NORTHEASTERNSPOTLIGHTSUMMER= 2006 VOLUME 1 • NUMBER 2

INSIDE:Staff Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Training Courses . . . . . . . . . . . . . . . . . . . . . . . . . 4-6What’s New. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7On the Lighter Side . . . . . . . . . . . . . . . . . . . . . . . . . 8Links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Upcoming TB Training Courses . . . . . . . . . . . . 10-11

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New Jersey Medical School

GlobalTuberculosisInstitute

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

Dear Colleague:Welcome to our second edition of the Regional

Training and Medical Consultation Consortium’s(RTMCC) Northeastern Spotlight. We are excited tohighlight some of the many quality and innovativeactivities – both training and medical consultation –occurring in our region.

We are looking forward to meeting many of you atNational Tuberculosis Controllers Meeting in Atlanta,June 12-15. We are eager to hear your thoughts at theRTMCC breakout session, for you to share your successes,and identify challenges you are facing so that we maydiscuss strategies on how we can best work together.

We also welcome you to visit our new website(www.umdnj.edu/globaltb), which was launched on WorldTB Day this year. The new look of the site reflects ourongoing commitment to regional, national, and global TBissues. Our collaborations become all the more importantas cuts in TB funding threaten our progress towards TBelimination.

Finally, we are anxious to meet with the medicalconsultants in our region this fall, when we host our firstmedical consultation meeting in Newark, September 19-20, 2006. In light of new guidelines and evolvingtechnology, we will present and discuss challenging casesand use this venue to identify opportunities for furtherstrengthening medical consultation throughout theRegion. We expect that during this gathering, we will be

able to share the thoughts and challenges associated withproviding consultation in this changing health careenvironment. In addition, we are looking at ways toensure ongoing close collaboration with the medicalconsultants in our region in the future.

If you have any feedback for us, I invite you to contactme or a member of the RTMCC staff at (973) 972-3270.

Lee B. Reichman, MD, MPHExecutive DirectorNortheastern RTMCC and the Global Tuberculosis Institute

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Timing is everything. In the middleof Dr. Alfred Lardizabal’s fellowship inpulmonary medicine under one Dr. LeeReichman, the New Jersey MedicalSchool National Tuberculosis Center(NTBC) was created. At the end of hisfellowship in 1994, the NTBC hadachieved federal designation as anational Model Tuberculosis Preventionand Control Center, and Dr. Reichmanimmediately invited him to join theCenter’s distinguished team ofclinicians, researchers, and educators.Call it luck or providence, but it seemedthat all his studies and life experienceshad been preparing him for this veryposition. Born in Cambridge,Massachusetts where his father was apulmonary physician, his family movedback to Manila in the Philippines, inthe early 1960s, where his grandfatherhad also practiced as a pulmonaryphysician. It was while growing up andvisiting his father’s practice that he firstbecame aware of the wide disparitybetween wealth and poverty and thatmost TB patients were very poor. Duringhis clinical training in medical school,he encountered many TB patients andwas troubled at only being able to treattheir disease without addressingunderlying problems of poverty, crowdedand unsanitary living conditions, andunemployment. After receiving hismedical degree from the University ofSanto Tomas in Manila in 1986, Dr.Lardizabal came to the US to finish hisstudies. He completed course work foran MPH at Yale University, followed byan internal medicine residency programat the UMDNJ before becoming aPulmonary Medicine Fellow under Dr.Reichman. Dr. Lardizabal noted that“When Dr. Reichman recruited me, itseemed like a perfect fit, given thefamily legacy of pulmonologists, myacademic training and experience, andmy desire to blend clinical practice,teaching, and research.”

First and foremost, Dr. Lardizabal is asuperb and compassionate clinician,beloved by patients, admired by staff,and respected by peers. He covers twoclinic sessions a week at the busy

to his attention and are willing toimplement innovations he has learnedabout from colleagues or from attendingconferences. In addition, he goes theextra mile to give in-services for theclinic staff and for other health careproviders in the community.

