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Northeastern Spotlight
Winter 2016
Volume 11 - Number 1

Dear Colleagues,

We hope your 2016 is off to a good start! Here at GTBI we have been reflecting on the past year and looking forward to the year ahead. There has been much news coming out of the TB community recently, with accompanying new activities, responsibilities and necessary approaches for those of us who work in this area.

Late last year the CDC Division of TB Elimination (DTBE) released their new Tuberculosis Elimination Strategic Plan: 2016-2020. This plan supports DTBE’s goal to reduce TB morbidity in the United States with a particular focus on reducing TB morbidity among disproportionately affected groups, including foreign-born persons and racial and ethnic minorities. The plan incorporates six specific strategies that support those efforts. These strategies are to: maintain control of TB, accelerate the decline, develop new tools, increase US involvement in international TB control activities, mobilize and sustain support, and track progress.  In another indication of the importance of TB control efforts, in December of 2015 the White House released the National Action Plan for Combating Multidrug-Resistant Tuberculosis, which identifies critical actions to be taken by key Federal departments and agencies to combat the global rise of multidrug-resistant tuberculosis (MDR-TB).

On the international front, the World Health Organization released the Global Plan to End TB: 2016-2020 and the Global Tuberculosis Report 2015, which contained the sobering news that TB now ranks alongside HIV as a leading cause of death worldwide. In 2014, TB killed 1.5 million people (1.1 million HIV-negative and 0.4 million HIV-positive). The toll comprised 890,000 men, 480,000 women and 140,000 children. HIV death tolls in 2014 was estimated at 1.2 million, which included the 0.4 million TB deaths among persons living with HIV infection.

Given these documented challenges and approaches, the TB control community can look towards redoubling its efforts in 2016.  Those of you in TB programs also know firsthand about obstacles faced by patients and communities, as well as the public health community. These include management of patients with complex social and medical needs, which along with MDR-TB can present challenges to state and local TB programs.

At the same time, we also have some newer strategies that can help us in our efforts. New data continues to be gathered about the safety and efficacy of the 12-dose regimen to treat latent TB infection; this regimen could be a game-changer in the strategy of treating TB infection to prevent new cases of disease.  As always, we at GTBI look forward to working with you on TB training and medical consultation to try to address some of the challenges and build on existing opportunities and strategies to accomplish our common goal of TB elimination!

Sincerely,
Alfred Lardizabal, MD

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Training Highlights

Mid-Atlantic TB Intensive - September 29-30, 2015

In the fall of 2015, GTBI collaborated with several states to plan a regional TB Intensive course. The four-day clinical TB Intensive Workshop is typically offered in Newark, NJ. However, on September 29th, participants from several states arrived at Rehoboth Beach, Delaware for a two-day training that mixed clinical and programmatic lectures and activities. The planning committee and faculty included representatives from Baltimore, Delaware, Maryland, New Jersey, Pennsylvania and Washington, DC. Speakers and topics were carefully chosen to address the needs of the approximately 50 participants. Topics included clinical talks such as diagnosis and treatment of TB infection and disease, pediatric TB, and pregnancy and TB. Programmatic talks included TB epidemiology, TB contact investigation and experiences regarding the implementation of 3HP (Lehigh University and Bethlehem Health Department, Pennsylvania) and video-based Directly Observed Therapy (Baltimore Health Department). The course provided an opportunity for networking and learning, as healthcare workers from different states had a chance to talk and share ideas. Overall, the course was well-received and we hope to implement the format again.

Submitted by Jennifer K. Campbell, MPH, CHES

 

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Product Updates

TB Training Roadmap for Public Health Nurses

GTBI is pleased to announce the availability of our TB Training Roadmap for Public Health Nurses, which is a collection of educational materials that can be used to train nurses who are new to TB or unfamiliar with the nuances of TB care. Users can use the Roadmap to create a personalized training plan; supervisors and employees can work together to create a customized Roadmap that is relevant and appropriate for the employee’s learning needs. Many of these materials are also appropriate for other TB staff, such as disease investigators. 

Updated GTBI Educational Materials Now Available!

We are pleased to announce that we just completed updates and reprinted several of our most popular materials. You can access them online at the links below, or order hard copies by completing a Product Order Form and submitting the completed form via fax or email.

