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Dear Colleague:Welcome to our third edition of the Regional

Training and Medical Consultation Consortium’s(RTMCC) Northeastern Spotlight. We are excitedto highlight some of the many quality andinnovative activities – both training and medicalconsultation – occurring in our region.

On September 19-20 the Northeastern RTMCChosted its first TB Medical Consultants Meeting inNewark. Twenty-one medical consultants from 18TB programs attended the meeting. The primarygoal of the workshop was to provide a networkingopportunity to TB medical consultants from TBprograms throughout the Region, to acquaint themwith the latest guidelines for managing TB andLTBI, and to build capacity for appropriatelyresponding to typical and challenging requests forTB medical consultation. By all accounts, themeeting was a resounding success, and I encourageyou to read the article in this issue which describessome of the highlights.

If you have any feedback for us, I invite you tocontact me or a member of the RTMCC staff at(973) 972-3270. Lee Reichman, MD, MPHExecutive DirectorNortheastern RTMCC and the GlobalTuberculosis Institute

NORTHEASTERNSPOTLIGHTFALL= 2006 VOLUME 1 • NUMBER 3

INSIDE:RTMCC Hosts Its First TB Medical Consultants Meeting . . . . . . . . . . . . . . . . . . 2Staff Profile: Nikki Pritchett, MPH . . . . . . . . . . . . . 4New Hampshire’s Customized Efforts. . . . . . . . . . . . 6An Ohio/RTMCC Training Collaboration . . . . . . . . 7QuantiFERON-TB Gold Education . . . . . . . . . . . . . 8What’s New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Upcoming Training Courses . . . . . . . . . . . . . . . . . . 10Audio/Web Archives . . . . . . . . . . . . . . . . . . . . . . . 13Links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

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225 Warren Street, Newark, NJ 07101-1709 (973) 972-3270 www.umdnj.edu/globaltb

The Northeastern Regional Training and Medical Consultation Consortium is a collaborative effort of the Charles P. Felton National TuberculosisCenter at Harlem Hospital, the Massachusetts Department of Public Health, Division of Tuberculosis Prevention and Control, and the NJ MedicalSchool Global Tuberculosis Institute and provides training, technical assistance, and medical consultation to health care professionals throughoutthe Northeastern United States.

RTMCC Communications Sub-Committee: Bill Bower, MPH • Chris Hayden • Erin Howe, MPHNewsletter design by Judith Rew

We would like your feedback…please let us know what you think of this newsletter, future newsletter ideas, and/or article contributions you wish tomake. Send an email to Chris Hayden, Newsletter Editor at haydench@umdnj.edu. Thanks!

NORTHEASTERN RTMCC TB PROJECT AREAS

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The Northeastern RTMCC is taskedby the CDC with strengtheningmedical consultation in theNortheastern Region. Last year’sRTMCC needs assessment revealedthat nearly all TB programs have theirown well functioning medicalconsultation systems in place. However,many areas indicated that the RTMCCcould help develop and enhancemedical consultation capacity through:

• Identifying and building a networkof consultants within the region toshare expertise

• Providing continuing medicaleducation, so consultants remain upto date on new guidelines andenhance expertise on complex issues

• Expanding and enhancing trainingopportunities for communityproviders

• Developing a system of trackingmedical consultations for projectarea use

To help build this capacity, theRTMCC held a TB MedicalConsultants Meeting September 19-20,2006 in Newark. Twenty-one medicalconsultants from 18 TB programsattended the meeting. The primary goalof the workshop was to provide anetworking opportunity to TB medicalconsultants from TB programsthroughout the Region, to acquaintthem with the latest guidelines formanaging TB and LTBI, and to buildcapacity for appropriately responding totypical and challenging requests for TBmedical consultation.

The meeting commenced with adinner on September 19, followed by apresentation by Dr. John Sbarbaro,Professor of Medicine at the Universityof Colorado School of Medicine onEngaging Primary Care Providers in theDiagnosis and Management of TB. Inthis spirited and highly interactivesession, Dr. Sbarbaro challenged

participants to consider basic principlesthat motivate physician behavior andto exploit these in designingapproaches to reach and influencecommunity providers who servepopulations with or at risk for TB.

Dr. Lee Reichman, ExecutiveDirector of the Global TB Institute, ledoff the next morning’s program with apresentation summarizing the findingsand recommendations of the RTMCC’smedical consultation needs assessmentconducted last year. He then gave anoverview of the RTMCC’s currentmedical consultation system (the TBInfoLine), characteristics of TBInfoLine calls received during the first6 months of 2006, and plans forevaluation. Next, Dr. Philip LoBue,Chief of the Medical ConsultationTeam at CDC’s Division ofTuberculosis Elimination, guided

participants on a well-organized,concise whirlwind tour of What’s Newin the TB Guidelines (9 total) thathave been published recently. Tocomplement this talk, the RTMCCprovided participants with hardcopiesand a CD-ROM of these guidelines andother Core TB Resources for reference.In his presentation, ImprovingCommunication with CommunityProviders and Among MedicalConsultants, Dr. Bernardo, TB Control

Officer for Massachusetts, summarizedthe results of an in-depth needsassessment conducted amongcommunity providers in Massachusettsand how the state has used these resultsto develop and implement training andmedical consultation interventions.

