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Federal Tuberculosis Task Force Plan in Response to the Institute of Medicine Report, Ending Neglect: The Elimination of Tuberculosis in the United States

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The documents listed below are historical, archived information. The information contained in these documents, while accurate at the time of release, may not be the most current available.

Strategies and Action Steps

Domestic Federal Actions in Response to the Institute of Medicine Report on TB:
Ending Neglect: The Elimination of Tuberculosis in the United States

B. Strategies for Accelerating the Decline of TB

Maintaining control of TB is not sufficient to eliminate TB. Individuals can unknowingly carry live bacteria that cause TB for years without getting sick (also known as latent TB infection). An estimated 10 - 15 million persons in the U.S. have latent TB infection, many of them in identifiable but hard-to-reach populations. Latent TB infection can suddenly turn active and contagious. Finding and treating high-risk persons with latent TB infection before they become sick - and infectious - is absolutely essential to eliminating TB. High-risk persons include those with recent infection, contacts of persons with infectious TB, persons with HIV or AIDS, substance abusers, persons who have immigrated to the U.S. from areas of the world with high rates of TB, prisoners, and the homeless. In addition, persons who reside or work in institutional settings (e.g., hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for patients with AIDS) may have an ongoing risk for acquiring TB infection and disease.

IOM Recommendation 4.1: “To limit the spread of TB from infectious patients to their contacts...”

Strategies
Action Steps

1. Develop national recommendations or/guidelines for contact investigation, addressing the challenges of investigations among the foreign-born and in various social networks, and define terms such as "close contact."

Lead Agency: CDC

Collaborating Agencies: SAMHSA, HRSA, NIH, NTCA, DOL

Start Date: FY 2002

Completion Date: FY 2010

a) Complete ongoing prospective study of contact investigations, which will provide the scientific basis for developing recommendations/guidelines for contact investigations.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2002

b) Conduct prospective study aimed at improving contact investigations among foreign-born populations in the U.S. Specific objectives of this study are 1) to improve contact identification for foreign-born TB patients, and 2) to improve interpretation of skin test results in foreign-born contacts. For objective 1), interviewing tools will be developed in multiple languages, input from an ethnographer will be sought in designing the study, and social networking approaches will be used. For objective 2), epidemiologic, immunologic, and non-tuberculous antigen test results will be correlated to develop an epidemiologic profile associated with increased risk of recent M. tuberculosis infection. Results of this prospective study will augment the scientific basis for developing recommendations and guidelines for contact investigations in foreign-born populations.

  • Lead: NCHHSTP
  • Collaborators: NIAID, NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2004

c) Evaluate intervention in 10 sites using social networking results and the epidemiologic profile associated with increased risk of infection, developed in the foreign-born contact study described in b) above. The evaluation will include the measurement of the impact of the intervention.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2005
  • Completion Date: FY 2006

d) Based on findings from a pilot intervention aimed at improving foreign-born contact investigations described in step c) above, modify intervention as needed and implement nationwide.

  • Lead: NCHHSTP
  • Collaborators: NCID, NTCA
  • Start Date: FY 2007
  • Completion Date: FY 2009

e) Develop process indicators for monitoring the quality of contact investigations. Preliminary achievement targets for each indicator will also be established by the panel. It is envisioned that these indicators will be an important tool for identifying contact investigation steps which need improvement, and for monitoring trends in investigation quality over time.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2002

f) Pilot intervention, introducing process indicators identified in step e) above to establish baseline quality and timeliness of sequential contact investigation steps at 20-30 pilot study sites. Trends in investigation quality will be monitored over time.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2004

g) Study the impact of pilot intervention described in step f) above with proposed process indicators. Outcomes will be 1) indicator results and 2) number and proportion of new TB cases prevented pre vs. post intervention.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2003
  • Completion Date: FY 2004

h) Implement nationwide the process indicators identified, pilot tested, and evaluated in steps e)-g) above, and monitor the following outcomes from all reporting sites on an annual basis: 1) indicator results; 2) number and proportion of new TB cases prevented pre vs. post intervention; and 3) TB case rates pre vs. post intervention. Indicator achievement will also be correlated with other outcomes.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2004
  • Completion Date: FY 2006

i) Develop and distribute recommendations/guidelines for contact investigations. The final product will include guidelines for contact investigations in U.S.-born populations, guidelines for contact investigations in foreign-born populations, and guidelines for use and interpretation of process indicators.

