CITC Newsletter - Winter 2016
An electronic newsletter from the Curry International Tuberculosis Center (CITC)
CITC creates, enhances, and disseminates resources and models of excellence, and performs research to control and eliminate TB in the United States and internationally. CITC 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, Nevada, Oregon, Utah, Washington, and the U.S. Affiliated Pacific Islands. Committed to the belief that everyone deserves the highest quality of care in a manner consistent with his or her culture, values and language, CITC develops and delivers highly versatile, culturally appropriate trainings, educational products, medical consultation, and technical assistance.
New national guidelines released for diagnosis of TB, LTBI
The 2016 Clinical Practice Guidelines for Diagnosis of Tuberculosis in Adults and Children provide updated recommendations on the diagnosis of latent TB infection (LTBI), pulmonary TB, and extrapulmonary TB in adults and children. The guidelines were developed by CDC, the American Thoracic Society (ATS), and the Infectious Diseases Society of America (IDSA), and they have been endorsed by the European Respiratory Society. Previous TB diagnostics guidelines were published by CDC/ATS/IDSA in 2000.
The twenty-three evidence-based recommendations include guidance for clinicians on how to employ newer tests to diagnose TB disease and latent TB infection, including interferon-gamma release assays (IGRAs) and molecular diagnostics.
View the guidelines.
A tribute to David Park, MD (1961-2016)
David R. Park, III, MD, a pulmonary disease and critical care physician at Harborview Medical Center in Seattle and Professor of Medicine at University of Washington (UW), died on September 29, 2016. For nearly 20 years he was a valued member of the Curry training and medical consultation faculty.
Dr. Park passed away peacefully at home, surrounded by family, following a six-year battle with brain cancer. He is survived by his wife Julie, his son Philip, and his daughter Giulia. CITC Principal Investigator Lisa Chen, MD, said, “A dear friend and colleague, Dave will be remembered for his quick wit and wisdom, wry humor and dry delivery – but always with a signature twinkle in his eyes.”
As noted in the Seattle Times obituary for Dr. Park:
“…David was a perceptive diagnostician with a soothing demeanor. He was a renowned teacher of all aspects of life, with teaching awards from the University of Washington and an Outstanding Educator Award from the American Thoracic Society. He was nationally recognized for his educational expertise in diagnosis and treatment of TB, and was a founding member of the Firland Northwest Tuberculosis Center.”
Two upcoming occasions are scheduled to remember Dr. Park’s life and career. On January 26, 2017, the Division of Pulmonary and Critical Care Medicine at Harborview will host a “Day for Dave.” According to Harborview Chest Clinic Director Shawn J. Skerrett, MD: “The day’s activities will include: The Seattle Area Chest Grand Rounds, featuring cases that Dave would have enjoyed, along with a quiz reminiscent of his style…a memorial tribute that will include speakers who will address Dave’s contributions as an investigator and teacher, his work in support of TB control, and his service to respiratory care. These presentations will be followed by an open microphone for Dave’s friends and colleagues to share their memories and experiences…the Translational Journal Club will feature articles that Dave might have chosen and refreshments that he would have approved.” On June 10, 2017, Dr. Julie Park will host a memorial event for her late husband at the Center for Urban Horticulture in Seattle.
Memorial gifts in honor of David Park may be made to the Firland Northwest Tuberculosis Center.
The Curry Center joins Dr. Park’s family, friends, and colleagues in mourning his death, and in praising his enduring legacy as a TB physician, researcher, and leader in the art of medical education.
Stop TB USA moving forward with community engagement for TB elimination
by Michael Sage and Randall Reves, MD, MSc
Stop TB USA is a coalition of organizations (voluntary, professional and community-based) and individuals committed to elimination of TB in the United States. Achieving TB elimination requires we make progress toward global TB elimination which includes a commitment to ensuring that individuals across the globe and in this country have access to safe and effective TB services without experiencing catastrophic loss of personal and family income. The goals of Stop TB USA include supporting the global End TB strategies of increasing global investment in research and development in order to provide better tools for diagnosing, treating, and preventing TB.
