CNTC Newsletter Archive — Fall 2010
A quarterly electronic newsletter from the Francis J. Curry National Tuberculosis Center (CNTC)
About CNTC
CNTC creates, enhances, and disseminates resources and models of excellence, and performs research to control and eliminate TB in the United States and internationally.
CNTC is designated by the Centers for Disease Control and Prevention (CDC) as the Regional Training and Medical Consultation Center (RTMCC) for the Western Region, serving 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.
Committed to the belief that everyone deserves the highest quality of care in a manner consistent with his or her culture, values and language, CNTC develops and delivers highly versatile, culturally appropriate trainings, educational products, medical consultation, and technical assistance.
TB Control in the Western Region
CNTC Newsletter is proud to highlight TB control programs in CNTC’s Western Region of the United States. In this issue, we feature the Utah Tuberculosis Control Program.
For the 2,700,000 residents of Utah (“Utahans”) living among 29 counties (ranging in size from 600 to 8,000 square miles), there is ample room to stretch one’s legs. Utah’s population density is quite low – less than half the national average. Most Utahans (80%) live in the region surrounding and including the state capital, Salt Lake City. Although vast areas of the state have almost no residents, and nearly three-quarters of the land is government-owned, Utah is clearly a state on the move. It was the fastest growing U.S. state in 2008, with the highest birthrate and the youngest average population in the nation. The Utah economy centers on transportation, information technology, government services, mining, ranching, outdoor recreational tourism, and yes, salt production. Over half of Utahans are reported to be members of The Church of Jesus Christ of Latter-day Saints. The church is a major influence on life in Utah, but certainly not a monolith; Utahans embrace a cultural spectrum that includes both the Mormon Tabernacle Choir and the Sundance Film Festival.
In 2008, Utah officially achieved the Healthy People 2010 goal of a TB incidence rate of 1.0 per 100,000 persons. Low TB incidence is nothing new to the state; for 16 years, Utah’s case rate has been less than one-third of the national rate. Not surprisingly, the majority of Utah’s TB morbidity occurs in the Salt Lake Valley Health District, an area that serves Utah’s population center. In 2009, the total number of TB cases (37) was slightly higher than 2008, but overall there has been a declining trend since 1993. Throughout the U.S., foreign-born persons bear a disproportionate burden of TB, and this is especially true in Utah. Looking at 2009, fully 95% of all reported TB cases were either foreign-born persons (70%); persons born in U.S.-affiliated islands (8%) or U.S.-born persons with a foreign connection, such as foreign-born parents or travel to a high-incidence country (16%). From 2005-2009, foreign-born TB patients in Utah came from 32 different countries; the top four countries of origin were Mexico, Vietnam, Peru, and Somalia. For the seventh consecutive year, Hispanics constituted the single largest percentage of TB cases among all racial/ethnic groups in Utah (41% in 2009).
Led by TB Controller Cristie Chesler, Utah’s TB Control Program resides within the Utah Department of Health, Bureau of Epidemiology. Utah’s low rate of TB means that Ms. Chesler’s program has fewer patients to treat for active disease, but much effort is devoted to targeted testing and treatment for latent disease – two essential activities that keep active disease rates low. The program coordinates a number of TB screening programs for sites with high-risk populations, including schools, migrant work sites, homeless shelters, and jails. For patients with active TB disease from 2005-2009, an impressive 96% had all doses of their medications given by directly observed therapy (DOT). Ms. Chesler comments on recent challenges: “Although Utah is a low-morbidity state, cases are becoming increasingly more complicated to manage. Of the three MDR-TB cases diagnosed in Utah over the last two years, one was HIV co-infected, one involved an extensive contact investigation, and one had complex immigration and mental health issues.”
Utah was one of four states recently involved in a five-year research project, “Regional Capacity Building in Low Incidence Areas,” conducted by the Tuberculosis Epidemiological Studies Consortium. Utah has the essential components for TB control in place including: legal authority and updated policies and procedures; programmatic and clinical oversight to ensure quality improvement; and diagnostic and treatment capacity for managing TB cases, including a designated Secured TB Unit, a special asset, according to Ms. Chesler: “While no one has been involuntarily isolated in the Secured TB Unit for over five years, the Unit has been used, on a regular basis, to isolate and treat unfunded and/or homeless patients. We consider ourselves quite fortunate to have such a Unit at our disposal.”
With her eyes on the horizon, Ms. Chesler reflects on the future of TB control and public health in Utah: “We in the TB Control Program feel very fortunate to live in such a beautiful and prosperous state. We look forward to continuing our work towards eliminating tuberculosis in our community. In the words of Yogi Berra, ‘You got to be careful if you don't know where you're going, because you might not get there.’”
CNTC Collaborates with Regional Training Organizations
In an era of dwindling public health resources across clinical disciplines, CNTC is collaborating with other federally-funded training centers (FTCs) to focus on the connections among health issues such as TB, HIV-AIDS, viral hepatitis, and sexually transmitted diseases (STDs). Integrating prevention activities and delivering services to patients efficiently is critically important, and this integration begins with the training of the workforce.
