TB Notes Newsletter
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No. 1, 2006
Following the publication of the 2004 APHL TB Task Force report, “The Future of TB Laboratory Services, A Framework for Integration, Collaboration, and Leadership,” the association will begin implementing the report recommendations. Heading this endeavor is a new APHL TB Steering Committee. The committee is a joint venture with APHL members, CDC staff, a National TB Controllers Association (NTCA) representative, and laboratorians from the clinical sector. It will also be tasked with reviewing other important TB laboratory and cross-cutting programmatic issues.
There are three benchmarks that the Steering Committee will be tasked with implementing. Benchmark one suggests that an ongoing assessment of available TB laboratory services is needed to determine the current status and capacity of services and to identify unmet needs, obstacles to obtaining laboratory services, and opportunities for improvement. Benchmark two addresses the need for an assessment of the true costs of providing TB laboratory services. The third and final benchmark involves the development of a strategic plan for implementing and maintaining a systems approach for TB control. The Committee met at APHL headquarters on November 21 and 22, 2005, to strategize a plan of action for implementing these benchmarks.
—Submitted by APHL TB Steering Committee:
Nancy Warren, Chair, PA; John Bernardo, NTCA; Edward Desmond, CA; Wendy Gross, VA Medical Ctr, CT; Bruce Hanna, NY Univ School of Medicine; Nancy Hooper, MD; Ken Jost, TX; Anthony Tran, APHL;
David Warshauer, WI; Michael Iademarco, John Ridderhof, and Tom Shinnick, CDC
The Northeastern TB Controllers Meeting was held on September 26 and 27, 2005, at the New York State Department of Health, Albany, New York. The Northeast Regional Training and Medical Consultation Center in New Jersey serves the following states and cities: Maine, New Hampshire, Vermont, Rhode Island, Massachusetts, Connecticut, New Jersey, New York, Delaware, Maryland, Pennsylvania, West Virginia, Ohio, Indiana, Michigan, New York City, Philadelphia, Baltimore, Detroit, and Washington, DC. For the first time, TB laboratory partners from each of these jurisdictions were invited to attend the meeting.
Day one of the meeting included separate morning breakout sessions for the TB controllers and laboratorians, allowing them to discuss issues of significance in their particular realm. During the laboratory session, there were several key issues noted by the laboratory participants:
- A discussion regarding funding brought to light the fact that
laboratories do not feel that they are seen as equal partners
in TB prevention and control. Federal guidelines (i.e., Healthy
People 2010) are now requiring faster turnaround times by laboratories
in identifying and reporting TB. However, to meet these shorter
turnaround times, the laboratories must use more sophisticated
and expensive diagnostic tools such as the Mycobacterium Tuberculosis
Direct (MTD) assays and QuantiFERON-TB Gold (QFT-G). In addition,
the costs of liquid media, probes, and reagents increase each
year, as do workforce salaries and benefits. TB funding has remained
level since 1995, and this lack of increased funding results in
the decreased ability to keep pace with laboratory requirements.
Flat funding affords less buying power for the laboratories.
- Each year the TB Laboratory Upgrade component of the Cooperative Agreement requests laboratories to fill in a “true needs” budget assessment, but no additional funds for meeting these needs had been provided until FY 2005. However, the laboratories that received less funding in FY 2005 as a result of the funding formula did receive a slight increase to help make up for this shortfall.
Several laboratory panel members also felt disconnected with CDC in terms of support and guidance during the Cooperative Agreement writing process. Still others felt that the goals CDC set are unrealistic without the promise of more financial support. These funding issues must be dealt with at the federal and state level in order for change to occur. The APHL TB Steering Committee has been addressing TB funding issues and will continue to be committed to helping the TB laboratory find equality of funding.
- A proposal was made that TB training and education for the performance of laboratory assays could be supported by the TB Regional Training and Medical Consultation Centers (RTMCCs), since they receive a large share of the total TB funding.
The afternoon session consisted of a joint roundtable session with both program and laboratory members. The roundtable discussion focused on the QFT-G assay, including issues surrounding funding, transportation of specimens, and cost, which is estimated to be $35 per test. While laboratorians agree that the QTF-G data look encouraging, the aforementioned questions still need to be answered before implementation can take place. New York State is currently the only jurisdiction in the region performing the QFT-G assay; however, this is only done on Department of Corrections patients. This specialized population was chosen in order to address the specimen stability problem. Inmates are transported from the prison to a site closer to the laboratory where blood is drawn and samples can be processed immediately.
Day two of the meeting was packed with plenary sessions on TB contact investigation guidelines, program evaluation plans, the role of the National TB Controllers Association (NTCA), implementation of QFT and real-time genotyping, surveillance in low-incidence populations, and the investigation of an M. bovis cluster in New York City.
The overall sentiment from participants was positive towards the first joint meeting of TB controllers and laboratorians in the Northeast region. Attendees felt that the meeting provided a good forum for sharing information from their respective jurisdictions and learning from others. In general, TB controllers and their laboratory partners have worked hard to establish good working relationships. Joint meetings afford all parties involved the opportunity to work together to improve funding, understand the limitations of new procedures, and address the obstacles encountered in new testing methods. This speaks to the need for collaborative education for both groups, in order to improve communication and maximize the use of resources. Hopefully future meetings with more time for discussion will help alleviate some of these issues.
For questions about APHL or the APHL TB Steering Committee, please contact Anthony Tran, HIV, STD, and TB program manager, at firstname.lastname@example.org or at (240) 485-2783.
—Submitted by Anthony Tran, MPH, MT(ASCP)
Association of Public Health Laboratories
On behalf of the APHL TB Steering Committee