  • Lead: NCHHSTP
  • Collaborators: NCID, NIAID, NTCA, OSHA
  • Start Date: FY 2002
  • Completion Dates: See below

    FY 2003: Guidelines for contact investigations in U.S.-born populations
    FY 2005: Guidelines for use of process indicators
    FY 2006: Guidelines for contact investigations in foreign-born populations

j) Conduct nationwide program evaluation to determine the extent to which state and local TB control programs have implemented the national recommendations/guidelines for contact investigations and determine the extent to which implementation has improved the quality of these changes.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2004
  • Completion Dates: See below

    FY 2005: US-born contact investigation guidelines
    FY 2007: Process indicators for monitoring contact investigations
    FY 2010: Foreign-born contact investigation guidelines

k) Develop an electronic contact investigation surveillance system with national standards for data elements and definitions, giving health department TB programs the ability to modify databases to (1) manage contacts through examinations and appropriate treatment, and (2) more effectively monitor and improve program performance.

  • Lead: NCID
  • Collaborator: NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2004

2. Implement CDC TB outbreak response plan for the U.S.

Lead Agency: CDC

Collaborator: NTCA

Start Date: FY 2002

Completion Date: Ongoing

a) Develop a computer-based methodology to improve the identification of acute outbreaks and assist state and local TB programs to implement it; clearly define what situations should be reported.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2003

b) Expand assistance to state TB control programs to improve their ability to respond to outbreaks. Develop flexible tools to be used during outbreak investigations, develop outbreak response training courses, develop a set of best practices that outline the most cost-effective options for conducting large-scale investigations, and provide templates of existing outbreak response plans as guidance to ensure that at least 75% have outbreak response plans.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2003

c) Expand capacity of CDC and state TB programs to respond to increasing number of reported outbreaks.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2002
  • Completion Date: Ongoing

d) Establish a new, computer-based, nationwide outbreak detection system, based on data from the national TB surveillance system. Determine under what conditions outbreaks are occurring and provide prevention recommendations. Hire and train staff at CDC to provide technical assistance for new system.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2002
  • Completion Date: Ongoing

e) Provide emergency outbreak assistance to states and localities experiencing outbreaks of tuberculosis that overwhelm existing public health capacity.

  • Lead Agency: NCHHSTP
  • Collaborator: NTCA
  • Start Date: prior to FY 2002
  • Completion Date: ongoing

3. Conduct epidemiologic studies and behavioral research on contact investigations (e.g, social network analysis, study of why people do not complete LTBI therapy, identification of appropriate incentives/enablers); develop/test behavioral interventions for at-risk populations, including substance abusers.

Lead Agency: CDC

Collaborating Agencies: NIH, IHS, HRSA, SAMHSA, NTCA

Start Date: FY 2002

Completion Date: FY 2007

a) Design, implement, and evaluate strategies improving the effectiveness of contact investigation activities (e.g., social network analysis, incentives/enablers).

  • Lead: NCHHSTP
  • Collaborators: NIAID, HAB
  • Start Date: prior to FY 2002
  • Completion Date: FY 2007

b) Determine what behavioral and social risk factors among contacts best predict adherence to testing and treatment.

  • Lead: NCHHSTP
  • Collaborators: NIAID, NHLBI
  • Start Date: prior to FY 2002
  • Completion Date: FY 2005

c) Assess the knowledge, skills, beliefs, and abilities of health care providers serving TB patients and their contacts and determine optimal practices to promote cooperation with the contact investigation process and completion of treatment for LTBI.

  • Lead: NCHHSTP
  • Collaborator: NHLBI
  • Start Date: prior to FY 2002
  • Completion Date: FY 2005

d) Ascertain the perspectives and special needs of TB patients and contacts (especially high-risk and vulnerable populations) to identify barriers to contact identification, testing, and treatment for LTBI.

  • Lead: NCHHSTP
  • Collaborators: IHS, NIDA, SAMHSA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2005

e) Explore the cultural and socioeconomic context in which contact investigations are conducted and determine the impact that communities, service providers and systems, policy makers, and fiscal decision makers have on the successful identification of contacts and the prevention of disease.

  • Lead: NCHHSTP
  • Collaborators: BPHC, SAMHSA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2005

f) Assess existing behavioral research across all fields of inquiry that may be relevant to contact investigations and determine how to apply this information.

  • Lead: NCHHSTP
  • Collaborator: NIH
  • Start Date: prior to FY 2002
  • Completion Date: FY 2004

g) Train investigators in applying effective strategies and optimal techniques to contact investigation practice.

