It’s only March, but 2011 is off to a fruitful and productive start here at GTBI. Like all of you, we have been busy helping bring CDC's cohort review mandate to fruition. In addition to offering in-person trainings, we just completed a series of three national webinars about the cohort review process. This newsletter contains an article about our first webinar, which gave an introduction to the TB cohort review process. An archived version of this webinar is available on our website at http://globaltb.njms.rutgers.edu/educationalmaterials/audioarchives.html, and archived versions of the other two webinars in this series will be available in the coming months.
This issue of the Northeastern Spotlight features Sue Etkind, the fearless director of the Massachusetts Division of TB Prevention and Control, discussing the importance of mentoring, healthcare reform, and rollicking theme parties. A new series exploring the behavioral & social science contribution to TB control kicks off with a piece about incentives and enablers in TB control. We also cover new suggested provisions for state TB prevention and control laws recently released by CDC.
A big thanks to those of you who participated in the first phase of the all-RTMCC needs assessment. We share a brief write-up about this phase as well as helpful tips if you want to create and conduct a survey in your area.
Finally, we share a new curriculum we developed with case studies, fact sheets, and PowerPoint presentations that help incorporate TB information into public health core curricula. The product can be accessed at http://globaltb.njms.rutgers.edu/educationalmaterials/productfolder/incorporating.html, and we encourage you to reach out to any schools of public health in your area to share this product with them.
I wish you all the best for a joyous and productive year.
Lee B. Reichman, MD, MPH
Northeastern RTMCC and the
Global Tuberculosis Institute
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Webinar Series on Cohort Review Process
Now that cohort reviews are required by all cooperative agreements, what’s a program to do? Sure, there is a fine instruction guide and DVD, but many programs are wondering “How do you actually go about implementing and conducting cohort reviews?”
In an effort to answer that question, NJMS GTBI, in conjunction with its partners, conducted a series of three national ‘best practices’ webinars on the cohort review process. Bill Bower, MPH, Director of Education and Training at the Charles P. Felton National TB Center, was the moderator for this series.
The first webinar, “Introduction to the TB Cohort Review Process,” was held on November 4, 2010 and had 389 participants from 38 states. Not surprisingly, two states with the highest number of TB cases also had the greatest number of attendees: California (74) and Texas (64). Mr. Bower presented principles and processes of the TB cohort review process. Dawn Tuckey, MPH, CDC Program Consultant, shared the recent CDC guidance on cohort reviews. Finally, three TB programs shared their experiences with the cohort review process. Chrispin Kambili, MD of the New York City Department of Health & Mental Hygiene gave a historical perspective of cohort reviews in New York City, including their key components, benefits, and challenges. Harvey L. Marx, Jr. of the Missouri Department of Health and Senior Services and Heidi Behm, RN, MPH of the State of Oregon Department of Human Services illustrated how their states have adapted the method to their particular location, staff pattern, and program needs.
The second and third webinars aimed to portray step-by-step how one actually goes about doing cohort reviews. The faculty was all professionals who do cohort reviews on a regular basis:
- Kim Field, RN, MSN
Section Manager, Tuberculosis Services, Washington State Department of Health
- Shu-Hua Wang, MD, MPH & TM
Medical Director, Ben Franklin TB Clinic
TB Consultant, Ohio Department of Health
Assistant Professor of Infectious Diseases, Ohio State University
- Christina Dogbey, MPH
Epidemiologist, Philadelphia Department of Public Health Tuberculosis Control Program
- Anthony Lloyd
Disease Intervention Specialist, Philadelphia Department of Public Health Tuberculosis Control Program
- Mary Sisk, RN
CIC Supervisory Nurse Coordinator, District of Columbia Department of Health, Bureau of Tuberculosis Control
The second webinar, “Activities and Roles in the TB Cohort Review Process,” was held on January 20, 2011. Three hundred participants from 30 states listened as presenters explained in detail how each one of them plays a different part on the team when preparing, conducting, and following up with cohort reviews. Issues of planning and staffing were explored in more depth.
