CITC Newsletter — Spring 2014
An electronic newsletter from the Curry International Tuberculosis Center (CITC)
CITC celebrates 20th anniversary of its founding (1994-2014)
2014 marks the 20th anniversary of the grand opening of the Francis J. Curry National Tuberculosis Center, named for Dr. Francis Curry (1911-1996), former director of the San Francisco Department of Public Health (SFDPH) and its TB Control Section. Dr. Curry was a pioneer in community-based, patient-centered TB control. Renamed “Curry International Tuberculosis Center” in 2011, the Center has evolved in several directions in its two decades of existence.
Highlights of the Center’s first twenty years include:
1994: The Francis J. Curry National Tuberculosis Center opens, funded by the Centers for Disease Control and Prevention (CDC) as one of three national “Model Centers of Excellence” in TB training and consultation. The Center was a joint project of the San Francisco Department of Public Health TB Control Division, and the Division of Pulmonary and Critical Care Medicine at University of California, San Francisco.
1995: The Center broadcasts its first satellite teleconference to a national audience of health care providers: Scientific Basis of TB Control, based on an ATS postgraduate course. Two subsequent satellite teleconference series broadcast in 1997 and 2000 reached a combined audience of 20,000 medical professionals.
2001: The Center becomes one of twenty-one sites that participate in the TB Epidemiologic Studies Consortium (TBESC), a network of public health, academic, and non-profit organizations funded through the Centers for Disease Control and Prevention to perform TB epidemiologic and operations research. From 2003-2008, the “Regional Capacity-Building in Low-Incidence Areas” project identified best practice models for regional capacity-building in Idaho, Montana, Utah, and Wyoming.
2002: Curry Center is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide category 1 continuing medical education credit to physicians.
2005: The Curry Center is designated by the CDC as one of four Regional Training and Medical Consultation Centers (RTMCCs). The Center’s Western Region service area includes 15 jurisdictions: Alaska, California (including Los Angeles, San Diego, and San Francisco), Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, Wyoming, and the U.S. Pacific Island Territories.
2005: The Curry Center broadcasts its first live webinar: Tuberculosis Clinical Web-based Workshop. Presented over four consecutive weeks, this training was targeted specifically to the states of Nevada, Oregon, and Alaska.
2006: Curry Center research associates develop the Systematic Reviews Series on TB Diagnostics. These series shed light on the methods and effectiveness of sputum smear microscopy and serological tests for TB.
2008: The Center releases Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, a co-production with the California Department of Health Services (now the CA Department of Public Health), TB Control Branch. The Guide becomes a standard resource for the management of patients with multidrug-resistant TB (MDR-TB) and has widespread impact and distribution (viewed/downloaded over 75,000 times; 9,000 print copies distributed; translated into Spanish and Mandarin Chinese). The fully revised 3rd edition is scheduled for release in early 2015.
2010: The Curry Center submits its CME program for an exhaustive review by ACCME for accreditation renewal. ACCME bestows on the Center its Accreditation with Commendation, the highest award given by the organization and one that bestows a six-year term of renewal.
2011: To continue honoring Dr. Curry’s vision and legacy while at the same time recognizing the global importance of TB, the Center is renamed the Curry International Tuberculosis Center (CITC).
2012: After a nationwide competition, CITC is chosen by CDC to continue serving as an RTMCC for the Western Region for a new five-year funding cycle. The Center’s service area includes 13 jurisdictions: Alaska, California (including Los Angeles, San Diego, and San Francisco), Colorado, Hawaii, Idaho, Nevada, Oregon, Utah, Washington, and the U.S. Pacific Island Territories. Lisa Chen, MD, succeeds Phil Hopewell, MD, as the RTMCC principal investigator; James Sederberg assumes duties as Deputy Director.
Twenty year milestones:
- Education and training delivered to over 35,000 participants, providing over 44,000 CME (physician contact hours) and over 100,000 CNE (nursing contact hours) to participants via 320 live trainings and live, online education opportunities
- Over 10,000 medical consultations provided via the TB Warmline
- 53 educational products developed and more than 55,000 copies disseminated
- Over 2.2 million website visits from 650,000 visitors supported
“TB is getting complicated again.”
An interview with CITC co-founder Phillip C. Hopewell, MD
As the Curry Center celebrates its 20th year as a TB training and medical consultation center, CITC Newsletter caught up with CITC co-founder Dr. Phil Hopewell for an interview on March 19, 2014. In the following excerpts, Dr. Hopewell discusses his current international work in TB, and shares his vision for the Curry Center in the years to come.
Newsletter: What are you working on these days?
Hopewell: “I’m spending a lot of time with the Curry group on international technical assistance, which is interesting in itself and also provides opportunities for operational and implementation research. We’re taking the lessons we’ve learned here [in the U.S.] and applying them to several high-burden countries; right now we’re working quite a bit in Indonesia. Specifically, we’re collaborating with Indonesia’s National TB Program, systematically involving private practice providers in TB care. Another project, led by Lisa Chen, looks at the quality of MDR-TB treatment via cohort reviews, with a focus on clinical issues and system barriers; another project is evaluating performance of primary care clinics in identifying patients who should be evaluated for TB.”
