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Update from TB Infection Control Sub-working Group

Update from TB Infection Control Sub-working Group. Bess Miller, M.D., M.Sc. Assoc Director, TB/HIV Prevention & Care Global AIDS Program CDC, Atlanta, Georgia, USA Chair, TB Infection Control Sub-working Group 13 th TB/HIV Core Group Meeting April 17-18, 2008 New York, New York.

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Update from TB Infection Control Sub-working Group

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  1. Update from TB Infection Control Sub-working Group Bess Miller, M.D., M.Sc. Assoc Director, TB/HIV Prevention & Care Global AIDS Program CDC, Atlanta, Georgia, USA Chair, TB Infection Control Sub-working Group 13th TB/HIV Core Group Meeting April 17-18, 2008 New York, New York CS113808

  2. Acknowledgements • WHO • Rose Pray • Fabio Scano • Reuben Granich • Karin Weyer • KNCV • Jeroen VanGorkem • Frank Cobelens • CDC - Paul Jensen • USAID - Cheri Vincent • OGAC - Bill Coggin • LSTMH --Liz Corbett

  3. Infection Control Sub Working Groupand Related Meetings • First discussions, Union Meeting Oct. 2006 • Placed under TB/HIV Work Group, Nov 2006 • First meeting, STOP TB MDR TB Workgroup Meeting, Tbilisi Sept 07 • Infection Control Consultation Geneva Oct 07 • 3 I’s Meeting, WHO HIV Dept. April 08 • 2nd Task Force Meeting on MDRTB April 08

  4. What did we hear at these meetings? • Update guidance on what to do and how to prioritize at national level. • Within two months, distribute “Ten Essential Infection Control Steps”. (3 I’s Meeting) • TB infection control is a critical component of health systems strengthening. Cuts across many disciplines. Engage other stakeholders • Address short supply of public health engineers • Labs, labs, labs, labs – strengthen diagnostics, lab turn-around times, communication between labs & programs, use new tools • Engage the community

  5. Response • Forming an Infection Control Subgroup Core Team • Letters of invitation sent out • IC experts, NTP and NACP program, engineers, community representation • Includes representation/liaises with other working groups, departments • MDR TB Working Group • Global Lab Initiative • Advocacy • HIV Department • Airborne Infection Unit • Epidemic and Pandemic Alert and Response Team

  6. ResponseGuidance • We are developing “A National Framework to Implement TB-IC Interventions in Health care settings in Resource-Limited Countries” • What needs to be implemented at country level and how to prioritize it • 10-15 page document • In accordance with principles of WHO Guidelines Review Committee (assessing and describing the evidence base). • Process includes: • Developing key questions for consideration and systematic review • Conducting systematic literature review and grading to provide evidence base • Crafting TB IC recommendations based on evidence collected and rated with a standardized grading system. • Considering feasibility and cost in final recommendations. • Final document – anticipated in last quarter 2008

  7. Examples of questions for review • What is the impact of natural ventilation vs mechanical ventilation vs UV lights on reduction of TB transmission? • What is the role of respirators and masks in reducing TB transmission? Is fit testing of respirators critical or would training and fit check suffice?

  8. ResponseUrgent guidance • Development of brief document “Ten Essential TB Infection Control Steps” • Work with advocacy/communications group • Disseminate widely • Produce posters, etc. for facilities, hospitals • Development of facility level Infection Control posters, “cough etiquette” posters

  9. ResponseCourses and Training Materials • 3-day course for national IC consultants, Nov 2007 • 3-day workshop for development of country strategic IC plans, Nov 200i7 • 5-day course for international consultants, Feb 2008 • 5-day course for public health engineers and architects, May and July 2008 • Training materials for managerial staff responsible for IC • Participant’s Manual with slides • Facilitator and course director manual • Available by end of 2008. • Country training material also being developed.

  10. Response • Demonstration projects to develop guidance/package of activities, tools, job aids for IC at facility level (PEPFAR, ICAP) • Project to develop standard M & E indicators for infection control at various levels (MDR TB Subgroup on Research and TB IC Subgroup, TB CAP) • Collaboration with WHO Epidemic and Pandemic Alert and Response Team to introduce TB IC in “Natural Ventilation for Infection Control in Health Care Settings” (Guidelines addressed to engineers and HCWs)

  11. TB Infection Control is not a quick fix.

  12. TB Infection Control must become a campaign. • Strategy • Workplan • Targets • Monitoring • Advocacy • Community involvement • Resources

  13. WHO DOTS Strategy for TB

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