The series concluded with “TB Cohort In Action: Putting It All Together,” on February 10, 2011. This was a simulated cohort review session, with each member of the presenting team playing their respective roles as Program Manager, Medical Reviewer, Epidemiologist/Data Analyst, and Case Managers. More than 250 participants from 36 states heard four cases reviewed in detail, and learned the aggregate outcomes of this cohort of 25 cases. The presenters concluded the session with a discussion of the benefits and challenges of holding cohort reviews.
The archives are available online at http://globaltb.njms.rutgers.edu/educationalmaterials/audioarchives.html.
Submitted by Bill L. Bower, MPH
Director of Education and Training
Charles P. Felton National Tuberculosis Center
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Spotlight article: Behavioral/Social Science Contribution to TB Control - Incentives and Enablers in TB Control
Following a series of installments highlighting specific studies of the CDC-funded Tuberculosis Epidemiological Studies Consortium, this column has begun a series presenting various interventions in TB control that are based on behavioral or social sciences findings. The previous newsletter focused on the use of peer workers in TB control; this installment examines the use of incentives and enablers.
There is growing interest in the use of incentives in many aspects of public life. Incentive programs have paid students for improved grades and/or attendance and welfare recipients for seeking work, in addition to employee health initiatives in which corporations give bonuses for employees’ smoking cessation or weight loss.1 Incentives are given to patients as a reward for being adherent -- they may not be directly related to the patient’s TB treatment. Incentives may include movie tickets, phone cards, and gift cards for groceries or clothes. In contrast, enablers are given to patients to remove barriers to treatment, such as transportation tokens or coupons, or assistance with child care. Enablers are meant to assist patients in adhering to TB treatment.
It is important to tailor incentives and enablers to the population being served. Carol Pozsik identified incentives and enablers appropriate in a rural setting, such as groceries, gasoline, or fishing equipment.2 In a Harlem, NY on-site DOT program, El-Sadr stressed the importance of group incentives that build social cohesion such as holiday dinners, trips to amusement parks, and parties to celebrate treatment completion.3
Current Clinical Practice in the US
Incentives and enablers have long been used in TB control in the United States. While recent CDC Guidelines do not specifically address incentives and enablers, they are presented as a “best practice” for ensuring adherence in the CDC Self-Study Module #9.4
TB/LTBI Studies on Incentives/Enablers
The literature offers a substantial number of studies demonstrating that incentives and enablers led to positive treatment outcomes in developing countries. In the US, the practice of providing incentives and enablers has become so common that few studies examining the practice exist. Bock found that when given a modest cash equivalent for each tuberculosis therapy session they attended, DOT patients became significantly more likely to complete therapy, compared with patients treated in a prior period.5
In the early 2000s, four randomized clinical trials examined the effect of monetary incentives as compared to peer workers in relation to LTBI treatment in high-risk populations. Two of these studies found higher completion in participants who received monetary incentives compared to those who had a peer worker, despite the fact that the peers provided DOT for LTBI.6,7 The other two found no differences.8,9 In Newark, NJ, provision of a nutritional supplement was associated with improved treatment outcomes for patients on LTBI therapy.10
Findings from the Health Psychology Literature
Despite an ongoing practice of rewarding medical providers for their performance, it is only recently that healthcare programs have begun to reward patients. Such rewards, or incentives, generally fall into two categories: 1) rewarding patients each time they exhibit a certain behavior, such as showing up for a DOT appointment or producing a urine sample free of illicit substances5; and 2) rewarding patients for reaching a pre-defined goal, such as losing 10 pounds or quitting smoking.11 In TB, incentives have been used for both purposes.
