CITC Newsletter - Spring 2021

An electronic newsletter from the Curry International Tuberculosis Center (CITC)

 

Highlights from World TB Day, March 24, 2021

Niagara Falls, Canada,  lit up in red to mark World TB Day

March 24, 2021, was World TB Day, an annual event commemorating the date in 1882 when Dr. Robert Koch announced his discovery of M.tuberculosis, the bacillus that causes TB. World TB Day is an opportunity for organizations of all sizes – from the World Health Organization to local health departments – to raise public awareness about the devastating consequences of TB, and to step up efforts to end the global TB epidemic. 

The University of California, San Francisco (UCSF) presented a World TB Day Webinar co-hosted by the UCSF Center for Tuberculosis and the Curry International Tuberculosis Center. The event featured presentations from international leaders in TB research and policymaking and showcased UCSF research advances and upcoming programs.  Highlights from the World TB Day event in London were also presented as a continuation of a longstanding trans-Atlantic partnership. The impressive roster of webinar presenters included:

World TB Day 2021 sponsored by Center for Tuberculosis, UCSF

View a recording of the World TB Day Webinar.

Charet Wynn [photo courtesy of WA State Dept. of Health]

In Washington State, World TB Day was celebrated on March 22 when the TB ECHO virtual learning community presented 270 Doses: A Patient Perspective. The webinar featured Charet Wynn telling her story as a TB survivor and her commitment to connecting with other survivors through we are TB, an advocacy and support network.

Julie Higashi, MD, PhD

Dr. Julie Higashi, director of the Los Angeles County TB Control Program (and longtime CITC Warmline consultant), presented “The State of TB in L.A. County in the COVID-19 Era” with Dr. Ramon Guevara, Supervising Epidemiologist. The presentation included 2020 TB case data, the impact of the COVID-19 pandemic on TB services, and special recognition for local frontline healthcare workers.

Read about other World TB Day events.

 

New 4-month treatment regimen for drug-susceptible TB

New 4-month treatment regimen for drug-susceptible TB

Results from an international, randomized, controlled clinical trial indicate that a four-month daily regimen containing high-dose, or “optimized,” rifapentine with moxifloxacin is as safe and effective as the existing standard six-month daily regimen at curing drug-susceptible TB disease. This regimen is the first successful short-course treatment regimen for drug-susceptible TB disease in almost 40 years.

The Phase 3, open-label trial, called Study 31/A5349, was led by the CDC’s Tuberculosis Trials Consortium (TBTC) with collaboration from the AIDS Clinical Trials Group (ACTG) funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). It is the largest drug-susceptible TB disease treatment trial that CDC or NIAID has ever conducted, with more than 2,500 participants ages 12 and older enrolled at 34 clinical sites in 13 countries. The trial included 214 people with HIV. Results were first presented at the virtual Union World Conference on Lung Health in October 2020, further discussed on World TB Day, and then reported May 6, 2021, in the New England Journal of Medicine.

Study 31/A5349 examined the efficacy and safety of two four-month regimens with high-dose rifapentine with or without moxifloxacin for the treatment of drug-susceptible TB disease. These were compared with the existing six-month regimen, which includes eight weeks of daily treatment with rifampin, isoniazid, pyrazinamide, and ethambutol and 18 weeks of daily treatment with rifampin and isoniazid.

One of the four-month regimens – 2PHZM/2PHM – included eight weeks of daily treatment with high-dose, or “optimized,” rifapentine, isoniazid, pyrazinamide, and moxifloxacin and nine weeks of daily treatment with rifapentine, isoniazid, and moxifloxacin. At the conclusion of the trial, the four-month regimen met non-inferiority criteria for efficacy in all of the planned analyses and was safe and well-tolerated.

A second new treatment regimen used in this study – 2PHZE/2PH – included eight weeks of daily treatment with the same dose of rifapentine, isoniazid, pyrazinamide, and ethambutol and nine weeks of daily treatment with rifapentine and isoniazid. This new regimen did not meet non-inferiority criteria when compared to the existing standard regimen.

The safety profile demonstrated that the proportion of patients who experienced adverse events was similar among patients in all three groups of participants (control and the two novel regimen groups). Study 31/A5349 will inform future TB treatment in the U.S., as CDC and NIH continue to work with TB control programs and clinicians to improve treatment and prevention regimens for TB disease.

