CITC Newsletter - Summer 2022

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

June 29, 2022, marks the Curry Center’s 28th anniversary. Since opening in 1994, the Center has remained true to the pioneering tradition of its namesake, Francis J. Curry, MD, whose life and distinguished public health career were committed to restoring health, happiness, and human dignity.

TB community convenes for in-person learning and honors

On May 23-26, the National TB Controllers Association (NTCA) and California TB Controllers Association (CTCA) combined forces to host the National TB Conference, “TB Elimination: Back in Focus” in Rancho Mirage, CA. TB program staff and affiliated providers from every state flocked to the beautiful desert setting to learn, share, network, and celebrate the long-awaited opportunity to gather with colleagues in person. Sessions featured expert panels that discussed new shorter-course regimens, the need for standardized isolation protocols, improving the diagnosis and treatment TB during pregnancy, how best to serve newcomers to the U.S., and implications of the 2021 bone allograft outbreak.

The NTCA/CTCA joint awards ceremony on May 25 was a particularly joyous event on the conference agenda. CITC congratulates all award recipients, and proudly highlights the following honorees from the Western Region:

Sheila Davis-Jackson, longtime Operations Manager with the San Francisco Department of Public Health (SFDPH), was one of two recipients of the CTCA “Andy Lopez Award” for Allied Health Professionals. SFDPH TB Control Medical Director Dr. Janice Louie presented the award to Ms. Davis-Jackson, praising her as a “role model for our staff” and emphasizing her decades of service to patients with extreme challenges, including many who experience homelessness.

The second CTCA Allied Health Professional award went to Angelina “Angie” Padilla of the Solano County TB Control Program. In accepting the award from her mentor Julie Morgan, Ms. Padilla noted that although she did not have a formal education, “I have been taught on the job for 32 years.”

Dr. Andrea Polesky, of the TB Control and Refugee Health Program in San Diego County. Dr. Smith revealed that several times when she has mentioned Dr. Polesky’s name to a colleague, she hears the same response: “If anyone in my family had TB, I would want Dr. Polesky to treat them!”

Chima Mbwakwem, TB/Hansen’s Diseases Program Manager of Guam’s Department of Public Health and Social Services, was named NTCA TB Controller of the Year. NTCA Immediate Past President Pete Dupree presented the award to Mr. Mbwakwem, who was also honored in 2021 as a CDC TB Elimination Champion for leading his team to provide uninterrupted TB services and scalable, patient-centered care during the pandemic.

The conference poster session was a showcase to display many innovative projects. CITC’s Associate Medical Director Ann Raftery and Program Manager Amelia Alonis presented From Competencies to Curriculum: Preparing Virtual Training Modules for TB Nurse Case Management. Their poster described the development of a virtual training platform for case management and contact investigation (CMCI) training. When the COVID pandemic imposed barriers to traditional in-person training events, the new virtual platform enabled CITC to reach a larger learner audience and increased access to training for many staff new to TB case management.

In memoriam: Paul Farmer, MD, PhD (1959-2022)

On February 21, 2022, news broke about the sudden cardiac death of Dr. Paul Farmer in Rwanda, and the international outpouring of grief and shock was swift. Obituaries in major media outlets referred to Paul Farmer as a “renowned humanitarian,” “global health pioneer,” and “visionary.” Bill Gates simply called him a “hero” noting, “I have never known anyone who was more passionate about reducing the world’s worst inequities in health—or who did more to live by his values.” As National Public Radio reported, when The New York Times contacted Dr. Anthony Fauci about Farmer's death, he wept in the interview, saying he and Farmer had been like soul brothers.

Physician, medical anthropologist, author, and tireless advocate of the world’s most underserved communities, Paul Farmer co-founded Partners in Health (PIH) in 1987 and served as its chief strategist. As a Harvard medical school student, he established a tiny clinic in Haiti’s rural Central Plateau in a village ravaged by malaria, TB, and typhoid. That single remote clinic has since evolved into six medical centers throughout Haiti. Today PIH works in 12 countries with 18,000 staff (99% from within the countries served).