  • Lead: NCHHSTP
  • Collaborator: NHLBI
  • Start Date: FY 2005
  • Completion Date: FY 2007

4. Ensure that health care facilities maintain infection control activities.

Lead Agency: CDC

Collaborating Agencies: OSHA, NTCA

Start Date: FY 2002

Completion Date: FY 2005

a) Update and disseminate guidelines for the prevention of TB transmission in health care settings.

  • Lead: NCHHSTP
  • Collaborators: NCID, NIOSH, OSHA, NTCA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2002

b) Conduct operational research on completeness of implementation of nationwide guidelines.

  • Lead: NCHHSTP
  • Collaborators: NCID, NIOSH, OSHA, NTCA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2005

5. Characterize circulating TB strains using DNA fingerprinting results.

Lead Agency: CDC

Collaborating Agency: NTCA

Start Date: FY 2002

Completion Date: Ongoing

a) Establish regional genotyping centers to perform molecular characterization of all isolates of Mycobacterium tuberculosis from patients in the U.S. Effort will require high-throughput DNA sequencers to be placed at Atlanta and one in each of five regional laboratories.

  • Lead: NCHHSTP
  • Collaborator: None
  • Start Date: FY 2002
  • Completion Date: FY 2003

b) Receive, process, and analyze M. tuberculosis isolates from an estimated 12,000 patients per year.

  • Lead: NCHHSTP
  • Collaborator: None
  • Start Date: FY 2002
  • Completion Date: Ongoing

c) Establish and support a national DNA fingerprinting registry to compare fingerprinting results from different geographic regions.

  • Lead: NCHHSTP
  • Collaborator: NTCA
  • Start Date: FY 2002
  • Completion Date: Ongoing

IOM Recommendation 4.2: “To prevent development of TB among persons with latent TB infection...”

Strategies
Action Steps

1. Ensure implementation of CDC guidelines for preventing and controlling TB in high-risk populations/environments.

Lead Agency: CDC

Collaborating Agencies: HRSA, INS, SAMHSA, IHS, VA, NIH, NTCA, DOL

Start Date: FY 2002

Completion Date: Ongoing

a) Increase the capacity of TB control programs and other governmental and non-governmental agencies to implement targeted testing and appropriate treatment for high-risk populations (including HIV at risk, American Indians/Alaska Natives, other minorities, prisoners and staff in correctional systems, homeless, immigrants, migrant workers, IDU contacts, and workers who provide health care or other services to these populations).

  • Lead: NCHHSTP
  • Collaborators: NTCA, NIOSH, IHS, BPHC, DIHS, FBOP, HAB, NIDA, SAMHSA, OSHA, VHA
  • Start Date: prior to FY 2002
  • Completion Date: Ongoing

b) Identify (i) incentives and barriers to seeking out services or completion of treatment; (ii) enablers to the receipt of services; and (iii) appropriate messages to motivate seeking care.

  • Lead: NCHHSTP
  • Collaborators: DIHS, IHS, BPHC, HAB, NHLBI, OSHA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2002

c) Ensure that federal agency RFAs include information on the need for TB education to health care providers.

  • Lead: All Federal TB Task Force Agencies
  • Collaborator: None
  • Start Date: prior to FY 2002
  • Completion Date: Ongoing

d) Develop and implement a plan to ensure compliance with CDC TB recommendations and establish grantee and contractor performance measures, contractual agreements, regulations, and links with health departments.

  • Lead: NCHHSTP
  • Collaborators: All Federal TB Task Force Agencies
  • Start Date: prior to FY 2002
  • Completion Date: Ongoing

2. For HIV-Use Ryan White Care Act guidance, and establish standards for TB-related clinical practices; identify active cases and opportunity to treat latent TB infection; and update AIDS educational training center material.

Lead Agency: HRSA

Collaborating Agencies: CDC, SAMHSA

Start Date: FY 2002

Completion Date: Ongoing

a) Coordinate announcements of Ryan White Care Act to include quality-of-care indicators and standards for TB.

  • Lead: HAB
  • Collaborators: NCHHSTP, SAMHSA
  • Start Date: FY 2002
  • Completion Date: Ongoing

b) Evaluate the number of active TB cases and latent TB infections identified and treated by Ryan White Care Act Clinics.

  • Lead: HAB
  • Collaborators: NCHHSTP, SAMHSA
  • Start Date: FY 2002
  • Completion Date: Ongoing

c) Develop periodic updates of AIDS education training center materials.