These talks were followed by two in-depth case presentations withdiscussion. First, Dr. George McSherry,Associate Professor of Pediatrics, NJMedical School, described an outbreakin a daycare center in which ninechildren developed TB within sixmonths of exposure. Throughout thepresentation, Dr. McSherry highlightedcommon errors and missedopportunities in the identification,treatment, and management of TBcases among children and how thesemight be prevented through effectivemedical consultation. Then Dr.Reynard McDonald, Medical Directorof the GTBI, presented a case whichillustrated the challenges andappropriate approaches in diagnosing,treating, and managing patients withMDR-TB.

In the next session, participantswere divided into four groups and eachgroup was given a typical case scenario(e.g., a community physician

RTMCC Hosts Its First TB Medical Consultants Meeting

continued on next page

Dr. Sbarbaro challengedparticipants to consider basicprinciples that motivatephysician behavior and toexploit these in designingapproaches to reach andinfluence community providerswho serve populations with orat risk for TB.

Dr. Lee Reichman

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prescribing an in appropriate drugregimen) and asked how they wouldrespond. Following a brief discussion ofthe appropriate clinical recommenda-tions, the group facilitator askedparticipants to address several issues orchallenges in providing consultation forthe case. For example, questions dealtwith how to deal with potential defen-siveness on the part of the communityphysician, how to ensure that sufficientinformation has been obtained to makeappropriate recommendations, andwhat to do if the physician chooses toreject recommendations. The processstimulated lively discussion andconcluded with each group giving asummary presentation to all partici-pants.

In the last formal presentation, Dr.Alfred Lardizabal Assistant Professor ofMedicine, NJ Medical School, spokeon Strengthening ConsultationCapacity through Medical EducationOpportunities. Following a summary oftraining courses, products, technicalassistance, and mini-fellowships likelyto be of interest to medical consultants,Dr. Lardizabal described the RTMCC’splans to conduct a series of Region-

wide web-based discussions of complexcases. All project areas will beencouraged to particip ate and will beprovided opportunities to present cases.The RTMCC will broadcast thewebinars, provide a template andtechnical assistance for developing casepresentations, and arrange for CME

credits. At the end of the meeting, Dr.Reichman led a discussion on otherways to strengthen consultationcapacity. There was overwhelmingconsensus that a similar type ofmeeting should be held next year.

In their evaluations, participantsrated the meeting as “very useful” andrelevant to their role as a TB medicalconsultant and indicated that theyespecially valued the networkingaspects of the meeting. All of the

participants “agreed” or “stronglyagreed” that the objectives of themeeting were met and all indicatedthat they would recommend this typeof meeting to other TB medicalconsultants. To improve futuremeetings for consultants, participantsrecommended increased time fordiscussion after presentations as well asmore detailed discussions on a varietyof topics, such as QuantiFERON-TBGold, managing drug resistance, newTB guidelines, genotyping, x-rayinterpretation, and communicatingeffectively with primary care providers.Some providers also indicated that theywould have liked the opportunity topresent difficult cases from theirprogram areas.

In December, a brief on-line followup survey will be sent to participants tohelp assess the impact of the meetingand provide direction on how theRTMCC can further assist instrengthening their role as medicalconsultants.

Submitted By Chris HaydenConsultant, Evaluation ActivitiesNortheastern RTMCC

Consultants continued from previous page

Dr. Lardizabal described theRTMCC’s plans to conduct a series of Region-wide web-based discussions ofcomplex cases.

TB Trivia - Who is it?What nineteenth century American writer who inspiredgenerations of naturalists and civil rights activists died oftuberculosis at the age of 44? Though he was well knownin literary circles in his hometown of Concord,Massachusetts, he only gained widespread acclaim yearsafter his death.

For the answer, click onhttp://www.poets.org/poet.php/prmPID/601

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Each TB control program funded by theCDC has a designated ‘training focal point’– but these people usually have other rolesbesides training. What is it like being desig-nated as training focal point in a big city?How do you balance the rest of your job withthe training responsibilities? Let’s visitPhiladelphia and find out.

Originally from Delaware, NikkiPritchett, MPH says she “wanted to staylocal while working in a large, urbanarea with an underserved population.”Consequently, she chose Philadelphiaand has been contributing in many waysto the success of its Department ofPublic Health Tuberculosis ControlProgram. Nikki finds that a career inpublic health combines her professionalcommitments. “I have always wanted toserve disadvantaged populations, and Ihave always had a great interest inhealth. Public health fused my twointerests together.” Her primary interestwas in infectious diseases that have

social and behavioral dimensions, suchas sexually transmitted diseases and TB.Since she had already worked in theSexually Transmitted Disease Program atthe Philadelphia Health Department,she was eager to gain experience in TBwhen she joined this program in 2004.

During her two years in TB Controlshe has helped develop, coordinate, andevaluate several programmatic activities.This has involved her in overseeingcontact investigations, assisting withconducting extended contact

Staff Profile: Nikki Pritchett, MPHCity of Philadelphia Department of Health TB Control BureauBig City Training Focal Point

investigations, analyzing data for cohortreview and other research projects. Shealso writes and edits a quarterlynewsletter for staff of the city’s TBcontrol program. Clearly, “educationand Training Focal Point” is only one ofthe many roles she fulfills.