Diagnosis and Treatment of Latent Tuberculosis Infection: This pocket-sized drug treatment card for clinicians provides information on diagnosis of latent tuberculosis infection (LTBI), treatment options and recommendations for infected patients. This edition of the card has been updated to include recommendations from the 2015 American Academy of Pediatrics Red Book: 2015 Report of the Committee on Infectious Diseases (30th ed.) on treatment of TB disease in children.

What You Need to Know About Tuberculosis: Patient Education Flipbook: This portable TB patient education resource was developed for TB program staff, including physicians, nurses, disease investigators, and case managers who provide one-on-one or small group patient education. The TB patient education flipbook has sections on TB testing, TB infection and TB disease and includes panels for patients with simple text and images to reinforce key points. Corresponding panels for providers include an easy to deliver script and teaching points.  The flipbook has been updated to include the 12-dose regimen for treatment of LTBI and the section on TB testing has been revised to reflect increased use of IGRAs.

Tuberculosis Handbook for School Nurses: This handbook is targeted to school nurses, who can play an integral role in the screening and management of children with LTBI and TB disease. The booklet includes a section on TB fundamentals as well as suggestions for applying them in a school setting, including provision on DOT and working in collaboration with community providers in both the public and private sectors. The 2015 edition includes information on the 12-dose regimen for treatment of LTBI, the 2015 AAP recommendations and updated epidemiologic data.

Treatment of Tuberculosis: Standard Therapy for Active Disease in Children: This pocket-size drug treatment card for clinicians provides information on the standard anti-tuberculosis therapy for active disease in children, including dosages, daily and intermittent regimens, side effects, treatment information and visual depictions of first-line medications. This edition of the card has been updated to include recommendations from the 2015 American Academy of Pediatrics Red Book: 2015 Report of the Committee on Infectious Diseases (30th ed.) on diagnosis and management of LTBI in children.

We hope these revised materials are useful, and we look forward to sharing the next round of updated materials later this year! Please also feel free to review the complete list of GTBI’s educational materials at http://globaltb.njms.rutgers.edu/educationalmaterials/productlist.html

 

Staff Profile: Rebecca Stevens, Public Health Representative, Lattimore Clinic

Rebecca Stevens has 23 years of experience in the field of TB as a Public Health Representative with the Lattimore Clinic at the Global Tuberculosis Institute. Recalling what it was like to be new to the world of TB, Rebecca says “I didn’t know much about TB when I started back in 1992. Everyone had so many misconceptions about it. My husband was paranoid when I started this job. He would keep a plastic bag by the door to put my belongings when I entered the house. I would even do my laundry separately! As I learned more about TB and how it is transmitted, I educated him and he got more comfortable with it. This job gave me an opportunity to meet people from around the globe.”

Rebecca

Unstoppable Rebecca Stevens: Amidst the aftermath of a major blizzard, Rebecca prepares for a day in the field.

Rebecca has had her share of the limelight, a simple online search for her name is bound to bring up television interviews as well as newspaper articles with her quotes. Most recently (in 2014), she was interviewed by Indian Bollywood star Aamir Khan on his television show (Satyamave Jayete) focusing on TB in India. 

Rebecca shrugs off all the attention directed to her and moves her focus on to persons affected by TB. She does not see her role as limited to providing Directly Observed Therapy (DOT); she views herself as a staunch advocate and a friend of the TB patient. When it comes to providing care to her patients, she leaves no stone unturned. She does her best to address the barriers that a patient may face while on DOT and do what it takes to get them to complete their treatment. In her words, “When I get involved in my patient’s care, I take it upon myself to fix a lot of things in their life such as getting them access to healthcare, housing and food. You become the patient’s extended family.”

Click below to watch this brief patient interaction that provides a glimpse of the strong bond Rebecca shares with her patients.

 

When asked about her biggest challenge in TB, Rebecca explains that providing care for her homeless patients proved to be the most challenging task. “It takes time to track them as they are not in the same location twice. Homeless patients are individuals who are overlooked by society. As field workers, we do a lot more than getting them through DOT. We try to help them get their life back!” says Rebecca. If the basic needs of a person such as food, shelter and clothing are not met, it is much more difficult to get them through treatment with these other competing life circumstances and priorities. Rebecca and other front line TB program staff try to tap into available community resources to advocate for necessary services for homeless patients and other hard to reach groups. When thinking about her accomplishments, she counts those instances where she was able to get a few patients to break the cycle of homelessness.