Dr. Lardizabal plans and oversees TBGrand Rounds held every Tuesdayafternoon at the GTBI and at which heis often the featured speaker. Dr.Reichman points out that Dr.Lardizabal’s presentations invariablyreflect a thorough diagnostic workupwhile posing provocative questionsabout the appropriate approach inmanaging difficult issues. Other ongoingresponsibilities include didactic lecturesand rounds as Assistant Professor ofMedicine in Pulmonary and CriticalCare Medicine, 2 months annualrotation as an attending in the IntensiveCare Unit/Critical Care Unit,participating as a member of the NJ TBMedical Advisory Board, and serving asan RTMCC medical consultant.

One of the highlights of Dr.Lardizabal’s career in TB includes beinga Principal Investigator on CDC-fundedQuantiFERON-TB studies. Dr.Lardizabal feels that QFT Gold will beparticularly helpful in rendering a moreaccurate diagnosis of LTBI among recentimmigrants with a history of BCG

Staff Profile: Dr. Alfred A. Lardizabal

Lattimore Chest Clinic in Newark andtwo sessions a week at the MiddlesexCounty Chest Clinic which serves alarge working poor, immigrantpopulation. Patti Woods, NursingDirector at the Middlesex Clinic notedthat “Dr. Lardizabal immediately

connects with his patients by listeningcarefully and gently probing to identifyand address barriers to care.” She alsonoted that he has established a trustingrelationship with the staff, so that theyfeel comfortable bringing difficult issues continued on next page

At the end of his fellowship in 1994, the NTBC hadachieved federal designation as a national ModelTuberculosis Prevention and Control Center, and Dr. Reichman immediatelyinvited him to join theCenter’s distinguished team of clinicians, researchers, and educators. Call it luck orprovidence, but it seemed that all his studies and lifeexperiences had beenpreparing him for this very position.

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vaccination, thus eliminating unnecessary chest radiographsand LTBI treatment in persons who were often falsely positiveto the TST. In relation to treatment of LTBI, Dr. Lardizabalwas concerned about poor adherence with the 9-monthregimen of isoniazid (9H) at the Middlesex County ChestClinic among persons with LTBI who are primarily foreignborn, working poor, or school children. In 2002, Dr. Lardizabalbegan offering the option of 4 months of rifampin (4R),recommended as an acceptable alternative regimen to 9H inthe CDC/ATS guidelines published in 2000. When given achoice, he found that patients overwhelmingly preferred 4Rover 9H and that patients receiving 4R in 2003 weresignificantly more likely to complete therapy (81% comparedto 53%) (in press).

On the international front, Dr. Lardizabal played asignificant role in implementing the Pharmacy DOTS Initiative(PDI), one of many components of the 3-year USAID-fundedPhilippines Tuberculosis Initiatives for the Private Sector (Phil-TIPS). Prior to PDI, pharmacists who frequentlydispensed TB medications without a prescription to patientswith TB-like symptoms were unaware of publicly-funded TBDOTS centers and rarely had TB patient education materials.Dr. Lardizabal provided leadership and technical expertise indeveloping and implementing a pilot project in 7 sites acrossthe Philippines to train pharmacists on TB and establish anincentive and referral system where patients who came to themwith TB symptoms requesting medication would be referred to anearby DOTS center. Since 11% of foreign-born cases are fromthe Philippines, this initiative is also likely to help control TBin the US. Dr. Lardizabal significantly contributed to anothercomponent of Phil-TIPS to modify and integrate the DOTSsyllabus into the curricula for pre-service nursing, medicaltechnology, and pharmacy students nationwide.

In addition to responding to calls on the TB InfoLine, Dr.Lardizabal is taking an active role in helping to shape theRTMCC’s role in developing and enhancing medicalconsultation capacity throughout the Northeastern Region,guided by results of last year’s needs assessment. He is overseeingthe program for a TB Medical Consultants Meeting to be heldin September at the RTMCC in Newark at which attendees

from across the Region will participate in discussions about newdevelopments in the diagnosis, treatment, and control of TB;measuring medical consultation effectiveness; and enhancingcontinuing education opportunities for TB medical consultants.Dr. Reichman described Dr. Lardizabal as a model consultant,because he listens carefully and provides concise, appropriaterecommendations in a non-threatening manner. Dr. Lardizabal isexcited about leveraging new technology—like “Webinars”—to

expand participationin quality casepresentations amongmedical consultantsthroughout theRegion.

