Update from TB Infection Control Sub-working Group

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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
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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

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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 Is Meeting, WHO HIV Dept. April 08
• 2nd Task Force Meeting on MDRTB April 08

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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 Is 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

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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

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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

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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?

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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

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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
• Participants Manual with slides
• Facilitator and course director manual
• Available by end of 2008.
• Country training material also being developed.

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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)

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TB Infection Control is not a quick fix.

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TB Infection Control must become a campaign.

• Strategy
• Workplan
• Targets
• Monitoring
• Advocacy
• Community involvement
• Resources

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WHO DOTS Strategy for TB