February/March 2012  •  Vol. 7, Issue 1

News from the Southeastern National Tuberculosis Center

Then and Now: A Strategic Plan for Tuberculosis Control in the Southeast Region

The year is 2001, the place is Alexandria, Virginia, and the event is the 19th Annual Meeting of the Southeast TB Controllers. Key state TB staff members from across the region are assembled to launch a new venture. Among the objectives of the meeting is to address the Comprehensive Tuberculosis Act of 2001. The group develops a prioritized list of issues and needs and begins to develop a strategic plan to address the top priorities identified by the participants. The conference yields a statement of needs, action steps, and measureable goals and objectives. A Steering Committee is created to draft a strategic plan.

The Plan development process continues at the 20th Annual Meeting held in Savannah, Georgia. The Plan development process is assigned to smaller work groups to further develop and refine each of the goal and objective statements. The planning process continues to dominate the agenda for the 2003 Annual Meeting held in Tampa, Florida. The work groups continue their deliberations at the meeting, however when the meeting ends, the controllers agree to stop focusing on the Plan at each annual meeting, but instead begin to move forward on the issues presented in the Plan.

Fast forward to October 2011; it is the 29th Annual Meeting of the Southeast TB Controllers in Charlottesville, Virginia. The challenge presented to the group is to review the 2001 Plan and determine if and how the Plan components are currently issues of concern, and if new TB control issues have emerged in the past decade. (Editor's note: Interestingly, very few from the 2001 meeting were in attendance at the 2011 meeting.) Participants were asked to identify and prioritize TB control issues/concerns/needs in contemporary TB Programs.

The table below lists the top TB concerns in 2001 and 2011, as identified by the participants of the SE TB Controllers meetings.

The participants in 2011 identified many of the same issues noted a decade earlier, however in some cases the order of the priority placed on the issues has changed. There were also new concerns identified in 2011, most notably "funding."

In 2011, conference participants met in small groups to tackle the issues listed above. This was just the beginning of the process. The work groups have refined the goals/objectives within their groups and will share with their regional colleagues. Ultimately, the participants of the 2011 meeting will invite the leadership in each SE state to further comment and define the scope and range of the plan. As the planning process evolves, some of the 2011 priorities may be collapsed into related categories.

The Southeastern National Tuberculosis Center (SNTC) was asked by meeting participants to coordinate the development of the components of the 2011 Plan. The exact method by which that will be accomplished is still under development and details will be made available as soon as possible. In preparation for the Plan development, SNTC has established a web site where Plan related materials may be found. Materials currently on the site include a number of presentations from the 2011 meeting, the participant list, and the 2001 Plan.

Looking back at the decade since the initial plan was developed, many of the issues initially identified have been addressed at the local, state and national levels. While the 2001 Southeast Plan cannot take sole credit for changes at the national level, it certainly contributed to changes by presenting a strong voice from the region. The initial drafters of the 2001 Plan must be credited for their foresight and contribution to shaping policy within the Southeast region and the nation.

Every element of the 2001 Plan has not been achieved, however many of the Plan's components have been implemented. For example:

• The move from the model center structure to regional training and medical consultation centers covering every state and big city to identify and address training and educational needs of TB public health staff;
• The expansion of the data elements collected on foreign-born populations, contributing to a revision of the RVCT;
• The need for advance notification of arrivals from other countries is reflected in the implementation of the EDN system;
• The need to establish a central web-based repository for TB educational materials led to a national catalog of educational resources maintained by the SNTC, and
• The model TB law document published by the CDC addressed many of the issues raised in the Plan.

Other notable successes attributed to the 2001 plan include:

• The movement toward risk-based screening policies;
• RTMCCs conducting periodic Needs Assessments;
• The development and implementation of new laboratory methods;
• The TB controllers have been approached for their input on elements critical to include in the national research agenda;
• The needs of special populations have been addressed but continue to evolve.

The list above addresses some of the successes (not all!) of the 2001 plan. At the same time, there are components of the Plan where success has been somewhat limited i.e., implementation of advanced communication technology, and establishment of a national policy for Medicaid reimbursement for TB services. Overall, winners outnumbered losers and the planning process served as a valuable tool to guide TB controllers forward during the past 10 years.

As noted above, a new Plan is under development for the year 2011 and beyond. The SNTC will keep Close Contact readers informed as the process develops and the 2011 Plan comes to fruition.

Submitted by John Grabau, PhD, MPH, editor of the Close Contact, e-newsletterAcknowledgements: Shea Rabley RN, MN and Jane L. Moore RN, MHSA