In his spare time,Dr. Lardizabal relaxesand rejuvenatesthrough suchactivities asattending livesymphonies and jazzconcerts in New YorkCity, attending plays,bike riding through

Liberty Park, swimming in warmer weather, and periodicallyvisiting his family in the Philippines. Dr. Lardizabal played theclarinet and saxophone while growing up and commented that“although I never became proficient, I believe that theexperience fostered a deep and lifelong appreciation of music.”

Dr. Lardizabal is quiet spoken, personable, easilyapproachable, and genuinely humble. These qualities, coupledwith his notable achievements and clinical excellence, haswon him the admiration and affection of colleagues andpatients alike.

Submitted By Chris HaydenConsultantNortheastern RTMCC

Lardizabal continued from previous page

In addition to responding tocalls on the TB InfoLine, Dr.Lardizabal is taking an activerole in helping to shape theRTMCC’s role in developingand enhancing medicalconsultation capacitythroughout the NortheasternRegion, guided by results oflast year’s needs assessment.

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The Northeastern Regional Trainingand Medical Consultation Consortium(RTMCC) and the MassachusettsDivision for TB Prevention and Controlhave found that using case presentationsand covering advanced topics related toTB diagnosis and treatment to be aneffective and well-received method ofproviding educational programs tophysicians. This knowledge led to theplanning of the 2006 TB ClinicalConference for Physicians, held at thePeabody Essex Museum in Salem,Massachusetts, on April 8, 2006. Forty-three participants attended theconference, twenty-nine of whom werephysicians. Other clinical and researchstaff attending the conference includeda TB laboratory director, several nursepractitioners, nurse clinic managers, andTB state program staff. Participantscame from five states in theNortheastern region including:Massachusetts, Connecticut, Maine,Rhode Island, and New Jersey.

Dr. John Bernardo, TB MedicalOfficer for the Massachusetts TBDivision, organized the conferencepresentations with assistance fromcolleagues at the Massachusetts TBDivision and the RTMCC’s healtheducator for New England. Theconference was developed to expand ona specialty-based, Department of PublicHealth-sponsored conference forMassachusetts TB providers that hadbeen conducted in previous years onCape Cod. Dr. Bernardo is the recentrecipient of the Chadwick Medal, thehighest honor awarded by theMassachusetts Thoracic Society, foroutstanding service in the field ofpulmonary disease. He is a professor ofpulmonary medicine at BostonUniversity and is the current presidentof the National TB Controller’sAssociation. He has been working with

the Massachusetts TB Division for 4 years.Key faculty for the conference

included Dr. John Bernardo, Dr. E. JaneCarter, Jo-Ann Keegan, RN, Dr. MarkLobato, Dr. Reynard McDonald, Dr.Jussi Saukkonen, Sharon Sharnprapai,MPH, Dr. Alexander Sloutsky, and Dr.Marie Turner. Alexander Sloutsky, PhD,gave an informative presentation on

new technologies in the MassachusettsState Laboratory and the potential forclinicians and state program staff towork more closely with TB laboratories.Dr. Reynard McDonald from theNortheastern RTMCC gave an in-depthtalk on the complexities of managingTB/HIV co-infection.

Other topics addressed included: areview of TB epidemiology in theNortheast; legal and ethical issues incase management; managing MDR-TB;an innovative, collaborative TB projectin Kenya; TB clinical trials and newdrug development; and riskmanagement: TB infection andenvironmental control. Mostpresentations were followed by livelydiscussions and debates betweenclinicians about their experiences

TB Clinical Conference for Physiciansdiagnosing and treating TB patients andthe appropriate treatment or infectioncontrol plan in a particular scenario.These discussions served as valuablelearning opportunities for cliniciansnewer to TB and an interestingintellectual challenge for seasonedclinicians.

Evaluations submitted by conferenceparticipants indicated that one-hundredpercent of attendees felt the overallobjectives of the conference had beenmet. Many positive comments werereceived about conference topics,conference facilities, and networkingopportunities. When participants wereasked to identify ways participation inthe conference would impact theirpractice, several mentioned increaseddiligence in managing pediatric TB,closer attention to monitoring liverfunction during LTBI treatment, andworking more closely with TBlaboratories. This type of advanced-levelconference is an effective way to reachTB clinicians to keep them up to dateon clinical, laboratory, and public heathaspects of their specialty practice, andmay serve as a model for otherNortheastern project areas as they planeducational programs targeting TBclinicians.