Findings from research in behavioral economics and psychology suggest ways in which incentives may be made more persuasive to patients.11 For instance, lottery-based incentives can be more effective than lump-sum payments. Behavioral economists have found that individuals tend to over-estimate the probability of unlikely events such as winning a lottery, and also tend to minimize small costs and benefits (the “peanuts effect”). Therefore, rewarding patients by entering them in a lottery for those who have achieve a specified goal may be more effective than offering all of them small rewards. Also, increasing the size of the incentive (e.g., $4 per visit in the first month, $6 in the second month, etc.) gives patients more to lose when they miss appointments and have to start again. Finally, small incremental rewards are more effective than one large reward. For that reason, most studies focused on adherence have relied on small, frequent rewards.12,13 While the incentives typically provided in DOT programs meet this third suggestion, they generally have not used gradated reward systems or included the element of chance.
Ethical Concerns about Incentives
Several aspects of incentivized health behaviors have provoked ethical concerns. Financial incentives may infringe on the autonomy of individuals to exercise particular personal preferences, such as tobacco use. Furthermore, the prospect of financial gain through incentives may exercise disproportionate influence on individuals of limited means, and incentives are therefore inequitable. Proponents respond that the effect of incentives is to provide individuals with an additional choice of incentives versus the undesired behavior, and that because incentives are tied to a specific event of behavior change and do not preclude future choices to return to the behavior, they cannot properly be thought of as restricting autonomy. Because incentives do not actually create additional burdens for vulnerable populations but offer new sources of potential reward, their effect is not truly inequitable.
Privacy concerns about incentives revolve around the need to monitor behaviors through blood, urine, or other analyses, which increases the involvement of employers and government in individuals’ lives. These concerns must be balanced against the legitimate concerns of public and corporate entities to control behaviors that add to their burden of healthcare or other costs.
An additional critique of financial incentives based on their societal implications suggests that monetizing health-promoting behaviors subverts the social value of those behaviors. This concern is relevant to incentivizing individual adherence to treatment of infectious disease, which has the public health benefit of reducing disease transmission in addition to the individual benefit of cure. Proponents of incentives argue that the power of extrinsic motivations (e.g., incentives) to override intrinsic motivations (e.g., taking actions to benefit society or an individual’s long term interests) has not been determined empirically. The practical benefit of extrinsic motivations to further a goal outweighs the theoretical risks that wider appeals to extrinsic motivations may be undermined.14
This final point about the collective benefits of promoting individual behavior through extrinsic reward is part of the rationale for incentivizing treatment for TB disease. This argument can be extended to treatment of Latent TB Infection (TLTBI) in that TLTBI is an important step toward the elimination of tuberculosis.
Submitted by Paul Colson, PhD, Program Director,
and Julie Franks, PhD, Health Educator and Evaluator,
Charles P. Felton National TB Center at Harlem Hospital. Thanks to Tal Gross, PhD, Mailman School of Public Health, Columbia University.
1. Belluck P. For forgetful, cash helps the medicine go down. NYT June 13, 2010
2. Pozsik CJ. Compliance with tuberculosis therapy. Med Clinics of N Am 1993. 77(6):1289-301.
3. El-Sadr W, Medard F, Dickerson M. The Harlem family model: a unique approach to the treatment of tuberculosis. J Pub Hlth Mgmt Prac 1995.1(4):48-51.
4. Centers for Disease Control and Prevention. Module 9: Patient Adherence to Tuberculosis Treatment. Available at www.cdc.gov/tb/education/ssmodules/module9/ss9reading3.htm. Accessed on November 17, 2010.
5. Bock NN, Sales R-M, Rogers T, DeVoe B. A spoonful of sugar…: improving adherence to tuberculosis treatment using financial incentives. Int J Tuberc 2001.5(1):96-98.
6. Malotte CK, Hollingshead JR, Larro M. Incentives vs outreach workers for latent tuberculosis treatment in drug users. Am J Prev Med 2001;20:103-7.
