Draft: CTCA 2013 Spring TB Controller Meeting Minutes
DATE: 5-29-13 LOCATION: San Jose DoubleTree by Hilton Participants: TB Controllers, in the room (on the phone)
EC Members: Mike Carson, Julie Higashi, Louise McNitt, Michael Stacey, Peter Kerndt, Jenny Flood, Jenny Hernandez, Tim Livermore, (Karen Tait)
TB Controllers/proxies: Barbara Cole, Wendy Malone, Charlie Crane, Julie Low, James Wong, Sandra Huang, Teeb Al-Samarrai, Charity Thoman, Ken Cutler, Connie Caldwell, Cora Hoover, Lisa Gooze, Tom Birch, Matt Willis, Jackie Sedgwick, JoAnna Zimmerman, Barbara Gregory, Kathy Moser, Tom Cole, (Karen Furst)
DTBE Ken Castro, Christine Ho, Sundari Mase
Item / Discussion / Action Steps / Who / Due /I. / Welcomes, Introductions, Agenda Revisions
II. National Presentation- Charles Dickens, 1859, A Tale of Two Cities
· Investments in Research: new diagnostics, new 12 dose regimen, and first new drug in more than 40 years.
· Premature declarations of victory over TB
· Budget cuts
· Shortages of drugs and diagnostic elements
· Infrastructure of local TB control cut
· Consider strategic reductions while still maintaining control over TB. He sees reluctance of programs to stop doing what is not necessary: e.g.– two step testing of persons not a part of periodic rescreening group, not high risk population all health care workers, even those in low incidence jurisdictions, all college entrants, all teachers, etc. We need to do better.
Small Pox Eradication Model for TB
1. Seek the Truth: Accurate and Timely Diagnosis of TB and high risk groups with LTBI
2. New Tools
3. Coalitions are powerful: Federal TB Taskforce, NTCA, Stop TB USA, National Health Care Homeless Council, National Commission on Correctional Health Care, Global Stop TB
State Refugee Programs,
4. Trust holds teams together: accurate data, safe discussions to identify productive and non-productive tactic
5. Social Will is crucial, Government support for programs depends on the will of the governed. Engage affected communities, new social media tools needed
6. Social Will must be transformed into political will
7. TB Caucus and others to reauthorize resources for TB Control: Nuala Moore (ATS) and others are working on new legislation for after 2015
State governments must invest in TB control efforts, increasing reliance on federal contributions
Public health solutions rest on good science and good management: training for public health staff
8 Allocate resources where they are needed
9. Effective leadership is crucial
10. Never give up
11. Be Optimistic – Public Health Mandates this
12. Global Efforts are Possible – US TB requires an alignment of global efforts with domestic efforts
13. The objective may be the goal but the implementation is always local
14. Communications function as the nervous systems of successful coalitions -. Real time reporting of local, state and national data: We need to collect the number of suspects and contacts needed to document workload and unmet need
15. Successful evaluation methods are required for success.
Q1.What are the top priorities for national program related to program cuts at the local level and drug shortages in the U.S.? A1.need to maintain data to show TB control unmet needs. Protect the ability to collect the data with the incident cases as a basic strategy. Re: drug shortages: supply chain management needs to be learned about. We need an early warning system by working with local programs and the FDA, vaccine for children legislation option to pursue, orphan drug access for diseases with few cases. Drug purchasing is a part of every other countries responsibility in controlling TB. This may be a new responsibility for us.
Q2.Coordinate communication to enable strategies of control to eliminate TB in the U.S. (CA, NTCA, CDC)-Eg. Immigration reform legislation being written now. SCC Rep on the Caucus and on Committee writing this immigration reform legislation. Data show overseas screening very effective. A2. work locally with federal representatives and work with partners like TAG, RESULTS, NTCA, Stop TB USA, and the like on the federal level. And maximize the opportunities to communicate what is necessary locally for TB control because political leaders falsely believe TB is not a problem anymore.
Q. Who is the contact at CDC for these communications – A. Mark Miner – new regional program consultant, he started in ’08 program consultant, Southwestern States, adding CA and big cities now. NY state TB staff, CDC Baltimore placement. Mark Miner is highly regarded
Aside: Programs need to work with the public information officers to maximize their exposure during a newsworthy TB event as a communication strategy.