CONTACT INVESTIGATIONSNikki is involved in oversight of all

contact investigations and expandedfield investigations in Philadelphia. Sheworks closely with the teams that dothis, even though she is not always outthere in the field finding people anddoing the interviews herself. Togetherwith Disease Surveillance SupervisorTony Lloyd, she makes sure that staffappropriately prioritize contacts, planhow best to approach them, ensure theirmedical evaluations if TST positive, andfollow up until treatment for LTBI iscompleted. Sometimes she does assist inthe field work herself, as part of theteam. Listening to the front line staff isNikki’s greatest source of inspiration; sheworks together with the team to solveevery day problems and occasionalcrises, learning what is needed and howto make things work. It is also a chanceto identify training needs and develop continued on next page

skills-based training that will buildteamwork and help staff to be moreeffective.

COHORT REVIEWFor over a year Philadelphia has been

using cohort reviews to assess outcomesof treatment completion and contactinvestigations. Under the leadership ofProgram Director Barry Dickman, MPAand CDC Public Health Advisor DanDohony, MPH, the TB Control Programhas embraced this process – finding thatit builds teamwork and improvesperformance. Each quarter, Dangenerates a list of TB patients reportedin a previous 3-month cohort. Then thecase managers and supervisors reviewthe cases for completeness, before theyprepare short presentations of theoutcomes for each case and contact.These are reviewed together at aquarterly meeting. As the Director callseach case, the case manager presents it,and Medical Director DavidSchlossberg, MD, adds his perspective.The case manager also summarizesinformation about the contactsidentified, tested, evaluated, and treated.Nikki pays close attention, verifying

Listening to the front line staffis Nikki’s greatest source ofinspiration; she workstogether with the team tosolve every day problems andoccasional crises, learningwhat is needed and how tomake things work.

Nikki Pritchett (seated) with Jennifer Beck, TB Program Intern.

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day?” patients often end up namingmany more people. So she translatesthese findings into training by teachingdisease control investigators to use themore effective question and follow upwith probes to elicit more contacts.

In this Genotyping Project theinterviewers also ask about how peoplethink they got TB. Most people answerin one of two ways: they say the got itfrom ‘so-and-so’, naming a person whohad infectious TB from whom theythink they got it – or they think they

got it from the cold or from being out inthe rain. The first group is correct, thesecond group could benefit from patienteducation that starts with what theyknow and builds on that. That’s asubject for another staff training!

Nikki has also used her epidemiologyexpertise to analyze data onhepatotoxicity among patients takingtreatment for LTBI and 4-drugtreatment for TB disease. ThePhiladelphia Department of PublicHealth recently submitted a manuscripton this topic for journal publication.

NEWSLETTERNikki took the initiative to produce

a quarterly newsletter for city TBcontrol staff. So far, two issues havebeen released. Nikki coordinatesproduction, getting colleagues to writesome articles and writing some herself.The most recent issue features articlessuch as “All about contactinvestigations,” “Preventing future TBcases,” “A TB case on an airplane

Staff Profile continued from page 2

that the spreadsheet used to track thecohort is up to date, tallying any newinformation, and listing occasional issuesfor follow up. At the end of the meeting,she calculates the cohort’s outcomes tocompare with national and localobjectives. Steady improvement has beenthe name of the game, and the staff cansee their own results. For the Philadelphiateam, the cohort review represents a bigimprovement over the lengthy casereview process which was used in the past.

From October 18-19, 2006, togetherwith the RTMCC, the program hosted acourse on The TB Cohort ReviewProcess for 13 participants from aroundthe US, Canada, and Guam. As one ofthe main instructors, Nikki introducedthe elements of the process and ledexercises in entering data, analyzingresults, and making reports on theoutcomes.

TRAININGIn the past year, Nikki has organized

two training courses for about ten TBControl staff members. One was areplication of training on contactinvestigation that she and a colleaguehad attended at the NortheasternRTMCC. The second was an in-depthexercise on work prioritization, alsofrom the NJMS Global TB Institute.Both courses were successful in gettingstaff together, building teamwork, anddeveloping skills they can applyimmediately in their work.

RESEARCH FINDINGS AFFECTTRAINING

As an epidemiologist, Nikki is ofcourse involved in research, but shefinds that this can have interesting,immediate application to training andeveryday TB control efforts. Forexample, the Genotyping Projectincludes in depth re-interviews ofpatients about their contacts. She findsthat how a question is asked can lead tovery different answers. When asked“Who do you spend most time with?”patients list only a few names. Whenasked “Where do you go during the

flight,” “TB among New Orleansevacuees,” and “An outbreak in aPhiladelphia day care setting.”

She explains that “eventually, I hopeto increase community outreach,particularly in the foreign-bornpopulation. Currently, we have anintern working with recent Mexicanimmigrants in order to identify keycontacts in the community and to gainan understanding of their healthcarebeliefs and practices.” That is whycultural competency is the main topicfor the next issue of the newsletter.

An additional goal is “to facilitatebetter communication with privatephysicians and hospitals. The quarterlynewsletter is an attempt at making thisconnection; it is intended to be apractical resource for clinicians, infectioncontrol personnel, and laboratories whodiagnose, treat, and/or report TB.”

