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Regionalization : A New Strategy for TB Control & Elimination The New England Experience

Regionalization : A New Strategy for TB Control & Elimination The New England Experience Mark Lobato, M.D. Division of Tuberculosis Elimination Centers for Disease Control and Prevention. Advisory Committee for the Elimination of TB Atlanta, GA March 3-4, 2009. Connecticut

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Regionalization : A New Strategy for TB Control & Elimination The New England Experience

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  1. Regionalization: A New Strategy for TB Control & Elimination The New England Experience Mark Lobato, M.D. Division of Tuberculosis Elimination Centers for Disease Control and Prevention Advisory Committee for the Elimination of TB Atlanta, GA March 3-4, 2009

  2. Connecticut Lynn Sosa, Heidi Jenkins, Tom Condren, Maureen Williams, Gary Budnick, James Hadler, CACET Maine Diane Brooks, Kathy Gensheimer, Joyce Roy, Julie Crosby Massachusetts Sue Etkind, Kathy Hursen, Sharon Sharnprapai, Marilyn DelValle, John Bernardo, Janice Boutotte, Alex Sloutsky, MACET New Hampshire Jill Fournier, Lisa Roy, Jody Smith, Peggy Sweeny Rhode Island Utpala Bandy, Mike Gosciminski, Paula Pullano, Toby Bennett Vermont Susan Shoenfeld, Susan Cook, Becky Temple RTMCC Nicolette Patrick DTBE Dan Ruggiero, Kashef Ijaz, Patrick Moonan, Maria Fraire, Ken Castro New England TB Consortium

  3. RegionalizationThe Time Has Come • Orients to field-based interventions • Rapid response to problems • Increases program capacity • Promotes federal-state cooperation • Attempts to improve program effectiveness • Reflects a changing relationship between DTBE and the states

  4. The Perfect Storm The Next TB Upsurge • Flat funding • Weakened public health infrastructure • Loss of TB expertise • Ongoing immigration • Continued outbreaks • Few new diagnostics and drugs

  5. “In the middle of difficulty, lies opportunity.”– Albert Einstein

  6. New England TB, 2007 • TB cases • - 408 cases • 3.0 / 100,000 (range 0.5–4.3) • 67% among FB • Equivalent to state with 8th highest TB burden

  7. “So, why did you do it?”

  8. Value Added New England TB.org

  9. New England TB ConsortiumCollaboration for Change • Leadership • Education • TB Talk • Eliminating TB Case by Case • Communication • Genotyping • Public Health Law • Awards

  10. Interactive Web Presentation June 24, 2008 Noon Eliminating TB Case by Case A Case Series for Providers and Clinicians Nira Pollock, MD, PhD Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston T “TB testing using QuantiFeronGold: What the provider needs to know” Access the TB Case Series at www.mymeetings.com/nc/join.php?i=PG1678747&p=2006&t=c - - Toll free audio access: 888 552 9191 Password = 2006 # Accreditation: CME, CNE, CHES

  11. Eliminating TB Case by Case • Presented by master clinicians • Designed to reach private providers • Created basis for distance learning • web-based • continuing education credit • Need for ongoing marketing

  12. TB Talk – New EnglandA case discussion by and for nurses, outreach educators, and case management staff January 13, 2009 12:00 – 1:00 pm John Bernardo, M.D., Boston University “Ask the Expert” Lloyd Friedman, M.D. (Pulmonary), Milford Hospital, Yale Joseph Gadbaw, Jr., M.D. (ID), Lawrence & Memorial Hospital Robert Husson, M.D. (Pediatrics), Childrens Hospital Boston Phone: 866-774-8920 Passcode: 8612841#

  13. NewEnglandTB.org • Built a website • To increase cohesiveness and visibility • To promote regional and state education • To exchange tools and materials • Partnered with HHS Region I (wiki)

  14. Genotyping Work Group • Defined data management capacity • Identified instances of interstate transmission in 2 clusters • Highlighted missed opportunities • Measured strain dispersion across states

  15. Consultation • Early detection of an outbreak and need for a CDC investigative team • Facilitated technical support for 3 large contact investigations • Performed on average 7 consultations for CIs and 20 for complex cases per year

  16. New England Public Health Law Project • Call to Action sent to NTCA • Addresses gap in Model TB Act • Formed a broad partnership • Defining options for involuntary isolation of patients from another state • Applied for CDC award “Innovations in Public Health Policy”

  17. TB Heroes Award • To recognize exceptional contributions to TB control and the well-being of patients and the community • First annual award presented at the 2008 northeast TB meeting • Article in current TB Notes

  18. Call for nominations New England TB Heroes Award New England TB Heroes In recognition of an exceptional contribution to TB control and the well-being of patients and the community Please send nominations to your TB program by April 1st Presented by theNew England TB Consortium

  19. PCSI • The best programs are the best collaborators • Beginning collaboration between TB and STD • TB Notes (2008)

  20. Lab Collaboration • 5 states using uniform lab survey • Questions regarding lab capacity and practices • Marketing tool

  21. Dissemination • Presentations • NTCA (plenary): 2008 • NTCA (posters): 2008 (“TB Talk” - D. Orcutt) 2007 (Regionalization), 2006 (Education) • ATS: 2007 (Genotyping) • IUTLD: 2008 (Isolation - Gensheimer; Regionalization) • TB ETN: 2009 (Education) • Northeast TB Conference: 2005, 2006, 2007 • DTBE Brown Bag: 2006, 2009 • Publications • TB in the foreign born (Lobato, et al.) • Prison outbreak in CT (Sosa, et al.) • Community outbreak (Buff, et al.) • TB Notes: • 2009 (TB Heroes – New England) • 2008 (PCSI) • 2007 (Regionalization) • 2006 (Education)

  22. Evaluation of the NETC • Carried out by Maureen Wilce, DTBE • To determinethe factors promoting or hindering this regionalization effort • Results • Created a formal framework with a consensus plan of action • Provided a structure for all voices to be heard equally • Facilitated the sharing of knowledge and resources • Found resource limitations that limit program staff from optimizing involvement

  23. Evaluation Conclusion The New England TB Consortium “provides a model for building consensus through strategic planning [and] establishing formal agreements” “Regional assignees can be effective to promote regionalization, providing skills and resources as incentives to promote collaborative efforts.”

  24. Lessons Learned • Modern TB control requires • Building a team leadership • Coordination and collaboration across jurisdictions • Regional efforts enhance programs • Regionalization offers advantages CDC

  25. Next Steps • Hold a leadership retreat • Improve collaborative efforts • Update the strategic plan • Examine how to replicate model • Extend the model to labs and refugee coordinators • Enhance resources for treating complex or non-adherent patients

  26. Future Outlook • Extend the model nationally • Strategic placement of TB staff

  27. Prepare, you’ll sleep better…

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