7. Tulsky JP, Pilote L, Hahn JA, et al. Adherence to isoniazid prophylaxis in the homeless: a randomized controlled trial. Arch Intern Med 2000;160:697-702.
8. Chaisson RE, Barnes GL, Hackman J, et al. A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users. Am J Med 2001;110:610-5.
9. Morisky DE, Malotte CK, Ebin V, et al. Behavioral interventions for the control of tuberculosis among adolescents. Public Health Rep 2001;116:568-74.
10. Mangura BT, Passannante M, Reichman l. An incentive in tuberculosis preventive therapy for an inner city population. Int J Tberc Lung Dis 1999:1(16):567-568.
11. Volpp KG, Pauly MV, Loewenstein G, Bangsberg D. P4P4P: an agenda for research on pay-for-performance for patients. Health Aff (Millwood) 2009;28:206-14.
12. Volpp KG, John LK, Troxel AB, Norton L, Fassbender J, Loewenstein G. Financial incentive-based approaches for weight loss: a randomized trial. JAMA 2008;300:2631-7.
13. Tulsky JP, Hahn JA, Long HL, et al. Can the poor adhere? Incentives for adherence to TB prevention in homeless adults. Int J Tuberc Lung Dis 2004;8:83-91.
14. Halpern SD, Madison KM, Volpp KG. Patients as mercenaries?: the ethics of using financial incentives in the war on unhealthy behaviors. Circ Cardiovasc Qual Outcomes 2009;2:514-6.
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Incorporating Tuberculosis into Public Health Core Curricula
The New Jersey Medical School Global Tuberculosis Institute has created TB-related materials for use in the training of public health students. These materials have been designed to address public health core competencies, helping students to build skills and to inspire further study of TB.
Teaching material has been developed for use in courses in the 5 core public health disciplines of biostatistics, epidemiology, environmental health sciences, health policy and management, and social and behavioral sciences. They also illustrate principles and issues relevant to the interdisciplinary/cross-cutting areas of communications, diversity and culture, program planning and evaluation, and public health biology. Some exercises include suggested readings and PowerPoint® slides for classroom presentation.
Although designed specifically for public health students, these materials may be equally useful for the training of TB program staff in areas such as epidemiology, statistical analysis of program data, program planning and evaluation and diversity and culture.
All materials have been developed using a uniform template, which includes a cover page with the learning objectives and the public health core and interdisciplinary/cross-cutting competencies addressed in each product. Individuals wishing to use these materials may simply download the Student Versions from the graphic on our website. All teaching materials are available, free of charge, at http://globaltb.njms.rutgers.edu/educationalmaterials/productfolder/incorporating.html.
Submitted by Marian R Passannante, PhD
University of Medicine and Dentistry of New Jersey
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RTMCC Needs Assessment – Part I
In 2009, we began planning for a national needs assessment to identify the training, education and medical consultation needs of TB program staff and other health care providers. This is a joint effort between the four RTMCCs and CDC, consisting of an online assessment and key informant interviews. The goal of this comprehensive needs assessment is to identify training and medical consultation needs that can be prioritized and addressed in future RTMCC activities. A working group that includes representatives from all the Centers helped to ensure the development of a standardized questionnaire and interview guide.
TB Controllers received advanced notification of the needs assessment with an opportunity to make comments. The online assessment was launched on June 29, 2010 with a cut-off date near the end of summer. Nationwide, there were over 2000 responses to the assessment. We would like to thank all of the individuals who participated in this process.
Currently we are cleaning the data to ensure accuracy as we complete the analysis phase and prepare for the key informant interviews. The information we learn from the online assessment will help inform interviews we hope to conduct with key TB program staff in Spring, 2011. We also plan to share results in aggregate form for the Northeastern region and with individual project areas.
For those who might be considering the use of surveys for informal or formal needs assessment, we would like to share some tips for survey design.