Rebecca has a lot of interesting stories about working in Newark, NJ. She laughs and recollects a particular incident when she was entering a building to provide DOT to her patient. She suddenly found herself surrounded by Newark police officers who pushed her against the wall and asked her to hand them the white paper bag she was carrying. One officer went on to explain that they had seen her go into the building regularly with the paper bag and come back empty handed; this made them suspicious. Rebecca remembers not having her work identification with her at that moment. However, she asked the officers to call her supervisor at the Lattimore Clinic to verify that she was doing her job of providing treatment to her patients. Once the officers spoke to her supervisor, they were apologetic and released her to continue about her work.

Rebecca shares some simple advice for healthcare professionals who are new to TB, “Be comfortable with what you are doing. You are not there to judge a person or change them. You are there to help them with their health problem.”
To quote one of her patients, “Rebecca is immaculate! She is the best ever. She is the real friend I have who is looking out for my best interest.”

Dr. Lee Reichman, Senior Advisor and founder of GTBI remarks, “Rebecca is the unsung hero of TB control. She exemplifies what a field staff should be like. She is well known for her empathy and all her patients were cured because of her dedication. She always made sure they never missed their doses. Lately there is a big push to replace field works with video-DOT and I find that idea absurd as no cell phone can replace Rebecca or any other field staff!”

Lillian Pirog, the nurse manager at the Lattimore Clinic, echoes the same sentiment as the comments above. In her words, “Rebecca is a dedicated, caring individual who puts her client’s needs first. She goes above and beyond the job requirements, making visits at late hours, providing clients with information and resources they need. She has accompanied clients to many local food pantries, soup kitchens and social service agencies. Clients who are discharged from the clinic keep in touch with Rebecca for years after that. Without her, our Lattimore clients would not have the excellent care that they receive. She is a true hero!”

When Rebecca is not in the field helping patients, you can find her listening to country and soul music or surrounded by her family. She favorite singers are Neil Diamond, Aretha Franklin and Frank Sinatra.

Submitted by Arpita Jindani, MSW, MA   

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Announcements: New England TB Hero Award

The New England TB Hero award was launched in 2008 by the New England Tuberculosis Consortium to acknowledge individuals who embody the highest qualities of public health care and service. The award also demonstrates the New England TB Consortium’s appreciation for the recipient’s dedication to their patients and their exemplary manner. The award recipient may be a member of a TB program, health department, a community clinic, hospital practitioner, or the lay community. He or she need not be a health care professional.

Please join us in congratulating the two award recipients for the 2015 New England TB Hero award: Kristin (Kris) Magnussen, RN, MSN from Connecticut and Myrna Leiper, RN, BSN from Massachusetts.

Kris Magnussen is a Public Health Nurse at the Ledge Light Health District in New London, Connecticut. Ms. Magnussen was recognized for her work managing a difficult case load of five pulmonary infectious patients in her health department’s jurisdiction in 2014 including one multi‐drug resistant patient. She was responsible for all aspects of their care including initiating case management, setting up directly observed therapy, and performing the contact investigations. Ms. Magnussen’s experience with one of these patients, a woman with cavitary TB in her ninth month of pregnancy, exemplifies her work as a TB hero. The patient ultimately delivered while still infectious and hospitalized; the newborn came home before the patient. Ms. Magnussen made sure the baby’s grandmother received visits from the local maternal child health nurse practitioner and received education and training on care of the newborn in addition to administration of the INH liquid for the baby. Ms. Magnussen made herself available to the family at all times, including evenings and weekends, to successfully earn the trust of the family. The TB controller from Connecticut, Dr. Lynn Sosa adds, “Kris is the kind of person that never says ‘no’ and will always find a way to ensure her patients are cared for in the best possible manner. Connecticut is a safer, healthier place with Kris Magnussen here to keep it that way!”