Newsletter: What part of your work gives you the most satisfaction?
Hopewell: “It’s satisfying to bring in the private sector, especially our work with the Indonesian professional societies as a vehicle for improving care. In Indonesia, compared to other parts of the world, there is a well-organized pulmonary society, and there are good resources with which to work. Indonesia’s large population means that the number of TB cases is quite high. Even though the incidence of drug-resistant TB is lower than other parts of the world, the number of cases is still challenging.”
Newsletter: Your UCSF colleagues honored you in 2008 with a Lifetime Achievement in Mentoring Award. If someone is just starting his/her career and has an interest in tuberculosis as a clinical and/or research focus, what do you advise?
Hopewell: “The paths to a career focused on TB are still through pulmonary, infectious disease, or epidemiology training. Currently, because TB has been on the decline for some time domestically, there’s more opportunity to build a career that emphasizes TB internationally. Although TB principles are the same everywhere, the circumstances of international work are very different. My advice is to pick out a technical assistance or research area and do it a lot, become an expert.”
Newsletter: What’s your vision for the Curry Center in the next 20 years?
Hopewell: “TB is becoming complicated again, especially with co-morbidities such as diabetes and immunosuppressive diseases. For that reason I think increasingly, Curry will be a consultation center, giving even more detailed clinical consultation than we do now. Large-scale training is likely to become less important, except there will always be a need for training in core public health functions, such as contact investigation. I see the Center playing a role in helping to build private/public collaborations. In the future I could see Curry having increasing emphasis on other respiratory illnesses, such as COPD and asthma.”
Phil Hopewell is an internationally recognized pulmonologist, renowned for his TB research. He is a Professor of Medicine at UCSF’s Department of Medicine, and practices pulmonary and critical care medicine at San Francisco General Hospital. Dr. Hopewell is a co-developer of the International Standards for Tuberculosis Care. In 2004, he received the American Thoracic Society’s Edward L. Trudeau Award. In 2009, the Japanese Anti-TB Association presented him with the Princess Chichibu Memorial TB Global Award; and in 2011 he was honored with a
On December 5, 2013, Dr. Hopewell was one of several featured speakers at “The Century Ahead,” a day-long symposium in San Francisco that commemorated 100 years of advances in the response to tuberculosis in California. Listen to Dr. Hopewell’s presentation, “Embedding Research in TB Control Programs: The Curry Legacy”
3rd edition of International Standards for TB Care (ISTC) now available
An updated third edition of International Standards for TB Care (ISTC), including a new mobile app version, are now available. Developed by TB CARE I with funding by the United States Agency for International Development (USAID), ISTC describes a widely accepted level of care that all practitioners, public and private, should seek to achieve in managing patients who have, or are suspected of having, TB.
Since Edition 2 of the ISTC was published in 2009, new information has emerged, new approaches are now feasible, and new guidelines have been written. Edition 3 presents an update of the ISTC to be consistent with the concept of a “living document,” while maintaining the basic principles that underlie the original ISTC document: that case detection and curative treatment remain the cornerstones of tuberculosis care and control.
A new mobile app version of ISTC provides: quick access to essential information and best practices for managing TB; specialized algorithms with step-by-step guidance for diagnosing and managing TB patients, and dosing tables and guidance on drug interactions.
Images from World TB Day 2014
World TB Day was observed on March 24, 2014, with several variations on the theme, “Find TB. Treat TB.” Colleagues from far and wide shared images from the day.
Briefing the U.S. House of Representatives TB Elimination Caucus in Washington, D.C. (L to R): Jonathan Mermin, MD, MPH (CDC); Jennifer Flood, MD, MPH (National TB Controllers Association); Diana Weil (WHO); Phil Hopewell, MD. (credit: ATS)
Charity Thoman, MD, MPH, of the Santa Barbara County (CA) Public Health Department, successfully advocated against repeal of Assembly Bill 803 (the Gotch law), a 1993 legislative act that modernized the California TB control statute and outlines the due process related to TB orders and detention.
Pennan Barry, MD, MPH, at a press conference held at the Curry Center in Oakland, CA, explains that a new case of TB is diagnosed every 4 hours in California, and a death from TB occurs every other day in the state.
In Jakarta, Indonesia, a cured patient expresses her gratitude to Dr. Erlina Burhan, head of the MDR Clinical Team.
Hawaii TB Controller Richard Brostrom, MD, MSPH, with Denise Garrett, MD, and Dolly Katz, PhD, notes that the Hawaii TB Program is one of ten TB centers in the U.S. participating in the TBESC research project at CDC.
See more photographs on the Curry Center’s Facebook page.
Notes from the Field
Recent TB field notes include a Union award for Alaska’s TB nurse consultant; a collaborative training in TB-HIV-HCV for Los Angeles providers; updated self-study modules from the CDC; and a new online TB imaging resource.
