from the public health community and other
health care providers, planning is well underway toward development
of a statewide TB control coalition in Kansas. The Kansas Department
of Health and Environment (KDHE) TB Control Program hosted two regional
planning meetings to begin dialogue and establish a framework for
the kick-off statewide coalition meeting, which was held in Salina,
a community in central Kansas, on November 30.
"This statewide coalition is being developed to unify the
efforts and voices of a broad-based group of Kansans representing
the public health community, private care providers, and others
interested in TB control to provide statewide collaboration through
local leadership, ongoing communication, and technical assistance
that will ultimately lead to decreases in TB incidence rates in
Kansas," commented Gianfranco Pezzino, MD, MPH, State Epidemiologist
and Director of KDHE’s Bureau of Epidemiology and Disease Prevention.
A total of 39 individuals attended the two regional planning meetings
held in Topeka (northeastern Kansas) on July 27 and in Garden City
(southwestern Kansas) on September 28, with diverse representation.
To date, KDHE has been joined in this effort by the American Lung
Association of Kansas, the Kansas Association for the Medically
Underserved, the Kansas State Nurses Association, the Kansas Public
Health Association, the Kansas Association of Local Health Departments,
the University of Kansas Medical Center at Wichita, the United Methodist
Mexican American Ministries, the Kansas Department of Corrections,
the Knoll Patient Supply Company, the Garden City Public Schools,
and public health nurses and administrators of 16 local health departments.
"The motivation being expressed by the public health community
for development of a statewide TB control coalition is quite impressive,"
said Dr. Pezzino. "I am most encouraged by the active participation
of so many individuals and organizations, and believe the momentum
we are building will lead to improved TB control activities in communities
all across Kansas."
Discussion at the regional planning meetings identified a number
of initiatives for the coalition to consider in its list of priorities.
Among them were the following:
- A medical card should be developed that patients can carry and
use to inform health care providers about their TB screening and
- Working relationships need to be established between local public
health representatives and the medical staff of meat packing plants
to ensure that the latter are aware of and looking for symptoms
of TB disease during new employee health screening visits (Kansas
employs thousands of persons in its meat processing plants).
- Payment of hospitalization costs for TB cases, especially for
those who cannot work for months, is an important financial concern
in Kansas. Further assessment of this problem is needed.
- A major concern in Kansas is the number of students from other
countries entering the state with TB disease or latent TB infection.
In our view, the Immigration and Naturalization Service needs
to be encouraged to develop a policy on TB screening for educational
- Language- and culture-specific educational campaigns should
be developed that will effectively educate target audiences and
motivate them to pursue screening and treatment for TB disease
or latent TB infection.
- Effective and audience-appropriate informational materials need
to be developed to educate providers about TB screening and treatment
- Summaries of TB control–related budget issues, medication costs,
and current data and trend information are needed.
- A fact sheet about the long-term benefits associated with completing
treatment for latent TB infection is needed.
Several additional coalition goals and timelines were crafted at
the November 30 statewide meeting. The group plans to facilitate
progress toward overall coalition goals by developing small workgroups
to focus on specific tasks.
Benefits of the communication and resource-sharing sparked by this
coalition-building effort are already evident. The Kansas Association
for the Medically Underserved invited the Kansas TB Control Program
to join forces in reaching out to providers with TB information
and education. The state’s TB Nurse Consultant, Allison Alejos,
RN, BSN, accepted a position on the steering committee for the statewide
clinical network that operates under the guidance of the Kansas
Association for the Medically Underserved. Rather than having to
start at the ground floor toward developing its own clinical network,
the Kansas program is fortunate to be invited to collaborate with
one already established and well-respected throughout the state.
Between January 1 and October 1, 2000, Kansas reported 37 cases
of TB, up from 26 cases for the same time period last year, a 42%
increase. Because the state covers 82,282 square miles and is home
to more than 2.6 million people, the collaborative efforts of a
statewide TB control coalition will ensure that greater gains are
made toward reducing the incidence of TB in Kansas, helping to further
the state’s progress toward meeting national goals established by
For more information about the coalition or other TB control initiatives
in Kansas, please contact Mindee Reece, TB Control Program Director,
at (785) 296-8893 or email@example.com
—Submitted by Mindee Reece
Director, Kansas TB Control Program
New York State DOH Produces
Over the years, a number of different measures have been used to
evaluate the effectiveness of TB control programs. At the national
level, the "rainbow reports" have been replaced with the
Aggregate Reports for TB Program Evaluation, also known as
ARPEs. There are two ARPE reports, Targeted Testing and Treatment
for Latent TB Infection and Follow-up and Treatment for Contacts
to TB Cases, which must be filed annually.
The ARPE reports, while gathering much the same information as
the rainbow reports, require the data to be grouped differently
and in some cases require a higher level of detail for individual
follow-up. This, along with the lengthy period of time before a
yearly cohort is reported, may lead to inaccurate reporting of some
information. New York State staff have devised a strategy to simplify
this change. Single-use worksheets have been created to enable users
to capture the required information on an ongoing, per-case basis.
Two of these worksheets very closely resemble the CDC-required ARPEs,
the TB Testing Worksheet and the TB Contact Worksheet.
This similarity allows completion of the annual summaries directly
from the worksheets. The TB Testing Worksheet compiles information
on testing outcome in a particular setting (e.g., homeless shelter,
jail) over a specified period such as a month or quarter year. The
TB Contact Worksheet summarizes the outcome of a contact
investigation around a single TB case. The third sheet, the Individual
TB Worksheet, was designed to aid the counties in recording
all pertinent information regarding the individual receiving a tuberculin
skin test, whether the result of a contact investigation or a testing
program. Each county is to submit these worksheets to the Bureau
as each investigation is completed. Submission as recommended will
allow the Bureau of TB Control to compile the data on an ongoing
basis, resulting in more accurate and meaningful summary information,
as well as relieving each county of this additional responsibility.
To help TB workers in each local health unit understand the new
CDC reporting requirements, the New York State Bureau of TB Control
has devised a workbook for use by the counties. The contents include
worksheets and instructions, as well as a series of educational
scenarios. This workbook was designed to provide examples of a wide
variety of real-world scenarios in which tuberculin skin testing
would take place. For each of these scenarios, an explanation is
provided about what type of testing is involved (targeted or administrative),
whether this testing was done on an individual or project level,
and what type of risk was involved (medical or population). The
scenarios also discuss whether or not the testing was part of a
contact investigation, and what level of risk was present for those
tested. Explanations as to which worksheets need to be filled out
and examples of completed worksheets have been provided with each
Owing to numerous inquiries from around the country, the New York
State Bureau of TB Control is making our ARPE Workbook available
to other TB programs on request. People who want a copy can write
to Stephen E. Hughes, PhD, Bureau of TB Control, NYSDOH, GNARESP,
Rm 831, Albany, NY 12237-0669, or email: firstname.lastname@example.org.
—Reported by Stephen E. Hughes, PhD,
and Cheryl Kearns, MPH
Bureau of TB Control
New York State Dept. of Health