- Keep it short and simple. Consider how much time it will take to complete the survey
- Ask yourself what you will do with the information from each question. Select the types of questions that support the analysis you wish to perform and the way you will report the results
- Avoid double-barreled questions. Do not put two questions into one. This may result in responses that are difficult to interpret
- Ensure the response categories are mutually exclusive and exhaustive. Categories are mutually exclusive when there is no overlap. Categories are exhaustive when there is a category available to all potential respondents
- Place questions in a logical order. Group questions of a similar topic together and use appropriate headings
- Consider your analysis plan before you finalize the survey format. Decide on a strategy for open-ended items and the time involved in coding such responses
- Make sure the question layouts are consistent. Do not put answer choices on the right for some questions and on the left for others.
- Write for the intended audience. Use simple, every day language that all respondents will understand and check the reading grade level
- Provide directions for how to answer questions. Brief directions can be placed at the beginning of the survey and more specific instructions before categories of questions if needed
- Pilot test the survey with a small group of people to identify unclear questions or instructions. This will allow for correction of minor problems before surveying a larger group
Anita Khilall MPH
Training and Consultation Specialist
NJMS Global Tuberculosis Institute
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Profile: Sue Etkind, RN, MS, Director of the Massachusetts Division of TB Prevention and Control
Sue Etkind, RN, MS, Director of the Massachusetts Division of TB Prevention and Control, is a challenging person to profile. Trying to condense over 25 years of prodigious TB work into one article is impossible, so up front I’ll state that there are many significant accomplishments beyond what’s written here.
Sue began working in TB control in July 1984, when she took a position as the Administrator for Surveillance and Public Health Nursing for the Division of TB Prevention and Control in the Bureau of Communicable Disease Control, and in January 1985 she assumed the position of Director of the TB Division. Some of Sue’s many accomplishments in this position include serving as an officer in the nursing section of the International Union Against Tuberculosis and Other Lung Diseases (IUALTD), North American Region IUATLD, the National TB Controllers Association, and the STOP TB USA Partnership; participating on numerous writing committees, such as the ATS/CDC TB Treatment Statement and TB Control Statement, the Institute of Medicine report Ending Neglect: The Elimination of Tuberculosis in the United States, and the CDC guidelines on Universal Genotyping and Contact Investigations; and extensive writings on the public health aspects of tuberculosis control on subjects ranging from the role of the health department to contact investigations, treating the hard-to-treat, delivery of TB treatment services, and TB in corrections and the homeless.
After more than 25 years as Director of the Massachusetts TB Division, new challenges continue to keep Sue on her toes. “Health care reform with universal insurance coverage began in Massachusetts in 2006,” notes Sue. “Although we have many more TB patients who now have insurance coverage (as of 2009, 97.3% of MA residents overall), there are still challenges relevant to TB control: Not all residents are covered, such as those with undocumented status; once insured, patients do not always stay insured due to increasing costs/co-payments or other factors; once insured, patients may not be able to access primary care in a timely manner due to lack of primary care providers in some areas, long waits for appointments, etc.; and primary care providers operating in medical service delivery models do not always think about or provide public-health related services such as assurance of monthly patient follow-up, contact identification, and adherence assessment.”
Sue notes that with the economic crisis, Massachusetts has noted a significant deterioration of the local public health infrastructure. “With 351 autonomous cities and towns and a shared public health responsibility between state and local health for communicable disease control, resources are scarce even with prioritization of TB control activities.”
Compounding these difficulties, last year the MA TB Division lost more than 100 years of expertise and experience when 6 senior managers retired. As usual, Sue took a positive spin on the situation: “Although this was a major challenge, it provided an opportunity to reorganize, rethink, refocus and reprioritize our efforts and to discover new partners and collaborations.”
