This is an archived document. The links are no longer being updated.
TB Notes 3, 2002
Updates from the Communications and Education Branch
PARTNERS in Peru
The PARTNERS TB Control Program consists of a consortium of health
organizations brought together by Harvard University, and funded
by a grant from the Bill and Melinda Gates Foundation, with the
purpose of addressing the problem of drug-resistant TB in Peru.
In addition, the PARTNERS program seeks to create an exportable
model for other countries to use in their MDRTB control programs.
The program has four objectives:
- Demonstrate the success of the project and take it to scale
- Define the necessary infrastructure and establish it in Peru
to sustain a successful integrated program independent of PARTNERS.
- Articulate the components of a replicable generic model drawing
on lessons from Peru and Russia.
- Provide strategies and a demonstration platform to strengthen
global TB control efforts.
In addition to CDC, the following institutions participate in the
PARTNERS program: the Peru Ministry of Health (MINSA) and Programa
Nacional del Control de la Tuberculosis (PNCT), Socios en Salud
(SES), Partners in Health (PIH), the Pan American Health Organization
(PAHO) of the World Health Organization (WHO), the Tomsk TB Program
in Russia, and the Task Force for Child Survival and Development.
The education, training, communication, and advocacy (ETCA) workgroup
is one of five workgroups in the PARTNERS project. In March 2002,
new representatives were appointed to the PARTNERS ETCA workgroup
from the Ministry of Health in Peru (MINSA) and SES. Additionally,
Dr. Eduardo Ticona was appointed in April 2002 to head the PNCT.
The ETCA workgroup now has representatives from all PARTNERS members.
The PARTNERS project is in the middle of the second year of funding,
and the ETCA workgroup assigned high priority to conducting a needs
assessment in Peru to assist in identifying future workgroup activities.
As representatives of the PARTNERS ETCA workgroup, Jacob Creswell
and Nick DeLuca from DTBE’s Communications and Education Branch
spent April 8-12 in Lima, Peru, conducting an assessment of Peru’s
MDRTB training and education needs, and Jacob returned for a follow-up
visit May 29-June 7. MINSA and SES work collaboratively to treat
MDRTB patients within the PNCT of Peru.
The agenda for the trip included the following activities:
- Meetings with staff from MINSA and SES.
- Meetings with all five Lima Health District (DISA) coordinators
and visits to different health centers within each DISA to talk
to staff and to view health care facilities.
- A total of 10 focus groups with MINSA and SES physicians, nurses,
nurses’ aides, health promoters, and MDRTB patients.
- Presentation of preliminary findings to MINSA and SES representatives.
The needs assessment focused on the following questions:
- What are the overall MDRTB education, training, communication,
and advocacy needs for health care workers (HCWs), patients, and
the general public?
- What current ETCA activities regarding MDRTB need to be strengthened?
Based on the needs assessment, the following general findings were
(1) training for HCWs on MDRTB is limited; (2) MDRTB educational
materials for HCWs are lacking; (3) the MDRTB training needs frequently
identified included knowledge and management of adverse reactions
to second-line drugs, management of comorbid conditions (e.g., MDRTB
/ HIV), infection control, HCW-patient communication, and patient
emotional support; (4) there is a lack of educational MDRTB materials
for patients and their families; (5) stigma is associated with MDRTB
and affects both patients and HCWs; and (6) HCWs and patients expressed
a desire to share common experiences regarding MDRTB.
The specific recommendations are based on the general findings
and must be tailored to each group of HCWs (physicians, nurses,
health promoters, DOT workers) and patients. The treatment guidelines
for MDRTB should be clarified and expanded. MDRTB training courses
and educational materials for HCWs must be created. Educational
materials for MDRTB patients should be developed as soon as possible.
After appropriate formative research has been conducted to determine
the most effective methodology, campaigns should be implemented
to combat stigma and discrimination associated with TB and MDRTB.
A systematic process should be followed for the development of training,
education, communication, and health promotion materials. Process
and impact evaluation of all activities should be conducted. HCWs
need channels for sharing their experiences and receiving updates
on the management of MDRTB (e.g., grand rounds, regular meetings,
written materials), and patients need forums for sharing their experiences.
Finally, communication and collaboration between all PARTNERS members
needs to be enhanced.
Some of the other priorities that came out of this assessment are
the need to (1) contribute to the new national TB plan being created
by MINSA; (2) create an inventory of existing and future TB and
MDRTB educational and training materials in Peru in order to guide
the development of materials; (3) develop an ETCA workgroup time
line and plan based on the needs assessment and inventory; (4) maintain
frequent communication among PARTNERS members; and (5) begin to
develop patient materials based on the inventory and needs assessment
Results of the needs assessment and future plans were presented
at the PARTNERS meeting in Lima, Peru, July 19-20.
—Reported by Jacob Creswell, MPH
Division of TB Elimination
HIV/TB Info for AIDS Service Organizations
The Communications and Education Branch has developed a new brochure
for AIDS service organizations (ASOs). The intent of the brochure
is to motivate and enable ASO staff to seek or provide services
for testing and treatment of latent TB infection (LTBI) among HIV-infected
Finding and treating people with LTBI before they become sick —
and infectious — is essential to eliminating TB in the United States.
In fact, to speed the decline of TB in this country, the Institute
of Medicine recommended that CDC increase testing and treatment
for LTBI in high-risk groups. To that end, CDC, the American Lung
Association, and the American Thoracic Society sponsored a partnership
meeting for leaders of various organizations providing services
for people at high risk for TB. Participants discussed what they
needed in their efforts to provide such services. At the meeting,
ASO attendees identified the need for educational materials about
the importance of TB skin testing for persons with HIV infection.
Based on suggestions from the partnership meeting, a brochure was
drafted and subsequently tested with a focus group which included
physicians, health educators, and executive directors of ASOs. The
brochure 1) incorporates specific language in the opening statement
that captured the attention of ASO leaders, 2) uses instructional
design that stimulated questions and reader desire to learn more,
and 3) lists resources participants suggested as being the most
The next step in conducting formative research on the brochure
was to obtain input on the document with state and big city TB controllers;
this process was completed. The brochure was printed and has been
distributed to TB control programs, and will be available for ordering
mid-September at the DTBE Web site, http://www.cdc.gov/nchstp/tb/.
—Reported by Scott McCoy, MEd
Division of TB Elimination