 

2021 TB Elimination Champions 

As a part of its World TB Day activities, the CDC’s Division of Tuberculosis Elimination (DTBE) announced the 2021 CDC U.S. TB Elimination Champions. This year’s Champions highlight the ways the COVID-19 pandemic has impacted TB control services, impacting staff roles, responsibilities, and resources in public health departments and healthcare facilities. Among the 19 individuals and organizations recognized this year as “TB Leaders” were 4 luminaries from CITC’s Western Region:

  • San Diego County Tuberculosis Elimination Initiative: Throughout the pandemic, San Diego County stakeholders collaborated to address latent TB infection screening, testing, treatment, and surveillance, expanding telehealth, and leveraging synergies with COVID-19 and influenza vaccination sites.
  • Dr. Scott Lindquist

    Dr. Scott Lindquist, Washington State Dept of Health: A long-time TB medical consultant for the state of Washington, Dr. Lindquist took on additional TB clinical responsibilities for multiple local jurisdictions, while contributing to the COVID-19 response.

  • Housing for Health, Los Angeles County Department of Health Services: Housing for Health collaborated with the Los Angeles County Tuberculosis Control Program to help TB patients who are experiencing homelessness connect to recuperative care and/or stabilized housing during the COVID-19 pandemic.
  • California Department of Public Health (CDPH) Tuberculosis Control Branch: CDPH leveraged their TB control skills in California’s COVID-19 response, supporting training, surveillance, modeling, contact investigation, clinical, and public health guidance.

Chima Mbakwem

Congratulations also to Chima Mbakwem with the Guam Department of Public Health and Social Services. Mr. Mbakwem introduced different forms of telehealth, video directly observed therapy, and audio calls between patients and providers. Guam is a Pacific Island nation served by all four TB Centers of Excellence.   

Another recipient of the TB Elimination Champion award was the group “TB Nurses in the U.S.: All Public Health Departments” in recognition of the essential care and invaluable related services for patients that public health nurses provide to COVID-19 patients and TB patients alike.

Read about all the 2021 TB Elimination Champions.

 

Provisional 2020 TB stats plummet

Downtrend line

Provisional 2020 TB data released by the CDC in March reveal a dramatic decline in the number of reported cases of TB disease in the United States. As announced in the March 25 issue of Morbidity and Mortality Weekly Report, the 2020 total of 7,163 TB cases compared to 8,909 TB cases in 2019, which represents a 20% decrease. The 2020 incidence rate of TB disease was 2.2 per 100,000 persons compared with 2.7 per 100,000 persons during 2019, a decrease observed in both U.S.-born and non-U.S.–born persons.

CDC links the steep decrease in reported cases to the COVID-19 pandemic, resulting in an under-ascertainment of cases and a true decline in TB incidence. For example, changes in immigration and travel patterns in 2020 as well as pandemic mitigation efforts (e.g., mask-wearing and social distancing) might have contributed to the decrease in the reported incidence of TB disease. The significant decrease in reported TB disease cases raises concern about potentially missed or delayed TB disease diagnoses. The COVID-19 pandemic may have limited patient access to care, and likely made patients more reluctant to seek medical care.

Read the provisional 2020 TB data report.

 

we are TB: A network of peer support and advocacy

Tenzin Kunor

we are TB is a network of tuberculosis survivors and advocates that offers comprehensive peer support for current TB patients and TB clinics. A subset of the National TB Controllers Association, we are TB works to achieve change in TB diagnostics, treatment regimens, and funding to support US-based public health programs. The group specializes in connecting medical professionals and current TB patients to TB survivors. we are TB brings an unparalleled depth of knowledge and provides compassionate support while using personal stories to empower survivors to break the stigma.

Tenzin Kunor, an MDR TB survivor and an inaugural member of we are TB, launched a new resource, we are TB’s Support Space, to support TB patients and survivors during the COVID-19 pandemic. This forum provides a safe space for those currently undergoing treatment for latent TB infection or TB disease, as well as TB survivors. Mr. Kunor was recognized by CDC as a 2021 TB Elimination Champion for his efforts to organize the support space and build community during the uncertainty presented by COVID-19.

 

Cure drug-resistant TB in 6 months? Trial shows promising results

Cure drug-resistant TB in 6 months? Trial shows promising results

TB-PRACTECAL, a clinical trial aiming to find a better treatment for multidrug-resistant TB (MDR-TB), stopped enrolling patients early after its independent data safety and monitoring board indicated that the regimen being studied is superior to current care, and more patient data was extremely unlikely to change the trial’s outcome. The phase II/III clinical trial tested a six-month, all-oral regimen of bedaquiline, pretomanid, linezolid and moxifloxacin, against the locally accepted standard of care. According to the trial’s sponsor, Médecins Sans Frontières (MSF), the findings have the potential to change clinical practice. At the time of the interim analysis, 242 patients had been enrolled in seven trial sites in Belarus, South Africa, and Uzbekistan. MSF is now preparing a dataset to share with the WHO, with full results to be submitted to a peer reviewed journal in the coming months. Since the first patient was enrolled onto the TB-PRACTECAL trial in 2017, new treatments for MDR-TB became available. Despite changes in WHO guidance, treatment often still includes painful injections and drugs that cause toxic side effects. WHO’s current guidelines recommend treatment lasting nine to 20 months for patients with MDR-TB.

