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TB Notes 3, 2006
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TB Notes Newsletter

No. 3, 2006


 TBESC Task Order 6 (TO6) Update: Regional Capacity Building in Low-Incidence Areas

Background. The TB Epidemiologic Studies Consortium Task Order 6 (TO6) focuses on developing and implementing regional tools for TB control and elimination in low-incidence areas. TO6 is being implemented through the Francis J. Curry National Tuberculosis Center of the University of California, San Francisco. Previous work identified the needs of four low-incidence states in the western region of the United States: Idaho, Montana, Utah, and Wyoming. Each of these states has differing TB epidemiology and TB control program structure, but they share the common challenge associated with maintaining TB control program and clinical expertise in the context of low TB incidence and few resources.

Process. Regional interventions were developed and prioritized through a consensus process that involved the four low-incidence states and many TO6 partners. The TB control programs of Idaho, Montana, Utah, and Wyoming actively participated in the development and implementation of a series of interventions. Advisory groups (AGs), comprised of members of each state’s TB control program and/or public health laboratory, national experts associated with TO6 (the principal investigators, nurse consultants, and CDC staff), and TO6 staff were routinely convened to make decisions and communicate progress in each intervention area. For example, the Policy and Planning Advisory Group was convened to develop a TB Manual template to standardize practice and tailor national guidelines to each state’s unique public health system. All AGs were facilitated so that the issues of importance to each state were raised and explored, and discussions were guided to ensure interventions will benefit the region. Evaluation plans are being introduced into each intervention to determine if objectives are achieved, and, where applicable, if TB control practice improved.  Guidance of the evaluation components will also occur through an AG process.

Interventions. The interventions, which are at various stages of development or implementation, were designed to address the TB control programs’ needs and include the following:

  • A customizable TB manual template that presents national TB control guidelines for use in the field

  • Assessments of regional laboratory practice

  • Collaborative regional laboratory trainings

  • Case management and contact investigation trainings using a collaborative model

  • A short audio course on the medical management of TB

  • Collaborative evaluation of a case management teleconference series

  • Regional clinical consultation

  • Tools for using genotyping and surveillance data to identify potential region-wide outbreaks, and to inform strategic program planning and program evaluation

  • An outbreak response plan template

  • A regional assessment of TB surveillance systems

  • A regional TB elimination plan 

Some of the interventions are completed or nearing completion. For example, the TB Manual template will be available online this summer; the audio course on medical management of TB has been completed and is available online at; a final report of the evaluation of a case management teleconference series in Idaho has been completed and was presented at the CDC poster session at the ATS conference in May 2006 and at the NTCA conference in June 2006; the regional assessment of TB surveillance systems was completed. Regional laboratory trainings are currently being developed in collaboration with the National Laboratory Training Network. One laboratory survey has been completed and presented in a variety of venues. A follow-up laboratory survey is in progress. The case management/contact investigation training is being developed to precede and complement Utah’s annual TB conference held in Salt Lake City. A draft outbreak response template is currently being evaluated in Idaho and will be finalized by fall 2006. The regional TB elimination plan is currently being developed. Additionally, the surveillance and genotyping interventions are in early stages of development.

Outcomes. The regional interventions were created in order to put the concept of regionalization into practice and to assess whether tools created and implemented in a low-incidence region provide added value to TB elimination efforts. As these interventions are being evaluated, we hope to determine effective practices for eliminating TB in a low-incidence region.

—Submitted by Lisa Pascopella
Francis J. Curry National Tuberculosis Center
of the University of California at San Francisco
and Charles Daley
National Jewish Medical and Research Center


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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