Sue believes it is important to actively mentor the next generation of the public health workforce, especially in TB when so many people are close to retirement. Eileen Bosso, a past CDC Public Health Prevention Service fellow assigned to the Massachusetts TB Division, said that she “started thinking about what a great manager Sue was after I’d been at the MA TB Division for about a year. She makes sure that everyone—regardless of rank—has the opportunity to voice their opinions at meetings. There are a lot of dedicated people working in the TB Division and they don’t always agree, but Sue makes sure that even if discussions get passionate and heated during a meeting, when they get up from the table there is no animosity and everyone is friends. I really admire everything about Sue, but I started thinking that there has to be a fault somewhere I just wasn’t aware of yet. A couple months later, Sue printed out several hundred color copies of an educational flyer. She took a look at the finished product but decided that the formatting could be improved slightly, so after a couple minor changes the fliers were all printed again. Sue took another look and decided that the colors needed to be brightened a little bit more, so they were all printed out again a third time. Sue is a great friend, unless you happen to be a tree…. Despite her paper usage, I can tell you that if I turn out to be half the manager Sue is, I will consider that to be a huge achievement.”
Sally Cheney, Associate Director of the MA TB Division, commented that “Sue is open, receptive and engaging with people she encounters. These qualities, coupled with her trust and belief in people, make her one of the best mentors I have ever observed. Her ability to convey this enthusiasm, trust and warmth helps everyone she encounters feel valued and respected. She brings out the best in people, gently challenging them to believe in themselves and their capabilities.”
To balance out all the work, Sue also takes parties with coworkers very seriously. They generally involve a theme where everyone comes in costume, plays games created by various staff members, and eats massive quantities of food, including Sue’s fudge. Past parties have included an outbreak theme party, in which guests came dressed as famous people from the 1930s and the guest of honor (an epidemiologist) had to investigate what the “disease” was and how it was being transmitted, and a Harry Potter party in which people came in character and played Harry Potter trivia and imbibed various potions.
Sue’s husband Paul is a senior policy analyst at National Association of County and City Health Officials in Washington, DC, and her daughter Molly is a first year law student at Michigan State University. Sally Cheney says, “I think Sue is the iconic Mom that everyone girl would love to have. Sue and Molly are truly friends as well as mother and daughter. To see them together or hear them talking, you can tell how much they truly enjoy one another’s company. And they have lots of silly fun together – shopping, riding around in Molly’s convertible with Sun-In in their hair; dressing up for Sue’s retro-hippie 60th birthday party, or just hanging out together.”
Looking back over her time in TB, Sue says “I cannot think of a career that can provide more satisfaction than working in TB control. In my 30 plus years at the Department of Public Health, I have seen accomplishments at many levels: from declining TB disease morbidity in Massachusetts, to continued TB Division organizational and clinical stability (in spite of the challenges noted above), to the personal level, where I have had the privilege of working with the most committed and dedicated individuals that you will ever find anywhere--an amazing group of people locally, in our own Massachusetts TB Division family, across the New England region, nationally and internationally. Finally, my Jewish faith is grounded in the concept of Tzedakah or giving back to the world. Where better to do that, than in the fight against TB. I feel that I have been truly blessed to be able to make that contribution.”
Sue Etkind with husband Paul at one of the many themed parties, dressed as characters from the movie The African Queen (Sue’s favorite)
Nickolette Patrick, MPH
Training and Consultation Specialist
NJMS Global Tuberculosis Institute
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CDC Releases Menu of Suggested State TB Laws
CDC’s Division of TB Elimination and the Public Health Law Program, in collaboration with the National TB Controllers Association, recently released the Menu of Suggested Provisions for State Tuberculosis Prevention and Control Laws. This Menu features a set of provisions for consideration by public health officials and their legal counsel in the enactment, promulgation, amendment, and implementation of TB prevention and control laws. It is intended to provide impetus for consideration of TB-related legal issues,
and to suggest possible approaches for addressing those issues.
