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TB Notes 4, 2006
Director's Letter
Highlights from State and Local Programs
  Los Angeles Presents "The Opera and Perspectives on TB"
  Arizona's and Sonora's Meet and Greet Program for Deportees with TB
  The Flex Power of Memoranda of Agreements (MOAs)
  HIV Status Not Routinely Determined for TB Cases: an Evaluation of Four California Local TB Programs
CDC/ATSDR Group Award for Minority Health Mentor/Champion of Excellence
Laboratory Update
  New Technologies Unveiled at the 2006 National TB Controllers' Workshop
Nursing Updates
  The Red Snappers of National Tuberculosis Nurses Coalition (NTNC)
  Pacific Island TB Controllers Association (PITCA) -  Workshop for Nurses
TB Education and Training Network Updates
  Member Highlight
  Sixth Annual Conference Highlights
  Cultural Competency Subcommittee Update
Communication, Education, and Behavioral Studies Branch Update
  New Communication Efforts to Stop TB in the African-American Community
Clinical and Health Systems Research Branch Update
  Using a Private Claims Database for TB Health Services Research, Evaluation, and Analysis
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  9th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium
  TBESC Task Order #10: Monitoring Performance and Measuring Cost of TB Public Health Practice at County and State Health Departments: Are We Making a Health Impact?
New CDC Publications
Personnel Notes
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TB Notes Newsletter

No. 4, 2006

Surveillance, Epidemiology, and Outbreak Investigations Branch Update

9th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium

The 9th Semiannual Meeting of the Tuberculosis Epidemiologic Studies Consortium (TBESC) convened July 12–13, 2006, in Atlanta, Georgia. The primary purpose of the TBESC is to conduct epidemiologic, behavioral, economic, laboratory, and operational research in TB prevention and control.

The goal of the meeting was to update consortium members on the status of research projects, discuss and refine the process by which research proposals are submitted and reviewed, and discuss the latest study on new diagnostic tests for detecting latent TB infection. Over 90 persons participated in the meeting. Attendees included CDC staff, consortium principal investigators, project coordinators, and project specific personnel.

Participants heard presentations from CDC, TBESC members, and invited guests on a broad array of topics that included-

  • Scientific updates from TBESC studies with new research results
  • Administrative and fiscal updates on consortium-related activities
  • Updates from the Bylaws and External Relations Committees, and the Translating Research into Practice Workgroup
  • The epidemiologic basis of TB control

Participants discussed modifying the process by which consortium research proposals are submitted, reviewed, and awarded, and reexamined the research agenda focus, goals, and research questions. The meeting was productive and responsive to the mission of the TBESC.

—Reported by Christopher J. Kissler, MPH
Div of TB Elimination and
TBESC External Relations Committee

TBESC Task Order #10: Monitoring Performance and Measuring Cost of Tuberculosis Public Health Practice at County and State Health Departments: Are We Making a Health Impact?

In the past, TB public health evaluation focused on two questions:

  1. Are we headed in the right direction (objectives)? and
  2. Are we making efficient progress (performance)?

These two questions are usually asked of TB case management, contact investigation, targeted testing, and outbreak investigation (action). However, for the most part, these questions ignore TB case detection, registration, and analysis (surveillance). Further, the question of effectiveness is unasked, and often, local and state TB programs remain unaware of missed opportunities to improve both efficiency and effectiveness. Further, the limited evaluation efforts that currently exist focus mainly on monitoring, with little to no in-depth evaluation, which is required to know where and how to intervene in response to poor performance. While objectives are established, programs have few tools to monitor and evaluate progress toward them in a user-friendly, Web-based, real-time manner.

Other evaluation areas remain problematic for TB managers. Program costs come to the manager in the form of line items (e.g., personnel, travel, or equipment). This does not allow costs to be translated into specific public health activities. For example, a program manager cannot answer the simple question, how much does it cost to perform case management or outbreak investigation? This is because cost data are not passed through what might be called an “interpretive grid” into specific public health activities. Often intuitive rather than data-driven decisions are made by program managers. Cost is important to program, but is not generally considered for evaluation. In recent years, TB budgets have shrunk, challenging programs to do the same or more with less money. Knowing the cost involved in running a successful TB program that achieves health impacts is crucial, especially in the face of shrinking budgets. Programs should and must be able to ask and answer questions such as, what is the cost of each program activity, such as case finding or case management? In what areas of my program is the most money spent?

Task Order #10’s vision was to develop tools that will facilitate quick, user-friendly monitoring and evaluation as a way to help TB programs target interventions toward cost efficiency and improved performance. The goal was to develop and implement simple, standardized, Internet-based tools for TB programs that can be used to monitor performance and measure costs. Task Order #10 achieved this goal. The Florida Department of Health (FL DOH) and the University of North Texas Health Science Center conducted this operational research and developed two tools. These two simple, standardized, yet customizable tools are based on an action-led conceptual framework that includes eight core activities (detection, registration, reporting, confirmation, analysis, feedback, acute response, and planned response) and four support activities (communication, training, supervision, and resource provision).

In phase I, we collected program indicators from a variety of national, state, and local programs. We compiled these indicators in a database totaling over 150 indicators mapped to the conceptual framework. Task Order #10 sites held focus groups at multiple locations with various levels of public health professionals ranging from nurses to program managers, to determine which indicators were the most useful. Group participants evaluated the indicators based on importance, understandability, utility, availability, measurability, and cost effectiveness. In phase II, we continued to collect and analyze evaluation data from additional counties or regions at the two project sites. In addition, the Task Order #10 teams began the process of costing TB activities using the conceptual framework. In phase III, we developed and refined the two tools.

The Florida Public Health Impact Tool (PHIT) assists TB control programs in monitoring performance, evaluating established objectives, examining related costs, and measuring the health impact of their interventions. PHIT uses data readily available to TB programs to calculate the costs associated with performance measures. These calculations can focus on specific program areas such as surveillance or contact investigation, look at program areas over time, and compare across programs. By linking the cost to performance outcomes, PHIT provides meaningful information that will help managers highlight program accomplishments or investigate areas that need attention. These evaluation findings provide useful data for improving TB programs and advocating for resources.

Texas’ Tuberculosis Program Economic Decision Support tool (TB EDS) can be used to assist TB control programs in modeling the effect of changes in local conditions. TB EDS can be used to estimate the resources required to achieve a level of performance and predict the additional resources needed to meet changing conditions. The ability to model the effect of changing conditions on performance enables managers to maximize resources and increase program efficiency. TB EDS can also be used to guide program staff in budget preparation, contingency planning, and comparisons of alternative program components or technologies.

Photos of the Task Order # 10 team
The Task Order # 10 team at the University of North Texas Health Science Center campus during the Second Annual Health Economic conference, October 2005.

The funding for Task Order #10 ends on September 30, 2006, but our work will continue. Three peer-reviewed manuscripts have been published, and five manuscripts are in preparation. Over our 3-year project, 28 abstracts have been presented at various meetings, including the National TB Controllers Association and American Evaluation Association. We have given numerous oral presentations including seven Division Brown Bag seminars. Two Economic Health Forums supported by Task Order #10 were held on the campus of the University of North Texas Health Science Center in 2004 and 2005. For a copy of our bibliography, a description of Task Order #10 tools, or copies of the tools themselves, please contact Bridget Young at

—Submitted by Bridget Young
Div of TB Elimination


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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