CNTC has a strong history of collaboration, especially with its colleagues in the field of HIV-AIDS training. In 2002, CNTC first partnered with the Pacific AIDS Education and Training Center (PAETC) to plan and implement the annual HIV Faculty Development Conference. HIV is the greatest risk factor for progression to TB disease, and this collaboration was a valuable opportunity for TB experts to share their knowledge with HIV faculty/trainers from across the western region, and to encourage health educators to further incorporate TB information into their HIV-AIDS curricula. CNTC has also worked with the UCLA AETC for the last six years to develop and present the TB, STDs, HIV, Hepatitis C, and Substance Abuse at the Border series, which focuses on the challenges faced by healthcare workers who serve at-risk bi-national patients.
In 2010 CNTC and other western region FTCs, working with a grant from CDC’s Minority AIDS initiative, developed and conducted two courses for those working with under-served migrant populations in California (Fresno) and Washington (Yakima).
The integrated training approach across clinical disciplines isn’t just a good idea, it is also a cornerstone of CDC’s Program Collaboration and Service Integration (PCSI or “pixie”) initiative which was officially rolled out in 2008. PCSI is a strategic priority designed to strengthen collaborative work across disease areas and integrate services that are provided by related programs.
All four RTMCCs now partner with regional health training organizations, including the AETCs, STD/HIV Prevention Training Centers, Addiction Technology Transfer Centers, Centers for Health Training (Family Planning), and Viral Hepatitis Centers. In July, representatives from these federally-funded training centers met for a summit in Kansas City to strategize further collaborative efforts over the next two years. In helping to lead these efforts, CNTC believes the ultimate result will be holistic prevention services that benefit all patients and help streamline the healthcare system in the U.S.
CNTC Products
Educational products developed by CNTC provide learning opportunities, resources, and tools for TB programs and providers. Available in December 2010: Asking the Right Questions – A Visual Guide to TB Case Management for Nurses.
Asking the Right Questions is a web-based educational toolkit for classroom instruction or self-paced learning that is designed to:
- Prompt critical thinking about TB case management
- Direct healthcare workers to applicable basic national training materials
- Provide an overview of the full case management timeline
This toolkit was borne from the reality that care for patients with TB disease is shifting to agencies and staff unfamiliar with TB case management. Because there is no single, step-by-step procedure to assess and treat TB disease, training in critical thinking is needed to help healthcare workers carefully collect data on the patient and consult guidelines.
The target audience for Asking the Right Questions is primarily nurses in the public and private health sectors, but also includes outreach workers, healthcare workers in facilities where cases are found, and community-based providers who may identify TB suspects or help to treat patients with TB.
Two TB professionals made important contributions to develop this product. Kim Field, of the Washington State TB Control Program, came up with the initial idea for the product and served as a subject matter expert throughout its development, and Dr. Masae Kawamura of the San Francisco TB Control Program provided her expertise as the medical content reviewer.
Watch for Asking the Right Questions on the CNTC website in December.
Upcoming Training Courses
CNTC’s schedule of upcoming training courses (through September 2011) offers a variety of courses for clinicians and public health providers.
January 12, 2011
National Web-based Seminar
Alcohol, Cigarettes, and TB
Ninety-minute web-based seminar for clinicians and others who provide services to TB patients or persons at risk for TB with significant alcohol and/or tobacco use.
February 15-17, 2011
San Francisco CA
Tuberculosis Clinical Intensive
Three-day intensive for physicians and other licensed medical professionals who diagnose and treat tuberculosis.
March 16-19, 2011
San Francisco CA
Case Management and Contact Investigation Intensive
Four-day training for nurses, communicable disease investigators, and medical social workers.
May 4-5, 2011
Seattle WA
Tuberculosis Clinical Intensive
Two-day intensive for physicians and other licensed medical professionals who diagnose and treat tuberculosis.
May 6, 2011
Seattle WA
Nurse Case Management Workshop
One-day update for nurses, communicable disease investigators, and other licensed medical care providers who work with tuberculosis patients
August 23-26, 2011
San Francisco CA
Tuberculosis Program Manager's Intensive
Four-day intensive for nurses, physicians and other health professionals working as tuberculosis program managers.
September 20-22, 2011
San Francisco CA
Tuberculosis Clinical Intensive
Three-day intensive for physicians and other licensed medical professionals who diagnose and treat tuberculosis.
For periodic updates on additional trainings, complete course descriptions, and application forms, view our training section.
Faculty Profile
To better acquaint our readers with the corps of TB experts that comprise our training and medical consultation faculty, each issue of CNTC Newsletter presents a profile of a CNTC faculty member. In this issue we feature Edward P. Desmond, PhD.
It is certainly gratifying to gain acclaim in one’s chosen profession by winning an award. But to have an award actually named for you is an honor very few people achieve. Edward P. Desmond, PhD, has earned that distinction for his distinguished career as a laboratorian, specializing in tuberculosis and many other mycobacteria.
