TB Notes, Updates from CDC's Division of Tuberculosis Elimination


TB Notes 2, 2023

Notes from the Director

Dr. Philip LoBue, Director and Susan McLure, Associate Director for Policy

Dear Colleague,

This quarter provided several opportunities for the Division of Tuberculosis Elimination (DTBE) to collaborate and connect with partners and colleagues.

In April, CDC held the first TB Program Managers’ Course since 2019, welcoming over 50 TB program managers, nurse consultants, public health advisors, and TB controllers who have program management responsibilities. In May, the Tuberculosis Trials Consortium held their Spring Meeting.

Last week, several CDC staff attended the National TB Conference. The theme, “Partnership, Innovation, and Equity” highlights the importance of continued partnerships to ensure innovative and equitable solutions to eliminate TB. It was a pleasure to connect with friends and colleagues during the conference.

In addition to courses and conferences, DTBE has also been working with partners on several important issues for TB programs.

In May, CDC released updates to the 2022 “Provisional CDC Guidance for the Use of Pretomanid as part of a Regimen [Bedaquiline, Pretomanid, and Linezolid (BPaL)] to Treat Drug-Resistant Tuberculosis Disease. The U.S. Preventive Service Task Force (USPSTF) published a final recommendation statement and evidence summary on screening for latent TB infection in adults. The USPSTF recommendation statement and evidence summary were published in JAMA. Resources for providers, including the updated USPSTF statement, can be found on CDC’s Latent TB Infection Resource Hub.

Lastly, we know that many of you are experiencing challenges with drug shortages and supplies due to multiple factors. I encourage you to read the recent Dear Colleague Letters from the Field Services Branch and Laboratory Branch for more information. Remember to keep your CDC Project Officers informed about drug shortages.

These are just a few highlights from our work over the past quarter. I invite you to read further for additional news and resources from across DTBE.

Thank you for your continued efforts towards our goal of TB elimination.
Philip LoBue, MD, FACP, FCCP
Division of Tuberculosis Elimination
National Center for HIV, Viral Hepatitis, STD, and TB Prevention

American Thoracic Society Conference

DTBE Associate Director of Science Dr. Carla Winston sponsored a session titled “Updates from the Centers for Disease Control and Prevention: Tools for Clinicians” at the May 2023 American Thoracic Society Conference. The goals of the session were to help clinical providers and researchers to identify local populations among whom tuberculosis and chronic pulmonary disease risk is highest, to better understand demographic differences in risk within their local area, to communicate effectively with patients, and to use updated approaches to treatment and medication adherence.

Speakers included Drs. Susan Carlson and Kathy Watson from the CDC’s Division of Population Health within the National Center for Chronic Disease Prevention and Health Promotion presenting data tools for state and local estimates for chronic obstructive pulmonary disease, and Drs. Nick DeLuca and Joan Mangan from DTBE presenting the Think.Test.Treat TB campaign and video directly observed therapy recommendations.

American Thoracic Society Conference American Thoracic Society Conference

Submitted by Carla Winston, PhD

DTBE Welcomes Dionicia Rodriguez

DTBE would like to welcome Ms. Dionicia Rodriguez, now serving as the Division’s Program Resource Manager. In this role she will provide leadership for the planning, execution, and closeout of the Division’s budget. Dionicia comes to CDC with extensive experience in financial management and oversight. She spent the past year working as a financial manager with the Joint Chiefs of Staff Directorate of Management, working closely with program managers and leadership to develop long-range plans and budget estimates. Prior to that, she spent several years working for the Department of Defense in multiple financial management roles, including Business Financial Manager for the Department of Navy Strategic Systems Programs and Supervisory Program Analyst for the Army Corps of Engineers.

Submitted by Kathryn Koski, MSEd, MPH

Tuberculosis Trials Consortium (TBTC) Spring Meeting

Tuberculosis Trials Consortium

The TBTC Spring Meeting was held from May 15 -17, 2023, in Atlanta, Georgia at Emory University’s Rollins School of Public Health. In addition to general sessions, the meeting included a TBTC Study Coordinators Forum and a TBTC Laboratory Forum.

Submitted by Carla Jeffries, JD, MPH

Think. Test. Treat TB Campaign

Think. Test. Treat. TB Campaign

The Think. Test. Treat TB Campaign continues to raise awareness about TB prevention. Free campaign resources are available for TB programs and healthcare providers. You may see the Think. Test. Treat TB message in outlets such as Medscape, Bulletin Health, and on LinkedIn. DTBE hosted an exhibit with materials and information about the campaign at the National Tuberculosis Conference.

