Lessons Learned

1
New Concepts in TB Control
Internet-Based Strategies for Reaching
Providers The New England Experience Mark
Lobato, Kathy Hursen, Erin Howe, Lisa Roy,
Judy Proctor, Helen McCarthy, Subroto
Banerji, CDC-DTBE, Massachusetts Division of
TB Prevention and Control, Northeast RTMCC, New
Hampshire TB Program, Rhode Island Office of
Communicable Diseases
NewEnglandTB.com
Eliminating TB Case by Case
One size does not fit all
New England TB, 2004
Background

• Developed a team with expertise
• Built a website to
• Increase cohesiveness and visibility
• Promote regional and state education
• Exchange tools and materials

• Providers present their cases
• Designed to reach private providers
• Created basis for distance learning
• web-based
• continuing education credit
• Held 3 successful presentations
• Need to market case series

Type of Provider (), 2004

• In 2005, the 6 New England TB programs started
  collaboration on a new approach to TB elimination
  by
• Building program capacity on a regional level and
• Identifying strategies for collective problem
  solving

• TB cases
• 486 cases
• 3.4 / 100,000 (range 1.2-4.3)
• Cases increased in 3 states
• MA (9)
• RI (10)
• NH (59)

90

• Maine, NH, and VT do not have outreach staff
• Connecticut and Mass. are organized into health
  districts

80
70
60
CT
A New Model of TB Control
MA
50
ME
40
NH
The traditional model of TB control is no
longer the optimal approach. CDC.
Controlling Tuberculosis in the United States,
2005
RI
30
VT
20
10
0
HD
Private
Both
Why Regionalization?
Resources
New England Regional Plan
Percent Foreign-born TB by State and Year

• The purpose of TB regionalization is to mobilize
  and coordinate broad collaborative actions
• The approach uses existing infrastructure

• State
• TB programs/health departments
• Schools of Public Health
• Regional
• TB Advisory Committees
• RTMCC
• CDC
• DTBE
• PHPS, Informatics

• The regional plan revolves around 5 strategies
• Communication
• Education
• Universal genotyping
• Program evaluation
• Consultation

90
80
70
What can regionalization do for TB control?
60
2002
50

2003

• Expand expertise
• Build on the diversity of experiences and
  practices
• Involve stakeholders
• Increase ability to affect health
• Strengthen advocacy

Genotyping Database
40
2004
30

• Work group defined data management capacity and
  needs
• Planning for a web-based regional data set
• Collaborated around CT cluster

TB Education Objective
The Internet as a Regional Tool
20
10
Support and assist the Northeast RTMCC for the
purpose of planning and promoting region-wide
training and education of staff, providers, and
patients using in-person or distance modalities.

• The Internet is a tool we have used for building
  program capacity.
• Educational series
• TB Case Series for Providers and Clinicians
• NewEnglandTB.com website
• To share materials and experiences
• Genotyping database

0
Lessons Learned
CT
ME
MA
NH
RI
VT
State

• The Internet is a useful tool for building
  program capacity
• Modern TB control requires
• Coordination
• Collaboration across jurisdictions
• Regional efforts offer benefits to state programs
  and to CDC