Photo of Kris Magnussen

Pictured above (Left to right):Maureen Williams RN, Nurse Consultant, Lynn Sosa, MD, TB Controller and Award Recipient Kris Magnussen, RN, MSN

The second award recipient, Myrna Leiper, RN, BSN, is a public health nurse with the Massachusetts Department of Public Health, based in the Western Regional Office. Ms. Leiper was nominated by the Board of Health for the town of Hubbardston, Massachusetts. Ms. Leiper was instrumental in helping the Board of Health manage TB – the first case reported in recent years – by empowering the board and patient with necessary information. She also provided hands-on support and just-in-time training to the nurse responsible for case management. Ms. Leiper assuaged fears of the patient and the town. She was extremely helpful through the process and made herself readily available at all times of the day for questions from the board as well as the patient. Ms. Leiper is a caring individual who deserves to be recognized for all her efforts. She treated the patient and family with respect, care, compassion and helped them get through this very trying time in their life. Tom Larson, the Chairman of Hubbardston Board of Health, MA reiterates, “Ms. Leiper is one of the most pleasant and caring person we have had the fortune of working with and she is a true hero worthy of this award.”

Myrna Leiper

Pictured above (Left to right): Jennifer Cochran, MPH, Award Recipient Myrna Leiper, RN, BSN and Pat Iyer, RN, MSN

 

Submitted by Lynn Sosa, MD, Connecticut Department of Public Health and Jennifer Cochran, MPH, Massachusetts Department of Public Health

 

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Upcoming Northeast RTMCC Training

The New Jersey Medical School Global Tuberculosis Institute (GTBI) sponsors courses and webinars on tuberculosis.  GTBI webinars are open to all participants in the United States.  For in-person courses, GTBI prioritizes participants from the Northeast Region (Baltimore, Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York City, New York State, Pennsylvania, Philadelphia, Rhode Island, Vermont, and Washington, DC), which is served by GTBI.
Click here for the list of upcoming trainings.

Medical Consultation

GTBI faculty and staff respond to requests from healthcare providers seeking medical consultation. We also provide consultation on nursing, case management and contact investigation issues on request. Consultants can be reached by calling the TB Info-line: 1-800-4TB-DOCS (1-800-482-3627) or by email (mc_gtbi@njms.rutgers.edu)

During each consultation, the GTBI consultants will advise callers about resources/TB Programs in their jurisdiction. In addition, TB programs will be informed of TB cases with public health implications such as MDR/XDR-TB, pediatric TB in children <5 years of age, or potential outbreak situations.

More information about our consultation service can be accessed at http://globaltb.njms.rutgers.edu/services/medicalconsultation.html

Links - Other TB Resources

Division 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, and by collaborating with other countries and international partners in controlling tuberculosis worldwide.

Find TB Resources Website
This website provides a central, comprehensive searchable database of international, national, state, and local TB-related education and training materials for TB healthcare workers, health professionals, patients, and the general public. Users can also submit their education and training materials as well find information on funding opportunities, TB organizations, TB mailing lists, and TB images.

TB Education & Training Network (TB ETN)
The TB Education and Training Network (TB ETN) was formed to bring TB professionals together to network, share resources, and build education and training skills.

Regional Training and Medical Consultation Centers' TB Training and Education Products
This website provides a searchable list of all RTMCCs' resources.

TB Wire Newsletter
Contents include announcements, current journal articles, available resources and training activities, upcoming meetings and conferences, etc. To subscribe to this service, click here

Other RTMCCs  
The Curry International Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Nevada, Oregon, Utah, Washington, Federated State of Micronesia, Northern Mariana Islands, Republic of Marshall Islands, American Samoa, Guam, and the Republic of Palau.

The Heartland National Tuberculosis Center serves: Arizona, Arkansas, Kansas, Louisiana, Missouri, New Mexico, Nebraska, Oklahoma, and Texas.

The Mayo Clinic Center for Tuberculosis serves:  Illinois, Indiana, Iowa, Michigan, Minnesota, Montana, North Dakota, Ohio, South Dakota, Wisconsin, and Wyoming

The Southeastern National Tuberculosis Center serves: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Puerto Rico, West Virginia, and the U.S. Virgin Islands.

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Key Contacts

  • Alfred Lardizabal, MD - Executive Director
  • Mitchell Gayer, MS, MPH - Deputy Director
  • Amee Patrawalla, MD - Medical Director
  • Anita Khilall, MPH - Program Director, Education and Training
  • Lee B. Reichman, MD, MPH - Senior Advisor

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