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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 – PowerPoint PPT presentation

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Title: Update from TB Infection Control Sub-working Group


1
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
2
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

3
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

4
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

5
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

6
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

7
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?

8
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

9
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.

10
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)

11
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12
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13
TB Infection Control is not a quick fix.

14
TB Infection Control must become a campaign.
  • Strategy
  • Workplan
  • Targets
  • Monitoring
  • Advocacy
  • Community involvement
  • Resources

15
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16
WHO DOTS Strategy for TB
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