A Guardian obituary of Paul Farmer described the approach behind the phenomenal growth and success of PIH: “Forging partnerships between governments, academic institutions and philanthropists, he made it possible for even the poorest communities to have world-class hospitals and astonishingly successful health programmes. A passionate believer in social justice and building local capacity, he said medical treatment is not enough if people are sick because they are starving and destitute.”

The TB care community feels a special connection to Paul Farmer given his focus on battling TB and other infectious diseases (HIV, Ebola) in the developing world. In 1994, PIH expanded to Peru to support the government in battling an unchecked epidemic of multidrug-resistant TB in Carabayllo, an impoverished neighborhood along the northern hillsides of Lima. CITC co-founder Dr. Phil Hopewell worked in Peru a few years prior to the arrival of PIH and shared his reflections about Paul Farmer’s life and legacy with CITC Newsletter:  "Paul Farmer was a committed and charismatic leader in global health who saw the inequities in health not in terms of programs and epidemiological data, but as individual people who were suffering. His concept was very clearly demonstrated in his approach to tuberculosis. In a time when global and national programmatic guidance was based on epidemiological principles and data, Paul and Partners in Health, stemming largely from their experience in Peru, argued strongly that patients with drug-resistant TB could not be ignored even if, based on the epidemiology of TB, it was thought that they contributed little to the global burden of the disease. Although it didn’t come easily, Paul and Partners in Health ultimately succeeded in changing the philosophy and technical approach to global TB from one focused on populations to an equal focus on individuals with the disease. Although there are many items in Paul’s legacy, I see this shift in emphasis as perhaps his major contribution."

Paul Farmer devoted his life to the passionate pursuit of a simple credo: Health care is a human right. In a PIH documentary, Bendng the Arc, Paul Farmer displays the “defiant optimism” for which he was so admired: “To pull a million people out of poverty in the last several years, to build stable institutions where none existed—to me, that is about hope and it’s about rejecting despair and cynicism. Those are the two biggest dead ends we’ve got: despair and cynicism.”

Learn more about the life and work of Paul Farmer:

• Mountains Beyond Mountains (2003) by Tracy Kidder
• Pathologies of Power by Paul Farmer
• Interviews with Paul Farmer on National Public Radio, Fresh Air program
• Partners in Health

Toolkit for TB contact investigations in schools

The average public health department may rarely be called upon to conduct a TB contact investigation (CI) in a school setting. When the need arises, the scope and complexity of the task can be daunting. First developed in 2004 in collaboration with the California Department of Public Health, TB Contact Investigation in Schools Toolkit has been released in a fully updated online version. The materials in the toolkit were developed based on lessons learned from CIs in a variety of school settings (elementary, junior high, high schools, and colleges in large and small, urban and rural jurisdictions) throughout California over the past several decades.

TB Contact Investigation in Schools Toolkit presents a 10-step framework for a school CI. Each step has a checklist with helpful tips to consider and the corresponding tools for that step. The tools include samples of letters, forms, reports, press releases, and meeting agendas that can be customized by any jurisdiction to local circumstances. Also included is a School TB CI Database (3.1) that organizes all the data collected during the CI for easy access. This data can then be used help decide next steps in the investigation.

TB news briefs

Updated WHO guidance for treatment of drug-resistant TB

On May 2, the World Health Organization (WHO) released a </span><a data-cke-saved-href=" who-ucn-tb-2022-2="" www.who.int="" />rapid communication to announce upcoming updates to its guidance on treatment of drug-resistant TB. The much-anticipated updates include shorter novel 6-month all-oral regimens for the treatment of MDR/RR-TB with or without additional resistance to fluoroquinolones (pre-XDR-TB) and an alternative 9-month all-oral regimen for MDR/RR-TB. WHO Global TB Programme Director Tereza Kasaeva hailed the potential benefits of the new treatment options: “This is major progress compared to what was available even a few years ago and will be of great benefit for people struggling with TB and drug-resistant TB, resulting in better outcomes, saving lives, and reducing suffering.”