In the MSF announcement, Professor Nargiza Parpieva, Country Coordinating Principal Investigator in Uzbekistan, said:  “Our hope is that rigorous data from TB-PRACTECAL will be reviewed by WHO urgently and allow for the recommendation of this six-month regimen, which should translate into countries incorporating it into national treatment programmes.”

 

Curry Center welcomes new team member

Colleen Hoehn, BSN, MPH

Colleen Hoehn, BSN, MPH, has joined the Center as a nurse educator, supporting the clinical consultation service and providing clinical information and administrative oversight for IRB requests related to drug acquisition. A nurse since 2001, Colleen brings to her role a wealth of nursing experience in the Curry Center’s Western Region:  “I assisted in education and training of clinicians in rural Washington through a grant from the Firland Foundation, managed activities of the Washington State TB Advisory Council, and helped the Curry Center plan local trainings from 2005-2007. After completing my MPH at the University of Washington, I joined the State of Alaska as a Public Health Nurse from 2009 to 2012. Working out of Bethel I cared for clients in remote communities with latent and active TB and conducted TB sweeps.” Colleen is also a nurse at the University of California, Berkeley, where she helps to manage mandatory TB requirements and TB care for all students. “Coming full circle from my early engagement with the Curry Center in 2005, I now am so grateful to be part of the Curry family and assist with the consultation team,” she said.

 

CITC’s Lisa Chen named president-elect for The Union – NAR

Lisa Chen, MD

CITC Principal Investigator and Medical Director Lisa Chen, MD, is 2021-22 president-elect for the International Union Against TB and Lung Disease (The Union) – North American Region (NAR), as announced at the organization’s 25th annual conference on February 25, 2021. The Union-NAR is the regional arm of The Union, a global public health organization with the vision to provide health solutions to the poor. Dr. Kevin Schwartzman is the 2021-22 president for The Union-NAR.  “The NAR organization has always brought together the best of academia and public health in a welcoming and collegial environment. I’m excited and honored to join this leadership team and to become more deeply involved with the Union and its mission,” said Dr. Chen.

 

Upcoming trainings

CITC’s schedule of upcoming trainings offers a variety of training opportunities for clinicians and public health providers.

Fundamentals of Medical & Case Management of Drug-Susceptible TB
May 21, 2021
[virtual training]   

Achieving Treatment Completion for Drug-Susceptible TB: Rarely a Straight Path
June 3, 2021
[virtual training]     

CDC Technical Instructions: What Civil Surgeons in California Need to Know

June 17, 2021
[virtual training]   

Case Management for Latent TB Infection

June 25, 2021
[virtual training]   

Focus on LTBI
August 3, 2021

[virtual training]

Tuberculosis Contact Investigation
August 5, 2021
[virtual training]

Tuberculosis Clinical Intensive
August 9-10, 2021
[virtual training]

Tuberculosis Nursing Workshop
August 24, 2021
[virtual training]

 

About CITC

CITC logo

 

 

 

 

CITC creates, enhances, and disseminates resources and models of excellence, and performs research to control and eliminate TB in the United States and internationally. The Curry Center opened in 1994 and is now designated by the CDC as a TB Center of Excellence (TB COE) for the Western Region, serving Alaska, Arizona, California (including Los Angeles, San Diego, and San Francisco), Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, and the U.S. Pacific Island Territories. 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.

 

CITC staff

Principal Investigator / Medical Director: Lisa Chen, MD
Associate Medical Director/Nurse Consultant: Ann Raftery, RN, PHN, MS
Deputy Director: Kelly Musoke, MPH
Director of Education: Elisha Couchman, MA
Nurse Educator: Colleen Hoehn, BSN, MPH
Program Manager: Jeannie Fong
Program Manager: Amelia Alonis
Web Developer: Mari Griffin, MS
Special Projects Manager/Newsletter Editor:
Kay Wallis, MPH

 

Contact us

Curry International Tuberculosis Center
University of California, San Francisco
2001 Center Street, 7th floor
Berkeley, CA 94704

(510) 238-5100

Warmline TB Medical Consultation: 877-390-6682 (toll-free) or 415-502-4700
CurryTBCenter@ucsf.edu
www.currytbcenter.ucsf.edu
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