TIPS FOR TRAINING FOCALPOINTS

How can a busy training focal pointkeep training efforts relevant to localneeds? Nikki’s advice is to “Listen to thefield staff. They are on the frontline andcan provide the most insight into wherethe training needs are in regards to bothpatients and staff.” In addition, she staysabreast of new guidelines andrecommendations by using a variety ofsources: researching articles for thenewsletter, CDC’s website, conferences,and emails from other staff members.

Nikki admits that “the greatesthighlight (of my public health career)has been working with a team ofdedicated, knowledgeable, andcompassionate workers.” Don’t we allwish for that!

Nikki, we wish you the best of luckin all of your efforts – and the same toall of the training focal points in theNortheast Region.

Submitted by Bill Bower, MPHDirector of Education and TrainingCharles P. Felton National TuberculosisCenter

How can a busy training focalpoint keep training effortsrelevant to local needs?Nikki’s advice is to “Listen tothe field staff. They are on thefrontline and can provide themost insight into where thetraining needs are in regardsto both patients and staff.”

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An Expanded Needs Assessment: New Hampshire’s Customized Efforts to Improve Education & Training

An integral part of successfuleducation and training programs isdetermining the appropriate audienceand planning programs relevant to theirwork. The Northeastern RTMCC’sneeds assessment process began togather this information by surveyingend-users of training, education andmedical consultation services. Byparticipating in this process, NewHampshire state TB program staff saw afuture opportunity to gain informationabout health care providers in theirstate. They modified the NortheasternRTMCC’s survey to reflect the uniqueprogram structure in their project areawhich consists of a centralizedorganization with no county healthdepartments, clinics or outreachworkers. Private providers diagnose andtreat active and latent tuberculosis(TB), and case management isconducted through the state and twolocal public health departments. NewHampshire has the twelfth lowest TBcase rate in the United States, and hashad an average of nineteen cases peryear over the last fifteen years.

In modifying the end-user survey,New Hampshire’s Evaluation WorkGroup identified two objectives toaddress: program evaluation andeducation and training. They decided totarget private providers (physicians(MDs), physician assistants (PAs), andnurse practitioners (NPs) in the fourhighest incidence counties of the statewith specialties in family practice,internal medicine, pediatrics, infectiousdisease (ID), and pulmonology.Providers could respond using an onlinesurvey tool (Zoomerang), mail or fax.398 completed surveys were receivedfrom a total sample of 1,230 for aresponse rate of 32%. Responses wereentered into Zoomerang and analyzed inEpi-Info 2004. Provider satisfaction andtraining needs were analyzed inaggregate and by provider specialty.

The majority of respondents’ primarywork setting was private practice (76%),

with significant but smaller percentagesfrom community health centers (7%)and hospitals (8%). Seventy percent ofrespondents were MDs, 20% were PAsand 88% were NPs. In the past five years,more than half (64%) of respondentsencountered 1-10 cases of LTBI, while31% saw 1-10 cases of active TB.Twenty-two percent of respondents hadnot encountered a case of LTBI and68% had not seen a case of active TB.

Ninety-five percent of surveyedproviders who had sought information/consultation or assistance (e.g., payingfor TB drugs) from the New Hampshire

TB (NHTB) program were highlysatisfied with the quality of services theyreceived. Topics most frequentlyaddressed by the NHTB program wereappropriate candidates for treatment ofLTBI, treatment regimens, and financingTB medications. The survey revealedthat 64% of respondents had neversought information/consultation fromthe NHTB program, while 53% hadnever sought assistance. When askedwhy they were not accessing the NHTBprogram for information, consultation orassistance the three top responses werethey were: unaware of the program, hadno TB patients or utilize an ID consult.

Top training needs identified bysurvey respondents overall included:treatment regimens for active TB diseaseor latent TB infection, multi-drugresistant TB, HIV/TB co-infection,pediatric TB and legal issues related toTB. Preferred training formats were: in-person training courses/workshops/conferences, in-service meetings, andwritten/self-study materials. Themajority of respondents’ specialties werefamily practice (n=122), internalmedicine (n=86) and pediatrics (n=65).All of these groups identified thefollowing topics as top training needs:treatment regimens for active TB diseaseor latent TB infection and completionof therapy/patient adherence. Providersspecializing in internal medicine andfamily practice also cited multi-drugresistance and legal issues related to TBas additional training needs, whileproviders specializing in pediatrics citedpediatric TB.

In conclusion, the survey results willenable the NHTB program to targetlimited resources towards improvingprogram interactions with medicalproviders and focus training and educa-tion. The NHTB program survey is alsoan example of how technical assistancefrom the Northeastern RTMCC forprogram-initiated evaluation projectscan improve understanding of programneeds and facilitate program initiatives.Next steps for the NHTB programinclude developing marketing strategiesto promote the program and its’resources and coordinating providertrainings based on survey feedback. Theinitial training to address provider needsemerging from this survey took placeSeptember 29, 2006. For more informa-tion about this needs assessment surveyfocused on private providers, pleasecontact Lisa Roy, New Hampshire HealthEducator at Lisa.B.Roy@dhhs.state.nh.us.