If you are interested in planning aphysician’s conference in your projectarea and would like advice or technicalassistance, please contact: RajitaBhavaraju, Program Director, Educationand Training, Northeastern RTMCC,bhavarrr@umdnj.edu, (973) 972-4811 orErin Howe, New England RTMCCHealth Educator, (617)279-2137,ehowe@tmfnet.org.

Submitted By Erin Howe, MPHHealth EducatorNortheastern RTMCC

This type of advanced-levelconference is an effective wayto reach TB clinicians to keepthem up to date on clinical,laboratory, and public heathaspects of their specialtypractice, and may serve as amodel for other Northeasternproject areas as they planeducational programs targetingTB clinicians.

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(Reprinted from TB Notes No. 1, 2006)Purpose and Goal of the TB Case

Series. In an effort to reach several keypartners using an educational venue, thesix New England tuberculosis (TB)control programs organized a Web-basedinteractive “TB Case Series.” The TBCase Series is designed to allowproviders to present cases that illustratepublic health principles and practices.The goal of the TB Case Series is tooffer a forum for:• Discussing the public health

importance of infectious TB• Describing the clinical management

of TB, and increasing awareness ofnational recommendations for TBdiagnosis and treatment

• Discussing options for ongoingpatient careThe course will promote standard

diagnostic procedures and nationalguidelines through analysis anddiscussion of TB cases. Additionally, thecourse offers continuing education creditfor physicians, nurses, health educators,and other participants.

First Two Presentations a Big Success.On October 26, 2005, more than 80persons participated in the first casepresentation. The inaugural presentationfeatured C. Robert Horsburgh, MD, alocal and national expert in TB and HIVtreatment. Dr. Horsburgh, formerly withCDC, is now the Chair of theDepartment of Epidemiology and theDirector of the Prevention ResearchCenter at the Boston University Schoolof Public Health and the BostonUniversity Medical Center. Dr.Horsburgh laid the groundwork for futurecase presentations and skillfully led thediscussion, drawing participants into anactive dialogue around the case. Thesecond presentation was given in January

2006 by C. Fordham von Reyn, MD,Chair, Infectious Diseases andInternational Health at Dartmouth-Hitchcock Medical Center. Thepresentation skillfully combined a caseand review of TB-relatedlymphadenopathy. About 45 participantsfrom New England called in to listenand discuss the case and other cases.

Evidence of the Need for EducationalActivities Targeting TB Providers. Severalsources of evidence indicate that TBcare providers have ongoing educationalneeds. These sources include 1) aregional education needs assessment, 2)studies documenting nonadherence tonational standards and guidelines byprivate providers, and 3) a CDC studydocumenting that 40% of privateproviders do not use a recommendedtreatment regimen (Sumartojo EM,Geiter LJ, Miller B, Hale BE. Canphysicians treat tuberculosis? Report ona national survey of physician practices.Am J Public Health 1997;87:2008-11).In addition, in 2004 DTBE and thethree Model TB Centers developed anational strategic plan for TB trainingand education in conjunction withexperts in TB and education, healthcare providers, and other partners. The

plan states that private providers whoserve high-risk populations need to learnabout TB diagnosis, treatment, andmanagement(www.nationaltbcenter.edu/strategicplan/).

Thanks to the Organizers. A coordinatinggroup representing the New England TB programs, the Regional Training and Medical Consultation Centers(RTMCCs), and DTBE organized thecourse. These contributors to the NewEngland TB Case Series included KathyHursen (Massachusetts TB Program),Judy Proctor (New Hampshire TBProgram), Rajita Bhavaraju(Northeastern RTMCC), and MarkLobato, Subroto Banerji, Regina Bess,and Judy Gibson (DTBE).