The Coordinating Board of Stop TB USA is convinced that two recent developments provide opportunities for getting our nation on track toward TB elimination by 2035:
- The publication of the updated US Preventive Services Task Force (USPSTF) recommendations call for expanded targeted testing of individuals at increased risk for prior TB exposure with the intent for providing LTBI treatment.
- A recent publication provides estimates for the full cost of TB in the United States including drugs, hospitalization, and downstream effects of disability and death and saving from improving TB control efforts (Institute of Medicine [IOM] 2000, Goal 1).
As noted in an editorial in JAMA Internal Medicine, the USPSTF recommendations – combined with better tools for diagnosing and treating LTBI (IOM Goal 3) – provide the opportunity for broad expansion of TB prevention (IOM Goal 2). We believe the full potential of these opportunities will be achieved only by mobilizing and sustaining public support (IOM Goal 5), for which we believe high-level engagement of communities at higher risk for TB will be required.
We are seeking the engagement of the current membership of Stop TB USA and recruiting new members and partners in order to achieve full community engagement in TB elimination in the United States.
1. Patient and Community Engagement Committee, chaired by Stephanie Seidel. This Committee has already worked in partnership with NTCA and RESULTS to support trainings for survivors and family members and in the formation of an active network of advocates known as, “We are TB.”
2. Membership and Outreach Committee, chaired by Ed Zuroweste. This Committee has begun engaging medical provider and community-based organizations to advance the implementation of the new USPSTF recommendations.
3. Media and Communications. We are seeking a Chair for this committee to assist Stop TB USA in developing a communication strategy and support for enhancing the capacity of Stop TB USA to more effectively use social media or other means of outreach to engage members, new partners, and the community.
[Michael Sage is Executive Director of Stop TB USA; Randall Reves, MD, MSc is Chair.]
The five TB elimination goals described by the Institute of Medicine in 2000:
- Maintain control of TB while adjusting to declining TB cases and rates.
- Accelerate the decline by increasing efforts at targeted testing and treatment of latent TB infection (LTBI).
- Develop and implement new diagnostic, treatment and prevention tools.
- Increase involvement of the U.S. in global TB control.
- Mobilize and sustain public support for elimination and measure progress toward the goal.
Institute of Medicine. Committee on the Elimination of Tuberculosis in the United States. Ending neglect: the elimination of tuberculosis in the United States. Washington DC, USA: IOM 2000.
Renee Simmons-Wilkins receives national TB educator award
Renee Simmons-Wilkins, a master trainer and communicable disease investigator in California, was named by the CDC as “TB Educator of the Year” on September 22, 2016. Nominated for the annual award by the Curry Center, Ms. Simmons-Wilkins was recognized for her wisdom and expertise in the art of effective TB contact investigation.
Ms. Simmons-Wilkins has worked in the field of communicable disease investigation since 1994 as a Consulting Communicable Disease Investigator assigned to the California Department of Health, TB Control Branch. From the beginning of her career, she mentored junior investigators and other team members on the intricacies and nuances of contact investigation interviews not often covered in textbooks.
When Ms. Simmons-Wilkins retired from the State of California in 2011, she was soon recruited by the San Joaquin County Public Health Services to continue her work training staff in the investigation of communicable diseases.
In 2000, Ms. Simmons-Wilkins led the development of a full day interview skill-building session as part of CITC’s Case Management Contact Investigation Intensive course. She has adapted this one-day, interactive curriculum for various settings to meet requests for TB contact investigation interviewing trainings in California, Nevada, Hawaii, and the Commonwealth of the Northern Mariana Islands. Some of her one-day interviewing session materials were integrated into CDC’s 4-day Contact Investigation Interviewing Training (CIIT). She remains a highly valued member of the CITC’s training faculty, delighting course participants with her real-life perspective and down-to-earth style. CITC Director of Education Kelly Musoke, MPH, sings her praises: “Renee is dynamic and very engaging. She is an excellent trainer and respectfully pushes participants just beyond their comfort zones so they can practice and perfect their interviewing techniques.”