Submitted By Erin Howe, MPHHealth EducatorNortheastern RTMCC

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With current budget restraints andtravel restrictions, TB programs arefinding it increasingly difficult toprovide their staff with much neededtraining. To help address one of theidentified TB training needs in Ohio,the Northeastern RTMCC collaboratedwith the Ohio TB program in planningand conducting a TB Basics for HealthCare Workers course, held August 11,2006 in Columbus. The RTMCC tookthe lead in designing and coordinatingthe training and the Ohio TB Programtook the lead in marketing the courseand selecting participants. Both theRTMCC and the Ohio TB programprovided faculty.

The course was designed to providean overview of TB transmission,pathogenesis, diagnosis and treatment oflatent TB infection and disease, contactinvestigation, and personal respiratoryprotection. Melinda Diaz, a nurseconsultant and the training focal pointfor Ohio, took great care in invitinghealth care workers from the variouscounties who would benefit the mostfrom the training. Originally, half theseats in the course were reserved forother TB programs in the NortheasternRTMCC region, but for a variety ofreasons, only one other program areawas able to send a participant. However,the Ohio TB program was happy to takeadvantage of this opportunity, and all 40slots were easily filled.

The prerequisite for the first twentyseats was that the health care workershad to have had little to no experiencein working with TB, either because they

were new to TB control or because theyworked in a low incidence county.However, the larger TB programs,which see a number of TB cases, werealso eager to send some of theirinexperienced staff to the course. Whenadditional seats were opened to thestate of Ohio, these workers were alsoinvited. Though the course was open toa variety of health care workers in TBcontrol (e.g., nurses, diseaseinvestigators, public health advisors,and health representatives), only nursesapplied.

Dr. Lee Reichman, ExecutiveDirector of the Global TB Institute wasthe keynote speaker and also presentedon most of the topics for the course. DrReichman is an internationallyrenowned TB expert, but his quick witand down-to-earth persona made for a

comfortable learning atmosphere. Thisatmosphere was continued with aninformative session led by Melinda Diazon contact investigation. RebeccaGroves, another nurse consultant withthe Ohio Department of Health,concluded the day with a session on theuse of personal respiratory protection.

The participants were encouraged toask questions throughout the day toensure clarity and understanding of theinformation being presented. The facultyalso asked questions of the participantsto ensure that they were grasping theinformation, since receiving so muchinformation in a short span of time maymake it more difficult to understand andretain. Course facilitators checked inwith the participants periodically tomake sure they got it.

They got it! Post-test scoresincreased a minimum of 15% comparedwith pre-test scores. The success of thecourse was due to the team effort madeby the RTMCC, Ohio TB ControlProgram, and the course participantswho came eager and ready to learn. TheRTMCC plans to conduct a follow-upsurvey in three months to determine ifparticipants have been able to apply theinformation taught in the course totheir day-to-day TB work situations.The information will be used to furtherdevelop and refine the course. For moreinformation about this course, contactMelinda Diaz at 614-644-8150.

Submitted By Valerie GunnHealth EducatorNortheastern RTMCC

TB Basics for Health Care Workers–An Ohio/RTMCC Training Collaboration

The success of the course wasdue to the team effort madeby the RTMCC, Ohio TBControl Program, and thecourse participants who cameeager and ready to learn. TheRTMCC plans to conduct afollow-up survey in threemonths to determine ifparticipants have been able toapply the information taughtin the course to their day-to-day TB work situations.

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QuantiFERON-TB Gold Education – Responding tothe National Need

On June 26, 2006, the 4 RTMCCsjoined forces to present a web-basedseminar, or Webinar, entitledQuantiFERON-TB Gold – Putting NewTechnologies into Practice. This nationaleducational offering had an estimated800 persons participating, some asindividuals while others listenedtogether in conference rooms. Theconference was funded by Cellestis, thecompany that developedQuantiFERON-TB Gold. Althoughthere was corporate funding for thisprogram, there was also a clear publichealth focus.

The RTMCC used the systematichealth education process to develop thisweb-based program. The combinedneeds assessment data from all fourRTMCCs was essential to the planningprocess. This data revealed that therewas both an interest in this topic and anability to access web-based technologyat a national level. Faculty membersprovided input on key topic areas forpresentation and discussion. Finally, theprogram was evaluated to assess theimpact of its content and format.

The Southeastern NationalTuberculosis Center facilitated theprovision of continuing educationcredits for physicians, nurses, and healtheducators to increase marketability ofthe program. The RTMCCs marketedthe program to their standard publichealth based audiences while Cellestiswas instrumental in reaching non-traditional audiences such as laboratorypersonnel, who may not normally betargeted for education and thus may nottypically participate in RTMCC courses.The Northeastern Regional Training

and Medical Consultation Consortium,which had prior experience with web-based training coordinated the programand speakers.

The seminar featured talks on thescience behind QuantiFERON-TBGold, a summary of the CDC guidelines,and practical uses of the test in the field.The majority of participants were nurses,followed by lab staff, and physicians.Presenters included Dr. AlfredLardizabal from the Northeastern

RTMCC at the NJMS GlobalTuberculosis Institute, Dr. Phil LoBuefrom the Division of TB Elimination atCDC, and Dr. Masae Kawamura fromthe Francis J. Curry NationalTuberculosis Center. Dr. David Lakeyfrom the Heartland NationalTuberculosis Center moderated theprogram.