Reported by Erin Howe, MPHRegional Training and Medical ConsultationConsortium – New England

Kathy Hursen, RN, MSMassachusetts Division of TB Preventionand Control

Mark Lobato, MD, New England TBConsultant, Division of TB Elimination

Lisa Roy, TB EducatorNew Hampshire TB Program Division ofPublic Health Services

Eliminating Tuberculosis Case by Case: AnEducational Initiative by New England TB Programs

Supplement: On April 11, Dr. Joseph Gadbaw, Jr. from the Lawrence and Memorial Hospital in New London, CT conducted a case presentation involving a patient with TB meningitis and HIVinfection. The replay can be accessed through October 2006 at:https://www.mymeetings.com/nc/join.php?i=PG1678747&p=2006&t=r.On June 21, Dr. John Landis, Chief of Pulmonary Medicine at theBayside Medical Center in Springfield, MA will present a case involvinga patient with pulmonary TB (See page 11 of this newsletter fordetails). Future cases presentations will be scheduled every 2 to 3months.

For the past 11 years, the MarylandDepartment of Health and MentalHygiene, Division of TB Control, hasprovided a 3-day course on the basics oftuberculosis diagnosis, treatment andcase management for local healthdepartment personnel. The goal ofMaryland TB Today is to provide a basictraining in TB prevention and controland TB program and case managementfor local health department andcorrections staff. It is preferred thatparticipants have at least four to sixmonths experience in TB control, butveteran staff from low incidence areasmay attend to update their knowledgeand skills. Each year a limited number ofspaces are available for TB control stafffrom neighboring jurisdictions. Thenumber of participants is limited to 30,in an effort to facilitate an interactiveexchange. Participants are expected toattend all three days of the program,which is offered at no cost to Marylandstaff. The training is held at aconference center located in centralMaryland. Meals are included, andovernight lodging is available for thosewho live a great distance away or havetransportation concerns.

Topics are covered by locally

recognized experts in the field, andrange from pathogenesis of tuberculosisto patient education to infectioncontrol. Practitioners, epidemiologists,and others from local TB clinics, theMaryland State TB Control office andTB laboratory, the Johns HopkinsSchool of Medicine and TuberculosisResearch Center, and the MarylandOffice of New Americans share theirknowledge and wisdom with attendees.Veteran TB case managers from localhealth departments share experiencesand lessons learned. Mycobacteriologylaboratory staff provide information onthe tests done for diagnosis andtreatment of TB. And TBEpidemiologic Studies Consortium staffdiscuss current research activities andgenotyping. Collaboration with a localcommunity college has been veryvaluable and continuing educationcredits are offered.

Maryland TB Today was developed inresponse to local health departmentrequests for comprehensive TB training.The course combines lecture formatwith interactive exercises whereapplicable, with ample opportunity fordiscussion and questions. On the finalday of the program, the group is divided

into teams who work through asimulated contact investigation,participate in a game of TB Jeopardyand engage in a group discussion on themanagement of several comprehensivecase studies; thus bringing together allthe aspects of TB prevention andcontrol that were presented throughoutthe training.

Evaluations of the program arerequested of all attendees, and in 2005 a95% “good to excellent” overall ratingwas achieved. Presentations andactivities not rated well are modified,which allows us to maintain the highquality of the training. We consider thiscourse one of our most important; notonly providing an avenue for TBeducation, but also a critical opportunityto network with those front-linecolleagues so critical to TB Control. For more information about this course,contact Cathy Goldsborough at 410-767-6692.

Submitted By Cathy Goldsborough, RNNurse ConsultantMaryland Department of Health & MentalHygieneDivision of TB Control, Refugee, andMigrant Health

Maryland TB Today Training Course

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6 NORTHEASTERN SPOTLIGHT SUMMER 2006W

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W CDC Fact Sheet: Respiratory Protection in Health-CareSettings (April 2006)http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/rphcs.pdf.

Based on CDC’s 2005 Guidelines for Preventing theTransmission of Mycobacterium tuberculosis in Health Care Settings(http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf ), this 2-page factsheet presents health care providers with a concise overview ofconsiderations for the selection of respirators and the keyelements in implementing a respiratory protection program.

CDC Fact Sheet: Infection Control in Health-Care Settings(April 2006)http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/ichcs.pdf.

Based on CDC’s 2005 Guidelines for Preventing theTransmission of Mycobacterium tuberculosis in Health CareSettings (http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf), this 2-page fact sheet presents health care providers with a conciseoverview of TB infection control measures and methods fordetermining the infectiousness of TB patients.

CDC Fact Sheet: QuantiFERON-TB Gold Test (March2006)http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250103.pdf.