Dr. Desmond was born in Buffalo, New York, but spent most of his childhood in California. He studied biology as an undergraduate, earning his Bachelor of Science degree from The University of Santa Clara in northern California. After completing Clinical Laboratory Technology training at San Jose Hospital, Dr. Desmond ventured to Lubbock, Texas, to pursue his PhD degree in microbiology (with a minor in chemistry) at Texas Tech University. Back in California, a postdoctoral fellowship in medical microbiology at the California Department of Health Services was followed by a two-year stint as a virologist with the Microbiology Laboratory at the San Francisco Department of Public Health. Dr. Desmond was mentored there by Dr. Art Back and came to appreciate the state’s strong local public health laboratory system.
At this point in his career, the East Coast beckoned to Dr. Desmond, and he began a productive seven-year association with The Mount Sinai Medical Center’s Department of Microbiology in New York, serving in increasingly responsible academic and administrative roles. Concurrently, he was also Chief of the Microbiology Section of Laboratory Service at the Veterans Administration Medical Center in the Bronx. This experience helped him to become board certified in Public Health and Medical Microbiology by the American Board of Medical Microbiology.
Returning to Northern California in 1986, Dr. Desmond worked as Laboratory Manager for Doctors Hospital in Pinole for several years before returning to the site of his postdoctoral fellowship, the California Department of Health Services in Berkeley (now called the California Department of Public Health [CDPH] and located in nearby Richmond). As a Research Scientist Supervisor in the Microbial Diseases Laboratory, Dr. Desmond is responsible for the Mycobacteriology and Mycology Section.
In addition to his work for the State of California, Dr. Desmond contributes his expertise to several national committees, including the American Thoracic Society’s Working Group on TB Susceptibility Testing, and the Clinical and Laboratory Standards Institute’s Subcommittee on Antimycobacterial Susceptibility Testing.
Research articles about various laboratory issues and tuberculosis that bear Dr. Desmond’s name have appeared in publications such as the Journal of Clinical Microbiology, Emerging Infectious Diseases, the International Journal of Tuberculosis and Lung Disease, and the American Journal of Tropical Medicine and Hygiene. He also serves on the Editorial Board of Clinical Microbiology Reviews. For over 20 years, he has lectured for the Northern California chapter of the Philippine Association of Medical Technologists, participating in review classes for license examinations and continuing education.
Dr. Desmond’s presentations on laboratory methods at CNTC clinical and program management intensive courses are highly praised by participants, who routinely comment on his ability to clearly explain technical information, and to make complex topics compelling, accessible, and relevant to health providers. Dr. Desmond was also a key contributor to the joint CNTC/CDPH publication, Drug-Resistant Tuberculosis: A Survival Guide for Clinicians.
In 2010, the National Tuberculosis Controllers Association established the “Ed Desmond Award” to annually recognize a tuberculosis laboratorian for outstanding tuberculosis laboratory services. The inaugural award went to Grace Shou–Yean Lin, MS, who works alongside Dr. Desmond in the CDPH Microbial Diseases Laboratory. Ms. Lin commends her longtime colleague: “Dr. Desmond generously shares his vast knowledge of mycobacteriology with me. We work together seamlessly and have brought several important projects to fruition, such as the development of a test for detection of MDR-TB using molecular beacon technology, and the validation of second-line drug susceptibility testing of Mycobacterium tuberculosis by MGIT 960. Currently we are participating in a project to build a new TB laboratory in North Korea and an XDR-TB project sponsored by the National Institutes of Health. Working on these pivotal projects, as part of the global effort to fight TB, is an unforgettable life experience.”
Back Issues of CNTC Newsletter Now Archived Online
Previous issues of CNTC Newsletter (reaching back to Summer 2006) are now available on the CNTC website. Visit the archives.
Contact Us
Francis J. Curry National Tuberculosis Center
3180 18th Street, Suite 101
San Francisco, CA 94110-2028
Telephone: 415-502-4600
Fax: 415-502-4620
Warmline TB medical consultation: 877-390-6682 (toll-free) or 415-502-4700
tbcenter@nationaltbcenter.ucsf.edu
www.nationaltbcenter.ucsf.edu
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CNTC Newsletter
CNTC Principal Investigator: Philip C. Hopewell, MD
RTMCC Co-Principal Investigators: Philip C. Hopewell, MD, and L. Masae Kawamura, MD
Task Order #1 Principal Investigator: Elizabeth Fair, PhD
Task Order #19 Co-Principal Investigators: Elizabeth Fair, PhD, and Christine Ho, MD
RTMCC Medical Director: Lisa Chen, MD
CNTC Director: Tom Stuebner, MSPH
Training Administrator: James Sederberg
Research Administrator: Baby Djojonegoro, MS, MPH
CNTC Newsletter Editor: Kay Wallis, MPH
CNTC Web Developer: Mari Griffin, MS