  • Lead: HAB
  • Collaborators: NCHHSTP, SAMHSA
  • Start: FY 2002
  • Completion Date: Ongoing

3. For Corrections - Establish an acquisition process in which all federal contracts negotiated between state, local, and private correctional facilities require health care services that are consistent with current CDC guidelines regarding infection control, TB-related examination, treatment of disease and latent infection, contact investigation, and referral for continuity of care.

Lead Agencies: DOJ, INS

Collaborating Agency: DOL

Start Date: FY 2002

Completion Date: Ongoing

a) Develop periodic communication between FBOP's contract team and the Federal TB Task Force to facilitate increased awareness of the agency's needs and role in the prevention and control of TB, based on CDC guidelines, in relation to contracting with external correctional facilities.

  • Lead: DOJ
  • Collaborator: None
  • Start Date: FY 2002
  • Completion Date: Ongoing

b) Assess pre-existing federal contracts to identify those which lack (1) sufficient content language to acquire the needed health care services that require screening, identification, evaluation, and treatment of TB disease and latent TB infection, and (2) criteria that will determine if appropriate services are fulfilled.

  • Lead : DOJ
  • Collaborator: DIHS
  • Start Date: FY 2002
  • Completion Date: Ongoing

c) Ensure ongoing coordination in the development of agency acquisition planning which supports the renewal, modifications, and/or initiation of contracts to obtain the needed TB health care services, consistent with current CDC TB guidelines and containing quality assurance provisions to evaluate the delivery of the services.

  • Lead: DOJ
  • Collaborators: DIHS, OSHA
  • Start Date: FY 2002
  • Completion Date: Ongoing

4. For Corrections - Establish networks and relationships with health departments and other key agencies (i.e., health care providers for the homeless, migrant centers, community-based organizations) to enable continuity of services and follow-up for prisoners and INS detainees upon release or parole.

Lead Agencies: DOJ, HRSA

Collaborating Agencies: DOJ, CDC, NTCA

Start Date: FY 2002

Completion Date: Ongoing

a) Identify barriers (geographic, technical, and legal) to patients treatment, health department access to essential health care records, and communication between corrections and health department staff.

  • Leads: FBOP, DIHS
  • Collaborators: NCHHSTP, D&R, NTCA
  • Start Date: FY 2002
  • Completion Date: Ongoing

b) Ensure TB continuity of care for prisoners leaving the correctional system and INS detainees leaving the detention system while still on treatment for TB or latent TB infection

  • Leads: FBOP, DIHS
  • Collaborators: NCHHSTP, D&R, NTCA
  • Start Date: FY 2002
  • Completion Date: Ongoing

5. For American Indians/Alaska Natives (AI/AN)-Provide training and education of health care workers and strive to maximize related cultural competency among health care workers who serve American Indians and Alaska Natives.

Lead Agency: IHS

Collaborating Agencies: HRSA, CDC, DOL

Start Date: FY 2003

Completion Date: Ongoing

a) Evaluate training needs of health care providers, mid-level practitioners, and public health staff. Identify most effective methods of delivering information.

  • Lead: IHS
  • Collaborators: NCHHSTP, NIOSH, BPHC, OSHA
  • Start Date: FY 2003
  • Completion Date: FY 2003

b) Based on results of step a) above, develop training modules and formal plan for disseminating training throughout IHS, tribal, and urban facilities serving AI/AN. Implement training in pilot sites to evaluate effectiveness.

  • Leads: IHS, NCHHSTP, NIOSH, BPHC, OSHA
  • Collaborator: None
  • Start Date: FY 2003
  • Completion Date: FY 2003

c) Fully implement national training plan for all IHS, tribal, and urban facilities serving AI/AN.

  • Lead: IHS
  • Collaborators: NCHHSTP, NIOSH, OSHA
  • Start Date: FY 2004
  • Completion Date: Ongoing

6. For American Indians/Alaska Natives—Disseminate information/education about systems of care and include AI/AN in education/ information dissemination.

Lead Agency: IHS

Collaborating Agencies: CDC, NTCA

Start Date: FY 2003

Completion Date: Ongoing

a) Identify most effective methods of delivering information.

  • Lead: IHS
  • Collaborator: NCHHSTP
  • Start Date: FY 2003
  • Completion Date: FY 2003

b) Collect, develop, and package information relevant to IHS, tribal, and urban health program practitioners.

  • Lead: IHS
  • Collaborator: NCHHSTP
  • Start Date: FY 2003
  • Completion Date: FY 2003

c) Disseminate information to IHS, tribal, and urban health program practitioners.