Based on CDC’s 2005 Guidelines for Using QuantiFERON-TB Gold Test for Detecting Mycobacterium Tuberculosis Infectionhttp://www.cdc.gov/mmwr/pdf/rr/rr5415.pdf, this 2-page factsheet presents health care providers with a concise overview ofhow the test works, its advantages and disadvantages, whenand how the test should be used, and how to interpret the testresults.

New Resources

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starts by promoting adherence toprotocols and standards for individualpatient services and results in better TBcontrol outcomes for the entire program.For the past dozen years it has been astandard management practice at the NewYork City Department of Health &Mental Hygiene (NYC DOHMH)Bureau of Tuberculosis Control. Thenumber of TB cases in the city hasdeclined by more than 74%, from 3,811in 1992 to only 989 in 2005, the first timeever there were fewer than 1000 cases.

Until now, other program areas couldlearn about cohort reviews only byvisiting the NYC DOHMH, attendingthe CDC TB Program Managers Course,or attending a course on cohort reviewoffered by the Charles P. Felton NationalTB Center at Harlem Hospital. Inaddition, staff of the NYC DOHMH andJudy Gibson (CDC) have providedtechnical assistance to programsinterested in adapting and implementingthe process. So far, the following programareas have adapted and implemented thecohort review process in some fashion:• Cities: Boston, Chicago, and Philadelphia

• Counties: Fulton County, GA andNassau County, NY

• States: Hawaii, Massachusetts,Missouri, New York, Utah, andWashingtonThere are many other areas which have

sent teams of program staff to the CohortReview Course and have contacted theRTMCC that are considering applying thecohort review approach to improving theirTB control programs.

Participants from the Heartland andSoutheastern RTMCCs, healthdepartments in El Paso, TX, New YorkCity, Pima County, AZ, the states ofArizona, Arkansas, Pennsylvania, andthe countries of Guyana and Russiaattended the most recent course in NewYork City, March 9-10, 2006. The nextcourse on the Cohort Review Processwill be held in Philadelphia October 18-19, 2006, in collaboration with thatcity’s Department of Public Health.

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

Understanding the TB Cohort Review Process:Instruction Guide and Video (or DVD)

Educating Health Care Workers for TB Interviewing for Contact Investigation

Digging into the personal lives of TBpatients and finding who they may haveinfected is not easy. It can rival thechallenges of any detective.

In response to the great need fortraining in the area of TB interviewing,the CDC contracted with theNortheastern RTMCC back in 2001 todevelop TB interviewing trainingmaterials. After a detailed process oflooking at the many materials alreadydeveloped by TB, STD, and HIVprograms, engaging expert contentreviewers, and field testing the materialswith actual interviewers and trainers,these educational materials will bedistributed by CDC this summer.

The materials consist of self-studymodules for the interviewer and a

facilitator led-training guide for programtrainers. The self-study materials contain4 modules including: Basics of PatientEducation and Communication,Fundamentals of the TB Interview forContact Investigation, CulturalCompetency, and Interviewing inSpecial Circumstances. The print-based,facilitator-led training guide includessections on needs assessment, trainingdesign and delivery, adult learning,developing learning objectives, andtraining evaluation. It holds manyinteractive activities which build onvarious communication skills and can beadapted to fill an area’s specific needs.Building on all of the aspects learnedfrom this project, a video was alsodeveloped and released by CDC in

2004. The video is a “docudrama”which portrays real interviewers inactions, working with the challenges ofhomeless, foreign-born, and privatesector patients.

These materials are a standardizedway to train interviewing staff who arechallenged by either a large case load ofTB patients, or the occasional caseinterspersed with many other diseasemanagement responsibilities.

The materials will be available inprint and on the web athttp://www.cdc.gov/nchstp/tb/pubs/interviewing/default.htm

Submitted by Rajita Bhavaraju, MPHProgram Director, Education and TrainingNortheastern RTMCC

Now, there are exciting new trainingmaterials to orient program managers andhelp train local staff in using an effectiveprogram improvement method. The CDChas released Understanding the TB CohortReview Process: Instruction Guide and Video(or DVD). If you have heard about cohortreviews, but can’t imagine what they reallylook like, or if you want to orient and trainyour staff to engage in this importantprocess, these new educational productsare for you. The three key elements of thecohort review process, preparation,presentation, and follow-up, are clearlyexplained in the self-study guide. It alsoexplores how to custom-tailor the methodand tools to your own program area.

