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Task Order 6: Regional capacity-building in low-incidence areas

Task Order 6 focuses on developing, implementing, and evaluating regional tools for TB control and elimination in low-incidence areas. The study is being implemented through the Francis J. Curry National Tuberculosis Center of the University of California, San Francisco (UCSF), and involves collaboration with Principal Investigators from Denver (Chuck Daley, Randall Reves) and Seattle (Charlie Nolan), and with the state TB control programs in Idaho, Montana, Utah, and Wyoming. Each of these states has differing TB epidemiology and TB control program structure but they share the common challenge associated with maintaining TB control program and clinical expertise in the context of low TB incidence and few resources. Task Order 6 has developed regional interventions that were prioritized through a consensus process that involved the four low-incidence states as well as the many TO 6 partners.


Utah, Montana, Wyoming, Idaho.

Study Objectives

  1. 1. Conduct a programmatic needs assessment of TB programs in selected low incidence states (Utah, Montana, Wyoming, Idaho)
  2. Develop and implement regionally-based interventions that address identified priority needs using the program needs assessment.
  3. Evaluate the interventions to determine which are most effective in improving program performance and accelerating progress towards TB elimination.
  4. Based on the evaluation, develop a model of best practices that be replicated in other low incidence areas. This model will be developed using a regional approach that takes into account the individual states’ needs.

Study Design

A public health intervention design was used. Program needs were assessed through self-administered and interview surveys of state public health staff involved in TB control. Decisions to identify priority interventions, and the implementation of these, were made in close collaboration with all stakeholders. Evaluation plans were created and followed using the CDC Framework for Public Health Evaluation.

Study Progress

Task Order 6 has completed the following regional interventions: short audio course on the medical management of TB; a regional outbreak response plan template; regional assessment of TB surveillance systems; surveys of laboratory mycobacteriology practice and reporting; trainings for laboratorians performing mycobacteriology services; trainings, modified for low-incidence settings, for local field-staff, in case management and contact investigation; and a customizable TB manual template that is a “how-to” guide for public health practitioners. A regional TB elimination plan is being developed to describe the core requirements of staff and resources necessary to perform TB control activities and move towards TB elimination in a low-incidence area. Additionally, a regional surveillance intervention is being implemented to answer the question: What are the programmatic improvements that result from routine review of genotyping and epidemiological data across the region? This intervention involves the implementation of a regional coordinator role, and tools for using genotyping and surveillance data to identify potential region-wide outbreaks and to inform strategic program planning and program evaluation. Evaluation of the TB manual template is underway; a baseline survey was conducted in ID and MT to determine the TB information-seeking practices of local public health practitioners, and their confidence in using the information to perform TB control and patient management activities. The TB manual template was customized to create a state-specific manual in the states of MT and ID. A follow-up survey will be implemented six months post-dissemination of these state-specific manuals. A manuscript has been submitted.

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