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Regionalization : A New Strategy for TB Control & Elimination The New England Experience Mark Lobato, MD Division of Tuberculosis Elimination Centers for.

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Presentation on theme: "Regionalization : A New Strategy for TB Control & Elimination The New England Experience Mark Lobato, MD Division of Tuberculosis Elimination Centers for."— Presentation transcript:

1 Regionalization : A New Strategy for TB Control & Elimination The New England Experience Mark Lobato, MD Division of Tuberculosis Elimination Centers for Disease Control and Prevention

2 The last TB upsurge Loss of public health infrastructure HIV co-epidemic Outbreaks in congregate settings Increasing immigration

3 Response to TB resurgence MDR-TB Action Plan & New Resources Improved Case Identification & Training Updated Diagnostic Labs New Infection Control & Rx Recommendations DOT & Improved Completion Rebuilt Research Capacity HRZE

4 Enhanced TB control

5 Reported TB cases United States, 1982–2007

6 High incidence areas lead the decline in TB Year Case rate US NYC LA Houston

7 Actual and adjusted Federal funds for TB Control

8 The next TB upsurge Decreased funding Weakened public health infrastructure Loss of TB expertise High growth of immigration Outbreaks in hard-to-reach populations Lag in new diagnostics and drugs

9 The perfect storm Mass. –37% staff loss –21% budget cut CT –33% staff loss –1 of 3 outreach RI –Program manager laid off

10 Erosion of infrastructure Mississippi Tuberculosis Rate Surges Past National Average - Clarion Ledger, March 24, 2008 Mississippi health officials announced the states rate of the disease has … increased 12 percent since Several factors could explain Mississippis rate, including the loss of nurses who investigate TB cases and notify others suspected of being at risk. Between 2002 and 2007, the number of nurses at the state Department of Health fell from 412 to 366.

11 TB cases increase in 16 California health jurisdictions San Jose Mercury News, March 13, 2008 All of the Bay Areas large counties recorded substantial increases in new TB cases in In Santa Clara, San Francisco, Alameda, and San Mateo counties, TB cases spiked last year. San Francisco County experienced its first significant jump since an AIDS-related TB outbreak in the early 1990s. The county now has the highest TB rate in the state. …Over the past two years, TB cases in Santa Clara have increased 21%.

12 National trends in TB case rates, Year Case rate U.S. Top 131 cos Other cos

13 County State % Increase Denver CO Marion IN Anchorage AK Guilford NC Franklin OH Tarrant TX Maricopa AZ Hennepin MN King WA Trends in cases Select counties, 1997–2006

14 CountyState % Increase Marion IN Pima AZ Guilford NC Franklin OH King WA Dallas TX Shelby TN Trends in case rates Select counties, 2000–2006

15 TB complexity

16 Safety net TB Cases in the US Drug resistant co-morbidity US Infrastructure

17 Existing regional TB collaborations Binational border projects Bay Area Coordinating Committee New England TB Consortium Capitol Region TB Council (MD-DC-VA) Low incidence region (TBESC TO #6) Genotyping laboratories RTMCC

18 Background New England TB Consortium The 6 New England TB programs are collaborating in new ways as an approach to TB elimination. Identifying strategies for collective problem solving Building program capacity on a regional level

19 New England TB, 2007 TB cases cases / 100,000 (range 0.5–4.3) Regional cases equivalent to state with 8th highest TB burden

20 Many cultures – one bug CTMEMANHRIVT State % FB

21 So, why did you do it?

22 World TB Day, 2008 This countrys progress in eliminating TB will not be sustainable without ongoing and strengthened collaborations with local, state, national, and international partners… Kevin Fenton, MD, Director, NCHHSTP, CDC

23 What can regionalization do for TB control? Build a diverse and effective team Solve problems collectively Expand expertise Enhance state and local programs Involve stakeholders Strengthen advocacy

24 New England TB Action Plan Five key strategies: Team building Education Capacity expansion Universal genotyping Medical and outbreak consultation

25 Resources State – TB programs – TB Advisory Committees Regional – RTMCC – Shattuck Hospital TB Unit CDC – DTBE – Fellows

26 Value added New England

27 Eliminating TB Case by Case Presented by master clinicians Designed to reach private providers Created basis for distance learning – web-based – continuing education credit Held 10 successful presentations Need for ongoing marketing


29 Built a website to Increase cohesiveness and visibility Promote regional and state education Exchange tools and materials


31 Genotyping Work Group Defined data management capacity Identified only 1 instance of definite transmission with a cluster of 26 cases Highlighted missed opportunities to prevent disease Measured strain prevalence and dispersion across states

32 Lessons learned Modern TB control requires – Building a team leadership – Coordination and collaboration across jurisdictions Regional efforts offer advantages to state programs and to CDC

33 Next steps Analyze project evaluation data – Improve collaborative efforts – Determine how to replicate model Created the New England TB Consortium Building a new case management series TB Talk

34 Future outlook Expand collaboration Increase capacity for managing MDR/XDR TB Initiate evaluation

35 We need a double hull infrastructure

36 New England TB Consortium Connecticut Heidi Jenkins, Tom Condren, Lynn Sosa, Maureen Williams, James Hadler, Gary Budnick Maine Kathy Gensheimer, Anne Sites, Suzanne Gunston, Julie Crosby Massachusetts Sue Etkind, Kathy Hursen, Sharon Sharnprapai, Marilyn DelValle, John Bernardo, Alex Sloutsky New Hampshire Jill Fournier, Lisa Roy, Jody Smith, Peggy Sweeny Rhode Island Utpala Bandy, Mike Gosciminski, Chris Goulette, Toby Bennett Vermont Susan Shoenfeld, Susan Cook, Becky Temple RTMCC Erin Howe, Nicolette Patrick DTBE Dan Ruggiero, Kashef Ijaz, Bob Pratt, Joe Scavotto, Ken Castro

37 Prepare, youll sleep better at night.

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