The TB Educator of the Year is awarded at the CDC’s annual TB Education and Training Network Conference and recognizes individuals who have shown dedication and leadership in the field of TB education and training. This year’s award was also presented to Denise Dodge from Virginia Department of Health.
Warmline faculty transitions
Dr. Charles Nolan will soon retire from CITC’s Warmline TB medical consultation service. During his 13-year tenure on the Warmline, Dr. Nolan provided nearly 200 consultations. His expertise was built from a 45-year career in communicable diseases and clinical TB epidemiology, extending from his home base in the Pacific Northwest to national and international arenas. Among his many contributions as a clinician, researcher, and educator was an influential 1999 study into the safety and effectiveness of isoniazid for treating latent TB infection that is still cited in TB medical literature. As he approaches his 80 th birthday celebration, Dr. Nolan will continue devoting his considerable energy and talents to many pursuits (including ten grandchildren.) The Curry team extends its deepest appreciation to Dr. Nolan for sharing his expertise with such skill, warmth, and generosity
In January 2017, the Warmline will welcome a new Nurse Consultant: Carolyn Bargman, RN-C, MA. Ms. Bargman works with the Denver Metro TB Clinic and Boulder County Public Health TB Control. With her arrival to the Warmline, the trio of sterling Warmline nurse consultants (Ann Raftery, RN, PHN, MS; Karen Martinek, RN, MPH; and Heidi Behm, RN, BSH, MPH) becomes a quartet. Ms. Bargman will also become the faculty's fifth consultant based in Denver, joining Drs. Chuck Daley, Randall Reves, Bob Belknap, and Michelle Haas.
CITC’s schedule of upcoming trainings (through March 2017) offers a variety of training opportunities for clinicians and public health providers.
January 25, 2017
Exploding Head Zone – The Interface of Molecular and Growth-Based Drug Susceptibility Testing Webinar; presented by Ed Desmond, PhD, Microbial Diseases Laboratory, California Department of Public Health
February 22, 2017
Vancouver, BC, Canada
Optimizing Outcomes of Drug-Resistant Tuberculosis in High-Resource, Low-Incidence Settings;
Jointly sponsored by the 5 Regional Training and Medical Consultation Centers (RTMCCs), this training takes place in association with The Union-NAR End TB 2017 Conference as an official pre-conference workshop
March 8, 2017
Walnut Creek, California
Difficult Dilemmas and Cutting Edge Solutions: Advanced Topics in TB;
One-day training to take place following the California TB Controllers Association Health Equity and TB Elimination Conference
March 27-30, 2017
Tuberculosis Case Management and Contact Investigation Intensive
To better acquaint our readers with the corps of TB experts that comprise our training and medical consultation faculty, each issue of CITC Newsletter presents a profile of a CITC faculty member. In this issue we feature Mike Carson, MS, program manager of Tuberculosis Control and Refugee Health Services at Orange County Health Care Agency in Santa Ana, California. Mr. Carson spoke with CITC Newsletter on November 29, 2016.
Where are you from? Tell us about your education.
I grew up in Girard, a small town in northeastern Ohio.
In school I was always interested in biology, chemistry, and math. I earned a Bachelor of Science degree in Pre-Medicine at the University of Toledo, and felt pulled toward the social side of medicine, the population side. At that time, Ohio State University Medical School offered a unique program in which non-physicians could study preventive medicine toward a Master of Science degree. Later the program was discontinued when OSU opened a School of Public Health. During graduate school I had the chance to volunteer for the American Red Cross as an AIDS health educator in schools. These were still early days in the AIDS epidemic and this experience solidified my interest in public health.
After graduate school, how did you come to work as a Public Health Advisor (PHA) with CDC?
