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No. 3, 2008

Directors Letter

Dear Colleague:

The 57th annual Epidemic Intelligence Service (EIS) conference, which is held in Atlanta, convened this year April 14–18. The Division of Tuberculosis Elimination (DTBE) had a very successful week of research presentations and recruitment. DTBE has recruited three new EIS officers from the incoming class; we welcome them to the division. Please see the summary of this conference provided by Kevin Cain and Tim Holtz in this issue.

The 2008 National TB Controllers Workshop, sponsored by the National Tuberculosis Controllers Association (NTCA), was held June 10–12 at the Crowne Plaza Hotel in Atlanta. My last TB Notes Dear Colleague letter devoted only a paragraph to the workshop; in this letter I will share some of the highlights of this important meeting.

The theme of the meeting was the appropriate and timely message of “Many Cultures, One Cause.” Several preworkshop activities were held on June 9, including the Advanced Medical Practitioner's Meeting. At that session, the National Society of TB Clinicians was formed. The Society will function as a section within the NTCA; its purpose will be to advance the elimination of TB in the United States and its Territories. Members of the Society will work in partnership with the TB control officials to provide the clinician’s perspective on issues vital to the success of eliminating TB.

The main activities of the workshop began on June 10. The first general session featured a number of welcomes and updates, including a motivational keynote speech by Stephanie Bailey, Chief of Public Health Practice at CDC. Asserting that health protection investments produce health system value, she challenged us to harness the incredible technology at our disposal to reduce health disparities and improve the health equity of all U.S. residents. During breaks, participants were able to view and discuss the posters on display, which represented some of the excellent work being done by TB control staff in this country. Please see the related article in this issue about the winners of the poster contest.

We also heard about some of the challenges of quarantine and global migration, with updates on the Electronic Disease Notification (EDN) system and the new 2007 TB Technical Instructions (TB TI) for Panel Physicians (physicians who examine foreign citizens applying for entry into the United States as immigrants or refugees). Gisela Schecter of the California Department of Public Health described the site visit that was conducted in May–June 2008 to evaluate the screening program for U.S.-bound Philippine immigrants using the new 2007 TB TI. The evaluation team reported that the Philippines TB screening program has done an outstanding job of developing thorough and effective procedures for implementing the TB TI; more than 21,000 patients have been screened using the TB TI since October 2007. The team found that implementation of mycobacterial culture in the screening process has produced improvements. Through March 2008, the program detected 244 TB cases among screened applicants; among those, 142 were smear-negative and culture-positive for M. tuberculosis and would not have been detected using the old screening instructions. The Division of Global Migration and Quarantine (DGMQ) has also updated the Technical Instructions for Civil Surgeons (physicians who perform the medical examinations of aliens within the United States). Please see Mary Naughton’s related article in this issue.

The third general session was dedicated to challenges encountered with specific social cultures. We heard sobering statistics that reminded us of the serious health disparities between white, non-Hispanic U.S. residents and racial/ethnic minority populations in this country that make cultural competency so compelling and important. Some of the presentations in this session reminded us that the challenges we face in treating TB patients can arise not only from the patient’s culture, but from that of the institution housing the patient. For example, we heard descriptions of the cultural divide between corrections and public health staff; two presenters noted that corrections and public health do not speak the same language, and that each culture must try to understand and respect the other’s mission and purpose.

The last general session dealt with the changes in practice and technology that TB controllers are experiencing. Patrick Moonan introduced TB GIMS (the Tuberculosis Genotyping Information Management System), which will advance genotyping information management from local, ad hoc reports to national, standardized reports. This will automate the process of submitting isolate information, reporting genotyping results, and tracking and analyzing data. Dolly Katz, Smita Chatterjee, and Margaret Oxtoby presented results from an NTCA survey about the Translating Research into Practice (TRiP) workgroup. The survey results indicated several key points for successfully translating research into practice: 1) it helps to start small, 2) it’s important to show how the change can benefit stakeholders, 3) for change to be institutionalized, it needs to be written down, and 4) remember that legislators and administrators can be your friends. The final session topic dealt with challenges with the patient. These presentations essentially confirmed what we know: that it takes collaboration among TB control, nursing, laboratory, and legal staff to manage challenges with patients. Please mark your calendars: the 2009 NTCA Workshop has been set for June 15–19, 2009. I hope to see you there!

On a final note, I am happy to report that on July 31, President Bush signed H.R. 5501, the Lantos-Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. The bill provides a 5-year strategy for confronting AIDS, TB, and malaria, authorizing $48 billion for these global health programs. The legislation also addresses TB prevention and control, incorporating language from the Stop TB Now Act. The measure allows expansion of the U.S. Agency for International Development's (USAID) global TB control activities, and commits $4 billion over the next 5 years to treat and prevent TB, the biggest killer of people with HIV/AIDS. The authorization supports treatment for 4.5 million TB cases, and diagnosis and treatment of 90,000 new MDR cases by 2013. In addition, Congress recently passed the Comprehensive TB Elimination bill, which reauthorizes domestic TB programs. As of this writing, the measure is awaiting signature by the President. Thanks to the many partners who make themselves available to answer policymakers' questions about TB prevention and control.

Kenneth G. Castro, MD
 

 

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