  • Lead: IHS
  • Collaborator: NCHHSTP
  • Start Date: FY 2003
  • Completion Date: Ongoing

7. For American Indians/Alaska Natives—Improve contacts between IHS providers and state TB control programs to make work complementary rather than competitive; identify and address gaps in services between IHS and public health agencies; and share assets.

Lead Agency: IHS

Collaborating Agencies: CDC, NTCA

Start Date: FY 2003

Completion Date: FY 2005

a) Evaluate effectiveness, using formal program reviews, of IHS/state TB control program interactions in each state with a sizable number of AI/ANs. Identify most effective methods of delivering information.

  • Lead: IHS
  • Collaborators: NCHHSTP, NTCA
  • Start Date: FY 2003
  • Completion Date: FY 2004

b) Address gaps in services identified above.

  • Lead: IHS
  • Collaborators: NCHHSTP, NTCA
  • Start Date: FY 2003
  • Completion Date: FY 2005

 

8. For American Indians/Alaska Natives - Provide tuberculin testing and related treatment for persons with diabetes.

Lead Agency: IHS

Start Date: FY 2003

Completion Date: Ongoing

a) Develop a plan to reach all IHS, tribal, and urban AI/ANs with diabetes. Secure adequate tribal and IHS consultation to ensure success of any plan implemented.

  • Lead: IHS
  • Collaborator: None
  • Start Date: FY 2003
  • Completion Date: FY 2005

b) Implement plan to test all IHS, tribal, and urban AI/ANs with diabetes for latent TB infection.

  • Lead: IHS
  • Collaborator: None
  • Start Date: FY 2003
  • Completion Date: Ongoing

c) Implement plan to treat all IHS, tribal, and urban AI/ANs with diabetes found to have latent TB infections that have not had documented adequate treatment.

  • Lead: IHS
  • Collaborator: None
  • Start Date: FY 2004
  • Completion Date: Ongoing

9. For persons who may move between localities, states and/or countries—enable tracking of TB-related health care records (including detainees, prisoners) among U.S. health departments and health care providers.

Lead Agency: CDC

Collaborating Agencies: HRSA, DOJ, USMS, INS, NTCA

Start Date: FY 2002

Completion Date: FY 2003

a) Review policies and processes for tracking TB-related health care records and convene a meeting of interested parties to develop comprehensive recommendations for tracking of TB-related health care records among U.S. health departments and health care providers.

  • Lead: NCHHSTP
  • Collaborators: DIHS, USMS, D&R, SITD, NCID, FBOP, NTCA
  • Start Date: prior to FY 2002
  • Completion Date: FY 2003

10. For INS detainees who are under treatment for TB, form a DHHS and DOJ workgroup to review policy issues that may improve the completion of TB treatment rates among detainees who are released before their treatment regimen is completed.

Lead Agency: CDC

Collaborating Agencies: HRSA, DOJ, USMS, INS, NTCA

Start Date: FY 2002

Completion Date: FY 2003

a) Review and analyze available data on INS detainees identified with active TB while in custody and review policies and practices that could be modified to help ensure that all INS detainees with TB who are released prior to completion of treatment actually have continuity of care and drugs to improve their chances for completing treatment for TB.

  • Lead: NCHHSTP
  • Collaborators: DIHS, USMS, D&R, SITD, NCID, FBOP, NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2003


11. For persons outside the U.S. - educate and train panel physicians and civil surgeons to ensure provision of quality service, and develop educational materials for immigrants and refugees under-going TB screening during the U.S. visa application process.

Lead Agency: CDC

Collaborating Agencies: DOS, DOJ, NTCA

Start Date: FY 2002

Completion Date: FY 2004

a) Develop and implement a multi-platform training program with training materials and modules to educate and train panel physicians and civil surgeons in the new Technical Instructions for screening for TB disease and latent TB infections.