Alaska TB Nurse Consultant Karen Martinek, RN, MPH, recently received an Outstanding Service Award from the Union-NAR. A consultant on the CITC Warmline service since 2010, Ms. Martinek accepted the award at an evening ceremony on February 28, 2014, during the 18th annual meeting of Union-NAR in Boston, Massachusetts.
On February 25, 2014, CITC co-sponsored a day-long symposium for over one hundred health care clinicians, advocates, and administrators in Los Angeles, titled: Alphabet Soup: HIV, TB, HCV, and the ACA in LA. Expert speakers presented updated treatment and referral information and the intersections of HIV, TB, and HepC in the Los Angeles area, and reviewed the impact of the Affordable Care Act (ACA) on these epidemics. Co-sponsored by the three AIDS Education and Training Centers based at USC, UCLA, and Charles Drew University, the Alphabet Soup event underscored the importance of collaborative training for providers who share overlapping patient populations. View the slides from the symposium.
The CDC’s Division of Tuberculosis Elimination (DTBE) recently released its updated Self-Study Modules on Tuberculosis, 6-9. These educational modules provide TB programmatic information in a self-study format for health care workers, such as outreach workers, nurses, physicians, and health educators. Topics include Adherence, Confidentiality, Contact Investigation, and Outbreak Detection and Response. Continuing education (CE) credits are offered free of charge for various professions. Access the modules online.
Imaging of Tuberculosis is a new online education module developed by the International Society of Radiology’s International Commission on Radiology Education (ICRE), through the Global Outreach Education project (GO ED), in collaboration with CITC and many of the world’s leading radiology societies, NGOs, and TB resource groups. This free online archive offers an array of recorded lectures, slide lectures, literature, manuals, case studies, and a section on pediatric TB. Visit Imaging of Tuberculosis
“The Century Ahead” Symposium Presentations Now Available
On December 5, 2013, nearly 200 scientists, public health professionals, and policymakers from around the country met at a day-long symposium in San Francisco to commemorate 100 years of advances in the response to tuberculosis in California. Titled, The Century Ahead: Tuberculosis Science, Public Health, and Policy, the event assembled an impressive roster of speakers, and their presentations are now available online.
Coinciding with the centennial anniversary of the creation of the state’s “Bureau of Tuberculosis” within the State Board of Health in 1913, the symposium showcased the innovations and complex science and public health interface required to achieve success in the century ahead. Symposium speakers included Peter Small, MD (Gates Foundation); Charles Daley, MD (National Jewish Health); David Dowdy, MD, PhD, ScM (Johns Hopkins University); Jonathan Mermin, MD, MPH (CDC); Ron Chapman, MD, MPH, Jennifer Flood, MD, MPH; James Watt, MD, MPH, and Gisela Schecter, MD, MPH (CA Department of Public Health); Philip Hopewell, MD, Henry Chambers, MD, and George Rutherford, MD (UCSF); Julie Higashi, MD, PhD (San Francisco TB Control); and Jonathan Fielding, MD, MPH, MBA and Mitchell Katz, MD (Los Angeles County Department of Health).
The symposium was a collaborative project among the California Department of Public Health TB Control Branch; University of California San Francisco; California TB Controllers Association; and Curry International Tuberculosis Center.
CITC’s schedule of upcoming trainings (through November 2014) offers a variety of courses for clinicians and public health providers.
June 24, 2014
Tuberculosis Nursing Workshop
One-day workshop for nurses, communicable disease investigators, and other licensed medical care providers who work with tuberculosis patients
June 25-27, 2014
Tuberculosis Clinical Intensive: New 2-Part Course format
Day 1 Optional (June 25): Focus on LTBI
One-day workshop for nurses, communicable disease investigators, and other licensed medical care providers who work with tuberculosis patients
Day 2-3 (June 26-27): Tuberculosis Clinical Intensive
Two-day intensive for physicians and other licensed medical professionals who diagnose and treat tuberculosis.
Third Quarter (TBD), 2014
September 30-October 3, 2014
Tuberculosis Clinical Intensive
Four-day intensive for physicians and other licensed medical professionals who diagnose and treat tuberculosis.
November 18-21, 2014
Tuberculosis Case Management and Contact Investigation Intensive
Four-day training for nurses, communicable disease investigators, and medical social workers.
Note: CITC is now accepting applications from TB programs within the Western Region for its “On-Demand Webinar program” for 2014. Learn more.
For periodic updates on additional trainings, complete course descriptions, and application forms, view our training section.
Curry International Tuberculosis Center
University of California, San Francisco
300 Frank Ogawa Plaza, Suite 520
Oakland, CA 94612-2037
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Principal Investigator/ Medical Director: Lisa Chen, MD
Associate Medical Director: Ann Raftery, RN, PHN, MS
Deputy Director: James Sederberg
Director of Education: Kelly Musoke, MPH
Program Manager: Jeannie Fong
Epidemiologist: Baby Djojonegoro, MS, MPH
Newsletter Editor: Kay Wallis, MPH
Web Developer: Mari Griffin, MS
Program Assistant: Dominique Reminick, MA