Characters on film bring the cohortreview process to life, illustrating thebenefits of adopting cohort review andhighlighting the role of each cohortreview team member.

Cohort review is a systematic review ofthe outcomes of treatment of patients withTB disease and the related contactinvestigations. It is a health departmentactivity that ensures accountability andleads to improved program performance. It

Worldwide, TB is the leadingcause of death among people infectedwith HIV. Since HIV infectionseverely weakens the immune system,people co-infected with HIV and TBhave a greater risk of developing TBdisease compared to people notinfected with HIV. Moreover, rates ofTB and HIV are higher for theincarcerated than among the generalpopulation. This high level of riskunderscores the critical need fortargeted TB screening and effectivetreatment for co-infected people whoare incarcerated. Many inmates havelittle or no access to health careoutside of correctional systems and mayonly have these health care needsaddressed while in prison or jail.Prevention efforts need to begin theminute inmates enter the correctionalfacility and continue post release.Effective TB control in correctionalsettings protects inmates, staff, visitors,

and the community at large.The NJMS Global Tuberculosis

Institute and the New York/New JerseyAIDS Education and Training Centerdeveloped this resource to address theneed for ongoing education forclinicians working in correctionalsettings. The resource provides current

guidelines for the treatment of latenttuberculosis infection (LTBI) in theco-infected patient and adherencestrategies to improve treatmentoutcomes. A case discussion is alsoincluded to emphasize valuable take-home points for ensuring preventionand successful treatment of TB andHIV. This resource will be availableas an audio-only and audio-visualCD-ROM. It can also bedownloaded in a month at:www.umdnj.edu/globaltb (click on“Products and Resources” and scrolldown to the product title).Continuing education credits will be

available for participation in thisactivity.

Submitted By Anita KhilallHealth EducatorNortheastern RTMCC

Treating the HIV and TB Co-Infected Patient in theCorrectional Setting – A New Training Product

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TB Trivia - Who am I? I was once a mild-mannered

dentist from Georgia who wentwest to cure a consumptivecough. It was there that I foundmy true calling as an ace gamblerwho could not be bested.Although I never cheated(frankly, I didn’t need to), I wasconstantly accused of it and gunsusually finished the arguments.My near lifelong friendship withWyatt Earp would last until Ifinally died from tuberculosis.Wyatt would later write thefinest eulogy I ever could havehoped for, “I found him a loyalfriend and good company. Hewas a dentist whom necessity had

made a gambler; a gentlemanwhom disease had made avagabond; a philosopher whomlife had made a caustic wit; along, lean blonde fellow nearlydead with consumption and atthe same time the most skillfulgambler and nerviest, speediest,deadliest man with a six-gun Iever knew.” After my death, alegend would be borne out of myGunfight at the O.K. Corral andmy image has been immortalizedby numerous Westerns.

For the answer, visit http://en.wikipedia.org/wiki/

Submitted By Anita KhilallHealth Educator Northeastern RTMCC

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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

Working Group on TB among Ecuadorian Migrants:Needs Assessment for Future Training and MedicalConsultation Initiatives

On May 18, a working group on TB among Ecuadorianmigrants held its first meeting in New York City. Ecuadorians,among the fastest-growing groups of migrants in the US, areconcentrated in the Northeast. In 2004, Ecuador ranked 10th

among countries of origin of non-US-born adults with TB inthe US, up from 15th in 1994. In the states of Connecticut,New Jersey, and New York, where over 80% of Ecuadorian TBcases are reported, Ecuador ranks among the top threecountries of origin of non-US-born cases. Many recentEcuadorian migrants come from the Province of Cañar andspeak limited Spanish, being more fluent in Quichua (alsospelled Kichwa), their native language. However, competentinterpretation and translation services for this language arevery hard to find.

In the meeting, three themes were discussed: improving TBcontrol efforts for Ecuadorian migrants in the US,strengthening TB control in Ecuador, and improving bi-national coordination in TB control. Participants came fromthe US, Canada, and Ecuador, from local and state healthdepartments, universities, and international organizations.