During the question and answersession at the end of the program,

participants were able to either askquestions verbally or submit themelectronically utilizing the web-basedformat. Participants were not onlyinterested in how QuantiFERON-TBGold works, but also in its practicalapplications. Written and verbalquestions ranged from the sensitivityand specificity of the test to how it canbe accessed by TB control programs.Participants demonstrated an eagernessto learn more about QuantiFERON-TBGold and as well as other potentialfuture advances in diagnosing latent TBinfection.

The course was evaluated via theInternet-based survey service,Zoomerang,® set up by theSoutheastern National TuberculosisCenter. There were 435 responses to theevaluation. The conference was wellrated in terms of knowledge of thespeakers, practical uses of theinformation, and the method ofproviding education via the web. Due torequests from participants, the audio andslides from the Webinar were posted onthe Northeastern RTMCC Website.The success of this joint event was aresult of the close collaboration and thewealth of experience in training andinnovative technology at the fourRTMCCs.

To access the archived presentationand copies of the presenters’ slides, visithttp://www.umdnj.edu/globaltb/audioarchives/qftweb.htm.

Submitted by Rajita Bhavaraju, MPH, CHESTraining and Consultation SpecialistNortheastern RTMCC

The RTMCC used thesystematic health educationprocess to develop this web-based program. Thecombined needs assessmentdata from all four RTMCCswas essential to the planningprocess. This data revealedthat there was both an interestin this topic and an ability toaccess web-based technologyat a national level.

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Notice to Readers: Revised Definition of Extensively Drug-Resistant Tuberculosis Morbidity and Mortality WeeklyReport. 2006 Nov 3; Volume 55, Number 43: 1176;http://www.cdc.gov/mmwr/PDF/wk/mm5543.pdf

In a report published on March 24, 2006(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm),MMWR reported that CDC, in collaboration with the WorldHealth Organization (WHO) and participating supranationalreference laboratories, had agreed to define extensively drug-resistant tuberculosis (XDR TB) as cases of TB disease in personswhose Mycobacterium tuberculosis isolates were resistant to isoni-azid and rifampin and at least three of the six main classes ofsecond-line drugs (aminoglycosides, polypeptides, fluoro-quinolones, thioamides, cycloserine, and para-aminosalicyclicacid). On October 8-9, 2006, WHO organized the first meetingof the Global XDR TB Task Force, held in Geneva, Switzerland.This meeting was called by WHO to develop a rapid response tothe emerging problem of XDR TB. As a result of the meeting,participants agreed upon a revised case definition of XDR TB:the occurrence of TB in persons whose M. tuberculosis isolatesare resistant to isoniazid and rifampin plus resistant to any fluo-roquinolone and at least one of three injectable second-linedrugs (i.e., amikacin, kanamycin, or capreomycin).

Health-care providers and local health departments in theUnited States should collect all second-line drug-susceptibilityresults obtained at diagnosis and during treatment of personswith TB disease and report these results to their local and statehealth department TB programs. Complete capture of theseresults will allow health departments and CDC to accuratelyidentify XDR TB cases and monitor trends. Additional infor-mation about XDR TB is available at http://www.who.int/tb/en.

New CDC Website: Stop TB in the African-AmericanCommunity (September 29, 2006) The Division ofTuberculosis Elimination (DTBE) of CDC has launched thenew Stop TB in the African-American Community website(http://www.cdc.gov/nchstp/tb/TBinAfricanAmericans/default.htm), which provides quick, any-time access to informationand resources related to tuberculosis (TB) prevention, control,and elimination in the African-American community. Thisresource has been developed for people who have an interest inthe topic of TB in the African-American community, andserves as a central repository for information related to thisissue. There are no subscription requirements for visitors to thissite. All materials that have been developed by CDC on thiswebsite are free of charge. In addition, DTBE has launched theStop TB in the African-American Community listserv(http://www.cdcnpin.org/scripts/listserv/tb_aa.asp).

Slide Set — Guidelines for Preventing the Transmission ofM. tuberculosis in Health-Care Settings, 2005 (September19, 2006)

http://www.cdc.gov/nchstp/tb/pubs/slidesets/InfectionGuidelines/default.htm CDC’s Division of Tuberculosis Eliminationdeveloped this slide set as an accompaniment to the Guidelines for Preventing the Transmission ofMycobacterium tuberculosis in Health-Care Settings, 2005(http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf). This slide setprovides an overview of the updated TB infection controlrecommendations.

2005 TB Surveillance Slides (September 12, 2006) The CDC 2005 TB Surveillance Slide Set and accompanyingtext are posted on the DTBE website athttp://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm This slide set was developed by CDC’s Division ofTuberculosis Elimination as an accompaniment to the fullannual surveillance report, “Reported Tuberculosis in theUnited States, 2005.” The full annual surveillance report willbe posted on the DTBE website soon and hard copy reportswill be available in November 2006.