CDC was recruiting for PHAs in Columbus. My original position was supposed to be in STD/HIV – a field I was familiar with – but a new program in New York City had just started. I ended up in the first class of PHAs assigned to the Division of TB Elimination in New York City. This was the time when MDR-TB had spiked in New York, and I was fortunate to work with Tom Frieden [now Director of CDC] and Paula Fujiwara. It was great to be on the ground floor. I was assigned to cover three hospitals in eastern Harlem. The training was intense; not only was the city grappling with the TB/HIV crisis, but we were also in the middle of the crack epidemic. We practiced true “shoe leather epi” – tracking down patients lost to care.
You crisscrossed the country with your next CDC assignments…
For a change of scene, after New York I transferred to another PHA position in Orange County, California. The first thing on my agenda in Southern California was to buy a car – I hadn’t needed one in New York City. Working in the Orange County Health Care Agency was an opportunity to expand my TB control skills; due to a huge MDR-TB outbreak in a local high school, I did everything from TB surveillance to DOT.
After two years in Orange County, I returned to the East coast to work at the Florida Health Department in Tallahassee. I was assigned to the western and mid-section of the state, providing technical assistance for health departments, and working closely with A.G. Holley Hospital in Lantana. This position also introduced me to refugee health.
How did you land back in Orange County?
The Orange County Health Care Agency reached out to me. They were initiating an Epidemiologist classification series and asked me to be the Senior Epidemiologist for communicable diseases. Working as a PHA for CDC had given me great experience at the city, county, and state levels. The time felt right to leave federal service and return to local public health. I did communicable disease Epi in Orange County for five years, and when the TB program manager retired, I stepped into that role in 2003.
What aspect of your work is the most rewarding?
My job is a good blend of the things I like to do. At the County level, I’m closer to patients, I use my epi and management skills, and I can see the impact of our work on a local level. Our staff operates as a team. There’s very little turnover. Even when people leave, several have come back!
What do you find least enjoyable?
Like many programs, we’re trying to provide the same level of services with reductions in monetary and human resources. Since I took the job 13 years ago, we now have half the staff we once did. We no longer have satellite clinics – all services are delivered from one central clinic. It’s frustrating – we’d like to do more.
Career-wise, what do you look forward to?
It’s exciting to be part of the California TB Elimination Advisory Committee. Although I don’t expect to be working in 2040 [CTEAC’s target year for TB elimination in California], it’s great to see the continuing downward trend. I look forward to the introduction of new medications and new technologies to fight TB.
[Orange County TB Controller Julie Low, MD, has worked with Mike Carson since 2003, and praises her colleague: “Working with Mike reminds me of something General Colin Powell once said: ‘Great leaders are almost always great simplifiers, who can cut through argument, debate, and doubt to offer a solution everybody can understand.’ Of the many things I have come to admire about Mike, I most appreciate his fine intellect and strong analytical skills. We can discuss complicated situations, and he can cut through all the extraneous details, and come up with a plan of action that is rational and easily understood by all levels of staff. I look forward to working with him every day, he is a great listener, and he laughs at most of my jokes!”]
Mike Carson served as President of the California Tuberculosis Controllers Association (2013-2014), and is a member of the California TB Elimination Advisory Committee (CTEAC). He has delivered training sessions for CITC on Program Planning and Funding and Determining High-Risk Groups: Using the Universal Risk Assessment Tool. Mr. Carson has also hosted mini-fellowships for new TB clinicians and program staff, providing first-hand knowledge and experience in carrying out TB control activities.
Curry International Tuberculosis Center
University of California, San Francisco
300 Frank Ogawa Plaza, Suite 520
Oakland, CA 94612-2037
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Principal Investigator / Medical Director: Lisa Chen, MD
Associate Medical Director: Ann Raftery, RN, PHN, MS
Deputy Director: James Sederberg
Director of Education: Kelly Musoke, MPH
Program Manager: Jeannie Fong
Epidemiologist: Baby Djojonegoro, MS, MPH
Epidemiologist: Cecily Miller, MPH, PhD candidate
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