Case identification provisions in the document include mandated reporting, screening, laboratory testing, and physical examination. Case management provisions include authority of public health officials to implement disease control measures and enforcement/validation of orders, investigation, treatment, isolation , emergency detention, confinement in a facility, social distancing measures, penalties/immunity, costs, and grants of authority to take any “necessary” action to protect public health. Other provisions include protection of individual rights and interjuristictional collaboration.
The full Menu of Suggested Provisions for State Tuberculosis Prevention and Control Laws can be viewed at http://www.cdc.gov/tb/programs/Laws/menu/default.htm. If you have questions or comments, please contact Melisa Thombley at firstname.lastname@example.org or (404) 639-6203.
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The Lighter Side: Food and TB
Match the picture to the correct description:
- An outbreak of M. bovis in southern California in the early part of this century was linked to this food product
- Frequently served in 19th century American sanitoria, thought to speed recovery from TB
- A form of TB is named after this food
- A popular way to get children to take their medicine, because crushed pills can easily be mixed with it
- Given in some places to help improve compliance
- Contains high amounts of a vitamin, which is sometimes also prescribed separately for people with TB
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GTBI faculty and staff respond to requests from providers seeking medical consultation through:
- Our toll-free TB Infoline: 1-800-4TB-DOCS and
During each consultation, the GTBI consultants will advise providers of TB Program resources for consultation 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, or potential outbreak situations.
More information about our consultation service, including downloadable Core TB Resources, can be accessed at Medical Consultant Web-Based Grand Rounds (http://globaltb.njms.rutgers.edu/services/medicalconsultation.html).
Periodically, designated TB program medical consultants are invited to participate in a web-based TB case conference (or grand rounds). Consultants are encouraged to present challenging TB cases on which they would like feedback from their colleagues throughout the Region. The next grand rounds will be held this Fall and we will notify TB programs when a date and time have been established. TB program medical consultants who would like to present a case should contact Dr. Alfred Lardizabal at 973-972-8452 or email@example.com.
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Upcoming NE RTMCC Training Courses Planned for 2010
Courses are open to participants in the 20 project areas (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, NJ, New York State, New York City, Pennsylvania, Michigan, Indiana, Ohio, West Virginia, Delaware, Maryland, Washington DC, Detroit, Baltimore, and Philadelphia) which are served by the Northeastern National Tuberculosis Center.
Individuals outside of this region who wish to attend our training courses should first contact their Regional Training and Medical Consultation Center to check if a similar course is being offered. If this is not the case, the out-of-region participant may then register for this course.
Click here for the list of upcoming courses.
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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.
TB Education and Training Resources Website
This website is a service of the Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination. It is intended for use by TB and other healthcare professionals, patients, and the general public and can be used to locate or share TB education and training materials and to find out about other TB resources.
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 4 RTMCCs' resources.
TB-Related News and Journal Items Weekly Update
Provided by the CDC as a public service, subscribers receive:
- A weekly update of TB-related news items
- Citations and abstracts to new scientific TB journal articles
- TB conference announcements
- TB job announcements
- To subscribe to this service, click here
TB Behavioral and Social Science Listserv
Sponsored by the DTBE of the CDC and the CDC National Prevention Information Network (NPIN), this Listserv provides subscribers the opportunity to exchange information and engage in ongoing discussions about behavioral and social science issues as they relate to tuberculosis prevention and control.
The Curry International Tuberculosis Center serves: Alaska, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, Wyoming, 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, Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico, Nebraska, North Dakota, Oklahoma, South Dakota, Texas, and Wisconsin.
The Southeastern National Tuberculosis Center serves: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Puerto Rico, and the U.S. Virgin Islands.
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- Lee B. Reichman, MD, MPH - Executive Director
- Reynard J. McDonald, MD - Medical Director
- Bonita T. Mangura, MD - Director of Research
- Eileen C. Napolitano - Deputy Director
- Nisha Ahamed, MPH, CHES - Program Director, Education and Training
- Nickolette Patrick - Northeastern Spotlight Editor
- Alfred S. Paspe - User Support Specialist/Webmaster
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