Submitted by John Parmer, PhD

TB Program Managers’ Course

TB Program Managers’ Course

DTBE hosted the TB Program Managers’ Course in Atlanta on April 11-14. This is the first time the course has been held since 2019. The TB Program Managers’ Course is designed for TB program managers, nurse consultants, public health advisors, and TB controllers who have program management responsibilities. Historically, the course enrolled about 30 participants each year, but this year the course had a total of 54 TB program managers from state and big city TB programs, as well as approximately 20 observers from DTBE.

Sessions from the course included Cohort Review, Contact Investigations, and A Program Manager’s Role in TB Elimination. The course highlighted practical ways to plan, manage, and evaluate TB programs. Participants were able to demonstrate these important skills during session exercises.

Karen Reyna, a TB survivor from We Are TB who is also featured in DTBE’s Personal Stories project, was invited to share her story. Karen’s heartfelt recounting of her illness and recovery from TB helped underscore the importance of the work of TB program managers. In a course that was filled with many firsts, participants also had the opportunity to tour the David J. Spencer CDC Museum and learn more about CDC’s history and accomplishments.

Submitted by Coralis Rodriguez Morales, MPH, Carissa Sera-Josef, MPH, and Peri Hopkins, MPH

DTBE Releases Targeted Testing Report

DTBE’s Program Evaluation and Health Economics Team released the 2020 Targeted Testing Report for TB, the first report describing targeted testing efforts in the United States. Targeted testing is used to identify and treat persons infected with M. tuberculosis and is a key strategy for reducing morbidity and mortality from TB disease. Identifying and treating persons who have latent TB infection is important as an estimated 80% of U.S. TB cases are believed to be the result of longstanding, untreated latent TB infection.

TB programs are able to report results of their targeted testing activities to CDC by entering the data into the Aggregate Reports for Tuberculosis Program Evaluation form through the National Tuberculosis Indicators Project (NTIP) performance-monitoring tool. Beginning in 2020, CDC-funded state and city TB programs with ≥150 TB annual cases are required to submit results of targeted testing in their jurisdictions. To learn more and explore the tables, please see the published report.

TB programs can review their targeted testing data through the NTIP performance-monitoring tool and compare them with the national averages. CDC staff are available to provide technical assistance to programs interested in designing and implementing strategies to improve targeted testing performance.

Submitted by Rachel Woodruff, MPH and Erin Thomas, PhD

Provisional CDC Guidance for the Use of Pretomanid as part of a Regimen [Bedaquiline, Pretomanid, and Linezolid (BPaL)] to Treat Drug-Resistant TB Disease

Bedaquiline, Pretomanid, and Linezolid (BPaL)

In May, CDC released updates to the 2022 “Provisional CDC Guidance for the Use of Pretomanid as part of a Regimen [Bedaquiline, Pretomanid, and Linezolid (BPaL)] to Treat Drug-Resistant Tuberculosis Disease.” Updates include:

  • A recommendation for an initial linezolid dose of 600 mg when using the BPaL regimen in the treatment of adults,
  • Additional information about adverse events, and
  • References to studies that were published after the initial release of the guidance.

We encourage healthcare providers, pharmacists, and public health professionals to review the updated provisional guidance. When drug-resistant TB is suspected or confirmed, providers should consult a TB expert physician. Healthcare providers can contact state and local TB control offices and TB Centers of Excellence for Training, Education and Medical Consultation for additional information on diagnosing and treating drug-resistant TB disease.

Submitted by Terry Chorba, MD, MPH, DSc

New Online Course: Understanding TB Laboratory Testing for Public Health Nurses

In collaboration with the Association of Public Health Laboratories (APHL) and contracting media company, Mind & Media, the DTBE Laboratory Capacity Team helped design and develop a new online course, “Understanding Tuberculosis (TB) Laboratory Testing for Public Health Nurses”.

This course was created for public health nurses who collect specimens for TB testing and are responsible for reported TB laboratory results; content may also be helpful to clinicians and other providers/submitters. The course will help participants better understand TB laboratory testing workflow, testing methods, and associated results. Being familiar with this information will aid effective and timely communication with the patient, clinician, and testing laboratory.

Content development and review was provided through collaboration with TB Care and Prevention Experts, the CDC Centers of Excellence at the Global Tuberculosis Institute Rutgers – The State University of New Jersey, and the National Tuberculosis Controllers Association.

Congratulations to all who worked on this web-based training module. The course and Mind & Media recently won an Award of Excellence through The Communicator Awards, a leading global awards program honoring creative excellence for marketing and communications professionals.

Submitted by Monica Youngblood, MPH, M(ASCP)

Return of the Mycobacterium tuberculosis: Diagnostic Principles and Procedures Workshop

Lab workers

The DTBE Laboratory Branch is excited to announce the return of the annual “Mycobacterium tuberculosis: Diagnostic Principles and Procedures” workshop in December 2023. Co-hosted with Association of Public Health Laboratories, the week-long course is intended primarily for public health laboratories that perform TB diagnostic services. Didactic lectures and hands-on exercises are used to discuss and compare state-of-the-art MTBC molecular and growth-based test methods for detection, isolation, identification, and drug susceptibility testing. More information to be released soon!