Resources to serve patients from Ukraine

Since the Russian invasion of Ukraine on February 24, 2022, more than 15,000 refugees from Ukraine have entered the United States. The U.S. government estimates the eventual admission will be 100,000. Public health and TB control programs that serve these newcomers can now access helpful materials.

The Southeastern National Tuberculosis Center (SNTC) offers a new, two-page Cultural Quick Reference Guide: Ukraine that gives country-specific information on cultural norms, health practices, and courtesies. The guide also contains facts about TB in Ukraine, with details about stigma, traditional beliefs, and remedies used. SNTC has also developed three patient hand-outs in Ukrainian on TB, LTBI, and the 3HP regimen. All materials are free and downloadable from the SNTC website.

Free patient educational materials that have been translated into Ukrainian can also be found on a CDC website: Uniting for Ukraine: Information for TB Programs.

CDC launches Think. Test. Treat campaign

On March 15, the Centers for Disease Control, Division of TB Elimination (CDC-DTBE) launched Think. Test. Treat TB, the first national communications campaign designed to increase testing and treatment for latent TB infection (LTBI) in the U.S.

Up to 13 million people are living with LTBI in the U.S. Without treatment, 5-10% of people with LTBI will develop TB disease. TB is also a disease of disparity, disproportionately impacting Asian American communities.

Think. Test. Treat TB campaign aims to raise awareness among Asian Americans and their healthcare providers about LTBI risk, and the link between LTBI and TB disease The campaign will initially reach individuals born in Vietnam or the Philippines, currently living in the Los Angeles and Seattle areas, and their healthcare providers. Materials in Chinese, Ilocano, Marshallese, Spanish, and Tagalog (in addition to English and Vietnamese) are also available for use nationwide.

TB in the U.S. in 2021

The global COVID pandemic has created many public health disruptions from 2020 to the present day. Would statistics about reported cases of TB in the U.S. in 2021 be impacted as dramatically as they had in 2020? CDC chose March 24, 2022 (World TB Day) as the occasion to release 2021 provisional data about TB in the U.S. in an MMWR report. Highlights included:

• A total of 7,860 TB cases were reported during 2021, 687 more than during 2020 (7,173) and 1,040 fewer than during 2019 (8,900)
• From 2020 to 2021, TB incidence (cases per 100,000 population) rose 9.4%, from 2.16 to 2.37, but remained 12.6% lower than during 2019
• California reported the highest number of cases (1,750), and Alaska reported the highest incidence (7.92). Eighteen states and DC reported the same number or fewer TB cases during 2021 than during 2020; the remaining 32 states reported more cases during 2021 than 2020.

Upcoming trainings

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

Achieving Treatment Completion for Drug-Susceptible TB: Rarely a Straight Path
Module 4: TB Case Management and Contact Investigation Core Training

July 21, 2022
[virtual training]

Tuberculosis Contact Investigation
Module 6: TB Case Management and Contact Investigation Core Training
Summer 2022
[virtual training]

Contact Investigation and Interviewing Intensive
September 27 -30, 2022
Oakland, CA [in person]

CA Civil Surgeon Training
Fall 2022
[virtual training]

TB Along the Border
October 2022 (date TBA)
[Webinar]

Focus on LTBI
October 25, 2022
Oakland, CA [in person]

Tuberculosis Clinical Intensive
October 26 – 28, 2022
Oakland, CA [in person]

For periodic updates on additional trainings, complete course descriptions, and application forms, visit the CITC training section.

About 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. The Curry Center opened in 1994 and is now designated by the Centers for Disease Control and Prevention (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
Program Manager: Emily Mabry, MPH, CHES^®
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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