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TB Notes 4, 2003

Summary of October ACET Meeting

On October 1 and 2, the Advisory Council for the Elimination of Tuberculosis (ACET) met in Atlanta. Following are several highlights of the meeting. There has recently been a considerable turnover in the ACET membership, with a number of long-time members rotating off the council and new members joining. The new roster of ACET members is included as an attachment to this issue of TB Notes. After the welcoming remarks, Dr. Ed Thompson, CDC’s Deputy Director for Public Health Services, described the Futures Initiative. Under this activity, CDC is re-examining its place in the broader public health system, using feedback from external partners to make strategic decisions that will guide programs over the next decade. Dr. Harold Jaffe, Director of the National Center for HIV, STD, and TB Prevention (NCHSTP), reported that the Division of AIDS, STD, and TB Laboratory Research (DASTLR) was administratively transferred from the National Center for Infectious Diseases (NCID) to NCHSTP on October 1, 2003. The transfer will not result in a decrease or increase to the NCHSTP budget. The Comprehensive TB Elimination Act of 2003 was introduced, calling for an FY 2004 appropriation of $528 million for CDC’s TB program; a Senate companion bill would authorize $235 million. In my DTBE Director’s Report, I described the recent activities and projects of DTBE’s branches; after my remarks, ACET members discussed the TB budget and strategies for addressing unmet TB elimination needs. We at CDC acknowledged that several TB activities are adversely impacted by the budget; e.g., dollars for targeted testing and LTBI treatment will be redistributed because of inadequate funding. ACET made a formal statement emphasizing that the budget is adversely impacting TB elimination strategies, and agreed to write a letter to the Secretary of the Dept. of Health and Human Services (DHHS) about the inadequacy of the TB budget for inplementing all recommendations by the Institute of Medicine for TB elimination.

Dr. Amy Bloom of the US Agency for International Development (USAID) described USAID’s global TB program to expand directly observed therapy, short-course (DOTS) through partnerships and capacity building. Dr. James McCauley, Director of Cook County Jail in Chicago, gave a status report on TB control in jails; he noted that corrections is one of the most important yet challenging issues to address in US TB control and elimination efforts. Dr. Mark Lobato of DTBE described a recent CDC-sponsored study of TB control activities in city and county jails. ACET acknowledged that TB prevention and control in correctional facilities is another area adversely affected by the TB budget. Dr. Diana Schneider of the Division of Immigration Health Services (DIHS), DHHS, gave an update on CDC’s ongoing collaboration with the Bureau of Immigration and Customs Enforcement (ICE) in devising mechanisms that will address the problem of immigration detainees with TB. Several CDC staff then gave presentations on TB in foreign-born persons. Dr. Eileen Schneider described the progress made on the US/Mexico binational TB referral and case management project, which ensures continuity of care and completion of therapy for TB patients who migrate between the two countries. She reported that the binational card project has already improved communication and collaboration between ICE detention centers and local TB programs. Mr. Subroto Banerji of DTBE reported that the Electronic Disease Notification (EDN) system being developed by CDC’s Division of Global Migration and Quarantine (DGMQ) will initially focus on TB; currently, CDC is expecting the national roll-out of EDN-TB in September 2004. Dr. Mary Naughton of DGMQ reviewed the revised technical instructions for civil surgeons, and Dr. Dolly Katz of DTBE described an upcoming study of the epidemiology of TB in foreign-born persons in the United States and Canada. Dr. Masae Kawamura, the TB Controller for San Francisco, described activities her department has conducted to evaluate its progress in implementing the 1998 CDC guidelines for TB control in foreign-born persons. Ms. Elizabeth Williams, TB Surveillance Coordinator for the Arizona Dept of Health Services, described activities her state is conducting to address detainees with TB who are deported before they complete treatment. Arizona has a “Meet and Greet” program that arranges for Mexican nationals who are being deported to Mexico to be met at the border and offered TB treatment. After her comments, ACET recommended adding the issues of TB control in correctional settings and in foreign-born populations to ACET’s letter to the Secretary of DHHS. In addition, ACET members agreed to form a new Foreign-born TB Workgroup in order to review the 1998 CDC guidelines on TB control in foreign-born persons, compile existing data, and determine elements missing from the guidelines (the workgroup will not address TB in undocumented persons).

The next day, the first presentation was an update by Dr. Zach Taylor on DTBE’s targeted testing projects. He outlined several challenges and problems the grantees had encountered, indicating that currently available results reflect mixed success. Consequently, when CDC announces the new cooperative agreements in FY 2005, only those projects with viable targeted testing interventions and those with demonstrated effectiveness will be eligible for funding. Dr. Paul Jensen then discussed the status of the draft revised infection control guidelines for health care settings. After the guidelines are cleared through CDC, the draft will be published in the Federal Register and comments addressed; the document will be revised, recleared through CDC, and published in the MMWR Recommendations and Reports series in 2004. The final topic was TB elimination among US-born African Americans, with Dr. Zach Taylor reporting on DTBE’s efforts in response to recent recommendations. DTBE’s activities have included initiating a newsletter, The TB Challenge: Partnering to Eliminate TB in African Americans; developing an MMWR article on TB disparities in the Southeastern United States; preparing a fact sheet template to be used by Southeastern states; and collaborating with NCHSTP in providing a DTBE booth at minority health meetings. Future steps will include conducting research in several Southeastern states to analyze treatment adherence problems in US-born blacks, and incorporating language in the next cooperative agreements that will address racial health disparities in TB in the United States. Dr. Stephanie Bailey, providing the perspective of the Southeast TB Workgroup, suggested that CDC remain involved with this activity. The ACET membership was very pleased that NTCA has formed a workgroup that will maintain the focus on TB in US-born blacks. Dr. Randall Reves of Denver, Colorado, reported on the Strategic Plan for TB Training and Education; a discussion ensued on the challenges and the importance of funding and implementing this plan.

—Reported by Ann Lanner and Kenneth G. Castro, MD
Div of TB Elimination

 


Released October 2008
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