Submitted by Monica Youngblood, MPH, M(ASCP)

Announcing New Laboratory Branch Deputy Branch Chief

Dr. Joan Mangan joined the Laboratory Branch as the new Deputy Branch Chief on April 20th. Joan previously worked in the DTBE Communications, Education, and Behavioral Studies Branch (CEBSB).

Joan Mangan

She began her career as a medical technologist in Ft. Lauderdale, Florida while earning a Master of Science in Teaching Biological Sciences, with a focus on immunology, virology, and genetics. She then served as Regional Laboratory Manager at a medical center, before pursuing her doctorate at the University of Alabama at Birmingham (UAB), School of Public Health. Following graduation Joan joined as faculty in the UAB School of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine – Lung Health Center as an Assistant Professor, and later the Department of Medicine, Division of Infectious Disease at the University of Florida as a Research Assistant Professor. Her laboratory background benefitted a number of projects and contributed to the establishment of sputum microscopy services in three prisons in Honduras, and quality improvements of laboratories within TB sanitoriums in Kazakhstan.

Since joining DTBE in September 2011, Joan has continued to capitalize on her training in both laboratory science and health behavior while working with colleagues across the Division and external to CDC.

Submitted by Monica Youngblood, MPH, M(ASCP)

Annual Epidemic Intelligence Service (EIS) Conference

Group of EIS Conference attendees

The annual EIS conference was held from April 24-27, 2023, in Atlanta, Georgia. EIS officers engaged in professional networking sessions, recognition ceremonies, and various learning opportunities.

This year, DTBE had two EIS officers present their work at the conference. DTBE’s first year officer, Kimberly Schildknecht, presented her analysis of TB and End-Stage Renal Disease. DTBE’s second year officer, Dan Filardo, presented on an investigation of a TB outbreak in rural Arkansas.

Submitted by Rebekah Stewart, MSN, MPH, FNP

National TB Conference

The 2023 National TB Conference (NTC) was held in Atlanta, Georgia, from June 12 – 15, 2023. This year, the National TB Conference was held in conjunction with the Association of Public Health Laboratories’ (APHL) 13th National Conference on Laboratory Aspects of TB. The co-location of these two TB-focused conferences and audiences provided an opportunity to explore recent advances in diagnostics and reconfirm the important collaborations between public health laboratories and TB public health programs. The theme of the 2023 National TB Conference was “Partnership, Innovation and Equity.”

2023 National TB Conference

TB Elimination Alliance Panel at NTC

During the 2023 National TB Conference, the TB Elimination Alliance (TEA) hosted a special panel discussion about the importance of community partnerships. The panel explored ways to strengthen relationships to work towards TB elimination in communities at higher risk. In addition, participants discussed how to strengthen partnerships and how to use resources from CDC’s Think. Test. Treat TB campaign. TEA grantees shared promising practices and lessons learned from partnerships with local health departments and TB controllers. Visit the TEA website to learn more about ongoing activities.

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Oeltmann JE, Vohra D, Matulewicz HH, DeLuca N, Smith JP, Couzens C, Lash RR, Harvey B, Boyette M, Edwards A, Talboy PM, Dubose O, Regan P, Loosier P, Caruso E, Katz DJ, Taylor MM, Moonan PK. Isolation and quarantine for COVID-19 in the United States, 2020–2022. Clin Infect Dis 2023. Epub ahead of print.

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Scott NA, Sadowski C, Vernon A, Arevalo B, Beer K, Borisov A, Cayla JA, Chen M, Feng PJ, Moro RN, Holland DP, Martinson N, Millet JP, Miro JM, Belknap R. Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine. Contemp Clin Trials 2023:107173. Epub ahead of print.

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Kurbatova EV, Phillips PP, Dorman SE, Sizemore EE, Bryant KE, Purfield AE, Ricaldi J, Brown NE, Johnson JL, Wallis CL, Akol JP, Ocheretina O, Van Hung N, Mayanja-Kizza H, Lourens M, Dawson R, Nhung NV, Pierre S, Musodza Y, Shenje J, Badal-Faesen S, Vilbrun SC, Waja Z, Peddareddy L, Scott NA, Yuan Y, Vernon A, Goldberg SV, Swindells S, Chaisson RE, Nahid P; AIDS Clinical Trials Group and the Tuberculosis Trials Consortium. A standardized approach for collection of objective data to support outcome determination for late-phase TB trials. Am J Respir Crit Care Med 2023. Epub ahead of print.

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