  • Leads: NCID, NCHHSTP
  • Collaborators: AND, CA, NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2004


    1. After completion and approval of the TB component of the revised Technical Instructions, complete and finalize the print-based training modules for the revised instructions, new medical forms and worksheets, and specific clinical, radiologic, and laboratory training in the area of TB screening, diagnosis, and treatment.
      • Leads: NCID, NCHHSTP
      • Collaborators: CA, AND
      • Start Date: FY 2002
      • Completion Date: FY 2004


    2. Develop and implement a multi-platform educational program for immigrant visa applicants abroad, refugees, and adjustment-of-status applicants in the U.S. who are being screened by panel physicians and civil surgeons to ensure that they can clearly understand the objectives and benefits of the medical screening components of the examination and the importance and methods of follow-up evaluations and treatment options. This step should include development of educational material for immigrants and refugees undergoing TB screening by panel physicians and civil surgeons about their TB status, and their responsibilities, options, and benefits of follow-up and treatment in the U.S. Educational material will include written and videotaped materials in appropriate languages explaining the process in a non- threatening manner. Development will begin by focusing on high-prevalence countries that significantly impact on U.S. morbidity (Mexico, Philippines, Vietnam, China, Haiti, and India).
      • Leads: NCID, NCHHSTP
      • Collaborators: AND, CA, NTCA
      • Start Date: FY 2002
      • Completion Date: FY 2004

12. For persons born outside the U.S.—explore feasibility of targeted testing of immigrants, refugees, and selected groups of temporary visa holders.

Lead Agencies: CDC, DOS

Start Date: FY 2002

Completion Date: FY 2006

a) Explore the feasibility of targeted testing for latent TB infection among U.S. overseas visa applicants (i.e., immigrants) with plans for long-term U.S. residence by developing pilot studies in crucial regions of the world with high TB prevalence rates (as identified by WHO. Determine the most effective methods and sites for screening for tuberculosis and ensuring appropriate therapy.

  • Leads: NCID, NCHHSTP, CA
  • Collaborator: None
  • Start Date: FY 2002
  • Completion Date: FY 2005

b) Evaluate the feasibility of screening for TB disease and latent TB infection among selected groups of temporary visa holders.

  • Leads: NCID, NCHHSTP, CA
  • Collaborator: None
  • Start Date: FY 2003
  • Completion Date: FY 2006

13. For persons born outside the U.S. - determine the immigration status of foreign-born TB patients, how they came to medical attention, and how their cases may have been prevented; and develop follow-up recommendations.

Lead Agency: CDC

Collaborating Agency: NTCA

Start Date: FY 2002

Completion Date: FY 2004

a) Conduct a study of immigration status of foreign-born TB patients, how they came to medical attention, insurance coverage, and how their cases may have been prevented.

  • Lead: NCHHSTP
  • Collaborator: NCID
  • Start Date: FY 2002
  • Completion Date: FY 2003

b) Develop comprehensive recommendations for surveillance (including immigration status), recommended follow-up diagnostic evaluations, treatment, contact investigations, and prevention of TB in foreign-born persons.

  • Leads: NCHHSTP, NCID
  • Collaborator: NTCA
  • Start Date: FY 2003
  • Completion Date: FY 2004

14. For homeless populations - enable tracking of health care records between health department TB programs and health care providers.

Lead Agencies: HRSA, CDC

Collaborating Agencies: HUD, NTCA

Start Date: FY 2003

Completion Date: FY 2004

a) Evaluate outcomes of treatment completion, contact investigation, and treatment of latent TB infection in selected homeless populations.

  • Lead: BPHC
  • Collaborators: NCHHSTP, HUD, NTCA
  • Start Date: FY 2002
  • Completion Date: FY 2004

 

 

15. For homeless populations - ensure that homeless persons have access to low- or no-cost skilled TB-related screening, treatment, and prevention services provided by culturally competent providers.

Lead Agencies: HRSA, CDC

Collaborating Agencies: HUD, NTCA

Start Date: FY 2002

Completion Date: Ongoing

a) Evaluate outcomes and cost effectiveness of targeted tuberculin skin test activities and completion of treatment of latent TB infection in selected homeless populations.

  • Lead: BPHC
  • Collaborators: NCHHSTP, HUD, NTCA
  • Start Date: FY 2002
  • Completion Date: Ongoing

 

16. For homeless populations - provide incentives to homeless persons to ensure completion of treatment for latent TB infection.

Lead Agencies: HRSA, CDC

Collaborating Agencies: HUD, NIH, SAMHSA, NTCA

Start Date: FY 2003

Completion Date: Ongoing

a) Provide housing as an incentive.

  • Leads: NCHHSTP, HUD
  • Collaborators: BPHC, NTCA
  • Start Date: FY 2003
  • Completion Date: Ongoing

b) Reduce barriers for homeless persons to substance abuse treatment and relapse prevention programs.

  • Leads: NIDA, SAMHSA
  • Collaborator: NCHHSTP, NTCA
  • Start Date: FY 2003
  • Completion Date: Ongoing
 
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