Presentations covered the epidemiology of TB in theNortheast US, migration of Ecuadorians to the US, and DOTSexpansion in Ecuador. Work groups discussed the three themesand recommended actions for follow-up. Among therecommendations were making Kichwa linguistic servicesavailable, developing training specifically about working withindigenous persons from Ecuador, and supporting/evaluatingoutreach efforts of local jurisdictions. After getting to knoweach other and discussing common problems and strategies forsolutions, participants agreed that more effective case transferand consultation on medical management may be a result ofthis first meeting. Future meetings will be announced.

Submitted byBill Bower, MPHDirector of Education and TrainingCharles P. Felton National Tuberculosis Center

Ruth Wangerin, PhD, MPHPace University, Department of Anthropology

NE RTMCC Training Courses Planned for 2006NAME OF COURSE TARGET AUDIENCE DATE(S) LOCATION

QuantiFERON-TB Gold: Putting New Physicians, Nurses June 26 NOT APPLICABLETechnologies into Practice (A Web-Based Seminar)

TB Clinical Intensive Physicians, Nurses June 27-28 Newark, NJ

Medical Update Webinar: TB and HIV Physicians, Nurses July 12 NOT APPLICABLE

Medical Update Webinar: Medical Physicians, Nurses July 14 NOT APPLICABLEManagement of Index Patients and their Contacts

Basic TB for Health Care Workers HCWs who serve patients at high August 11 Columbus, OHrisk for TB

Training Focal Points Workshop Training Focal Points August 14 Atlanta – TB ETN meeting

Field Staff Webinar: Risk Communication Disease Investigators, September NOT APPLICABLEPublic Health Nurses, Outreach Staff

Medical Update Webinar: Pediatric TB Physicians, Nurses October 4 NOT APPLICABLE

TB Field Investigation Disease Investigators, October 10-11 Newark, NJPH Nurses, Outreach Staff

Cohort Review Methodology NYC Disease Investigators, October 18-19 Philadelphia, PAPublic Health Nurses

TB Case Management for Nurses Course Nurse Case Managers October 23 NE TB Controllers Meeting, Princeton,New Jersey

Northeastern TB Controllers Meeting TB Program Staff October 24 Princeton, NJ

Field Staff Webinar: Basics of TB All TB Control Staff November 9 NOT APPLICABLEInterview for Contact Investigation

Infection Control Course Infection Control Practitioners, November 14-15 Newark, NJProgram Management Staff

Regional TB Conference New England TB Control Staff November 16 Western MA

Field Staff Webinar: The Congregate TB Program Staff December 6 NOT APPLICABLESetting Contact Investigation

Check our website for full information and to confirm dates: www.umdnj.edu/globaltb (Click on “Education and Training”)

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

MD Annual TB TB Clinicians MD Sept 14 Clarksville, MD Arlene HudakMeeting 410-767-6698

MA Regional TB TB Control & New England Sept 28 Northeast MA 978-851-7261 X4075Conference clinical staff 978-851-7261 X4049

New England Eliminating TB Providers and New England June 21 Web-based https://www.TB Programs Case by Case Clinicians September mymeetings.com

/nc/join/Conference #: PG7958836Passcode: TBCASEToll Free Number 800-857-0637Leader: Dr. Mark Lobato

NY City New Staff New NYC staff, NY City June 12-30 253 Broadway, Martha AlexanderTraining especially PHAs NYC 212-442-9983

malexan1@health.nyc.gov

NY City Tuberculin Non-NYC NYC & Sept 2006 253 Broadway, Elvy Barroso Skin Test HD staff Vicinity NYC 212-676-2914Administration ebarroso@

health.nyc.gov

PA 2006 TB Correctional PA June 1 Elizabethtown Terri WilsonUpdates ICNs Training 717-787-6267

Academy terwilson@state.pa.us

PA 2006 Clinician TB Clinicians PA June 16 Central Terri WilsonConference Pennsylvania 717-787-6267

College terwilson@state.pa.us

PA TB PA TB PA July 16-20 TBD Terri WilsonFundamentals Field Staff 717-787-6267Course terwilson@state.pa.us

PA 2006 TB PA TB PA Fall TBD Terri WilsonSymposium Field Staff 717-787-6267

terwilson@state.pa.us

WV Infectious Providers, WV Oct 18-19 Charleston, Scott ArringtonDisease Clinicians, WV scottarrington@Conference Local HD Staff, wvdhhr.org

Students in Health Professions