Prevention and Control of Tuberculosis in Correctional andDetention Facilities: Recommendations from CDC;Endorsed by the Advisory Council for the Elimination ofTuberculosis, the National Commission on CorrectionalHealth Care, and the American Correctional Association.Morbidity and Mortality Weekly Report: Recommendationsand Reports. July 7, 2006; 55(RR09); 1-44.http://www.cdc.gov/mmwr/PDF/rr/rr5509.pdfRecommendations were developed on the basis of the mostrecent set of published guidelines and a review of the scientificliterature. This document covers effective TB prevention andcontrol measures in correctional facilities including early iden-tification of persons with TB disease through entry andperiodic follow-up screening, successful treatment of TBdisease and latent TB infection, appropriate use of airborneprecautions (e.g., airborne infection isolation, environmentalcontrols, and respiratory protection), comprehensive dischargeplanning, and thorough and efficient contact investigation.

Revised Adult HIV Treatment RecommendationsOn October 10, 2006, the DHHS Panel on AntiretroviralGuidelines for Adults and Adolescents released a new revisionof the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Although there are no newrecommendations to the Mycobacterium Tuberculosis (TB/HIVCo-Infection section (p. 38-39), the Panel revised, among otherthings, its recommendations for preferred and alternative anti-retroviral components when initiating antiretroviral therapy intreatment-naïve patients.

The full version of the revised Guidelines is available athttp://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.A summary of what’s new in the Guidelines is listed on page i.

What’s New

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NE RTMCC Training Courses Planned for 2006/2007(Click on Name of Course for Details)

NAME OF COURSE TARGET AUDIENCE DATE(S) LOCATION

Effective TB Interviewing and Contact Disease investigators and public health Nov 16 Columbia, MDInvestigation nurses in Maryland, Washington, DC, http://www.umdnj.edu/globaltb/courses/ and Virginia (by invitation)effectivetbinterviewing.htm

Regional TB Conference Clinical and TB Control Staff Nov 16 Western MAhttp://www.umdnj.edu/globaltb/courses/regionaltbconf-nov.htm

Field Staff Webinar: The Congregate Disease investigators and staff Dec 6 WEBINARSetting Contact Investigation involved in TB contact investigationshttp://www.umdnj.edu/globaltb/courses/fieldstaffweb-congregate.htm

Medical Update Webinar: Health care workers in corrections and Jan WEBINARTB and Corrections TB programs

Medical Update Webinar: Health care workers who have Feb 8 WEBINARInfection Control primary responsibility for infection

control in their setting

Effective TB Interviewing & Contact Disease investigators and public health Feb or Mar Newark, NJInvestigation nurses

TB Intensive Physicians & Nurses Mar Newark, NJ

TST Train-the-Trainer Nurses who train HCWs who perform June Newark, NJskin testing

Effective TB Interviewing & Contact Disease investigators and public Spring Rochester, NYInvestigation Workshops (2 Workshops) health nurses Spring Kingston, NY

Pediatric Update Physicians and nurses Spring Michigan

Cohort Review Methodology Lead TB Program Staff Spring New York, NY

TB Clinician’s Update Physicians and Nurses Spring MA

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Best Practices in TB Control TBD based on “Best Practice” Spring WEBINAR(Series of 3) topics selected Summer

Winter

Medical Consultant Quarterly TB program medical consultants Spring WEBINARWeb-based Grand Rounds Summer

FallWinter

The TB Laboratory’s New Tools for Health care workers in TBA WEBINARDiagnosing TB and LTBI: TB programsA Primer for TB Control Staff(Series of 2)

TB in Correctional Settings Updates Corrections staff TBA MA(Series of 2)

TB Updates TBD based on topic selected TBA CT

Medical Update Webinar: MDR TB Physicians and nurses Summer WEBINAR

Effective TB Interviewing & Disease investigators and public Fall MDContact Investigation Workshop health nurses

TB Case Management and Contact Nurse case managers Fall Newark, NJInvestigation for Nurses

TB Field Investigation Disease investigators Fall Newark, NJ

Program Manager’s Workshop for TB program staff in a management Fall Newark, NJRegional and Local Staff or supervisory role

TB Intensive Physicians and nurses Fall Newark, NJ

TB Among Ecuadorian Migrants in the Nurses, disease investigators, and Fall NY StateNortheast: The Cultural Competency translators serving Ecuadorian migrantsResponse

Medical Consultants Update TB program medical consultants Fall TBD

Medical Update Webinar: TB in Physicians and nurses Fall WEBINARthe Elderly

NE RTMCC Training Courses Planned for 2006/2007(Click on Name of Course for Details)

NAME OF COURSE TARGET AUDIENCE DATE(S) LOCATION

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TB Program Training Courses Planned for 2006/2007TB NAME OF TARGET TARGET DATES LOCATION CONTACT PROGRAM COURSE AUDIENCE AREA PERSONSPONSOR

PA Southeastern Private PA Nov 29 King of Terri WilsonHealth District physicians with Prussia 717-787-6267TB Clinician clinical terwilson@state.pa.usConference responsibility

for patients with TB or LTBI

NY City Tuberculin Non-NYC NYC & Jan 23-26 253 Broadway, Elvy Barroso Skin Test HD staff Vicinity May 22-25 NYC 212-676-2914

Administration Sept 11-14 ebarroso@health.nyc.gov

MI Tuberculin Skin TST Trainers MI & Jan 11 Lansing American Lung Test -Train the Vicinity March 5 Lansing Association of MichiganTrainer June 8 Lansing (800) 678-LUNG

MI Contact Public MI & Nov 13 Lansing Gail Denkins Investigation Health Vicinity (517) 335-8165for TB Personnel Julie McCallum

(616) 583-0647

MI Directly Observed Public MI & Nov 14 Lansing Gail Denkins Therapy Seminar Health Vicinity (517) 335-8165

Personnel Julie McCallum(616) 583-0647

MI TB Case Public MI & Nov 14 Lansing Gail Denkins Management Health Vicinity (517) 335-8165

Personnel Julie McCallum (616) 583-0647

MD TB Skin Licensed MD Mar 13 Baltimore Arlene HudakTesting Clinicians Mar 28 Easton 410-767-6698

Apr 10 SaliburyMay 24 Columbia

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Audio/Web Archives(Click on Conference Title for Details)

CONFERENCE TITLE TARGET AUDIENCE CONFERENCE DATE

An Introduction to Cultural Competency in TB Health care workers serving culturally April 25, 2005Prevention & Control diverse patients with or at risk for TB http://www.umdnj.edu/globaltb/audioarchives/culturalcompetency.htm

Monitoring Patient on Anti-TB Medication Health care workers serving patients May 18, 2005http://www.umdnj.edu/globaltb/audioarchives/ on anti-TB medicationmonitoring.htm

Pediatric Tuberculosis Update Physicians, physician assistants, nurse July 27, 2005http://www.umdnj.edu/globaltb/audioarchives/ practitioners, and public health nursespedtbupdate.htm

Addressing HIV/AIDS Issues for TB Program Staff Health care workers serving patients November 30, 2005http://www.umdnj.edu/globaltb/audioarchives/ with HIV-related TB addressinghiv.htm

TB Testing Update physicians, physician assistants, nurse December 5, 2005http://www.umdnj.edu/globaltb/audioarchives/ practitioners, and public health nursestbtesting.htm

TB Transmission and Infection Control Public health nurses, field staff, outreach December 13, 2005 for TB Program Staff workers, and disease investigatorshttp://www.umdnj.edu/globaltb/audioarchives/tbtransmission.htm

Diagnosis & Management of TB in the Medical providers December 14, 2005HIV-Infected Patient http://www.umdnj.edu/globaltb/audioarchives/diagnosis&management.htm

Working with TB Patients with Mental TB control staff who work in clinical May 2, 2006Health Issues http://www.umdnj.edu/globaltb/ or field settingsaudioarchives/mentalhealth.htm

QuantiFERON-TB Gold: Putting New Physicians, nurses, lab staff June 26, 2006Technologies into Practice (A Web-Based Seminar) http://www.umdnj.edu/globaltb/audioarchives/qftweb.htm

2006 Northeast TB Controllers Meeting TB controllers, program managers, October 24, 2006http://www.umdnj.edu/globaltb/audioarchives/ clinicians, & other health care 2006ntca.htm workers serving patients with or at

risk for TB

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S Other TB ResourcesDivision of Tuberculosis Elimination

The mission of the Division of Tuberculosis Elimination (DTBE)is to promote health and quality of life by preventing, controlling,and eventually eliminating tuberculosis from the United States, andby collaborating with other countries and international partners incontrolling tuberculosis worldwide. http://www.cdc.gov/nchstp/tb/default.htm

TB Education and Training Resources Website This website is a service of the Centers for Disease Control and

Prevention (CDC), Division of Tuberculosis Elimination. It is intendedfor use by TB and other healthcare professionals, patients, and thegeneral public and can be used to locate or share TB education andtraining materials and to find out about other TB resources. http://www.findtbresources.org/scripts/index.cfm

TB Education & Training Network (TB ETN)The TB Education and Training Network (TB ETN) was formed tobring TB professionals together to network, share resources, andbuild education and training skills. http://www.cdc.gov/nchstp/tb/TBETN/default.htm

TB-Related News and Journal Items Weekly UpdateProvided by the CDC as a public service, subscribers receive:• A weekly update of TB-related news items • Citations and abstracts to new scientific TB journal articles• TB conference announcements• TB job announcements

To subscribe to this service, visit:http://www.cdcnpin.org/scripts/listserv/tb_update.asp

TB Behavioral and Social Science ListservSponsored by the DTBE of the CDC and the CDC National

Prevention Information Network (NPIN), this Listserv providessubscribers the opportunity to exchange information and engage inongoing discussions about behavioral and social science issues asthey relate to tuberculosis prevention and control.http://cdcnpin.org/scripts/tb_behavioral_science.asp

OTHER RTMCCS

The Francis J. Curry National Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Montana, Nevada,Oregon, Utah, Washington, Wyoming, Federated State ofMicronesia, Northern Mariana Islands, Republic of Marshall Islands,American Samoa, Guam, and the Republic of Palau. http://www.nationaltbcenter.edu

The Heartland National Tuberculosis Center serves: Arizona,Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico, Nebraska,North Dakota, Oklahoma, South Dakota, Texas, and Wisconsin. http://www.heartlandntbc.org

The Southeastern National Tuberculosis Center serves:Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana,Mississippi, North Carolina, South Carolina, Tennessee, Virginia,Puerto Rico, and the U.S. Virgin Islands. http://sntc.medicine.ufl.edu