III. State Presentations-
Drug Shortages: Way Forward? (Neha Shah)
Tripled since 2005. Second line drug shortages for TB in 2011. At the end of 2012, we saw the first shortage in routine, first line drugs. One third of CA Counties were affected by the INH shortage. Most counties prioritized their highest risk TBI patients for INH. Assisted a pharmaceutical procurement guideline
Three State Run Options:
Stockpiled medications, 6 month supply. Bought up front. Costs are lower before the shortage. Expiration dates are an issue, so is storage.
Costco Option: Bulk buy and send to a repackager, repackager stores and distributes. Shelf life is also a concern here. Drugs need to be packaged and distributed.
Strategic supplier reserve: Prepaying supplier, funds are used when order is drawn. Six month supply is available. Shelf life not a concern. Only one wholesaler provides this option.
Discussion:
Second line drug shortages ongoing and need a solution.
The other national stockpiles are dissimilar to the TB drugs because TB dugs are more rare than the other stockpiled meds like vaccines, etc.
-State based procurement and distribution option does not address the private sector need.
Q- Work with larger wholesaler providers, if we were working with those distributors, we would know sooner about looming shortages.
Neha will look into the Military, what they are doing to secure and provide drugs.
Start with second line drugs, where we have a chronic problem.
Q. Let’s look at other states like Texas and New York, lessons learned. And, if the state purchases the drugs, where does the money come from?
E.g., Riverside reached out to corporate offices for Walgreens and CVS to see how broad the shortage was in the county. And, they couldn’t find out. They couldn’t call all of the places they needed to call.
Our drugs are unlike national stockpile efforts, because people are on TB meds for long periods of time.
Instead of money coming from the state, one idea is that local dollars would pay for the drugs for emergency allocations for drugs being discussed. It certainly would require a state investment up front. The amount is unknown and where the money would come from still being discussed.
CDC efforts about this: working on a white paper, moving it up the chain, working with the FDA for cross agency solution. CDC strategic stockpile folks are more receptive to the idea of working with us than they initially were. Looking at all of the possible solutions now.
Q. Price gauging. INH went from ~$1.50 to ~$27.00
Report price gouging to the department of justice.
State and Local Assistance TB Budget (Sue Spieldenner)
Sue Spieldenner – Presentation Given on the Budget –State and Federal Dollars combined = $16.4 Million, 2/3 go out to local assistance awards – Real time allotments for previously unfunded/low morbidity jurisdictions to 19 jurisdictions.
29 funding matrices – overall decline 18.7% funding from local budgets, overall decline in direct funding to big cities, level funding from the state.
NTCA Survey Results: 25 LHJs participated – 80% of cases in CA represented in those responding LHJs -All high and medium morbidity jurisdictions experienced a funding decrease and all high and most of medium experienced a decrease in the number of staff. More than half of the responding LHJs reported increase in case complexity, most reported decline in the ability to do extended CIs and outbreak investigations.
CA formula is like the CDC’s. Put the money where the cases and the complex cases are. That is the goal.
Discussion: San Bernardino uses the NTCA Patient Acuity Tool and all of the San Bernardino patients are complex cases of TB.
Ask for additional, augmenting funds for extended CI and Outbreak Assistance, called special needs funds. There is a form on the TB control webpage. Special needs funds have also been used on urgent needs of counties when they have asked to adjust their submitted budget to do something urgent.
Augmentation funds have been used for the following needs: Santa Clara County used this money to buy their GeneXpert machine.
Sputum Induction booths have been purchased with these funds. It is considered one time money.
Wanted to use the money for travel and training. Can this money be used for this purpose? Yes.
The NTCA survey results aggregate report is available for the 25 responding jurisdictions.
IV. NTCA Update – National Report
New Executive Director, Donna Wagner
Big issues nationally, budget cuts at every level. Some states don’t contribute at all to TB control in their state. Programs are restructuring due to significance of cuts. Drug Shortages and how to remedy this situation. We are working with partners nationally to find solutions to this. TB Trials Consortia cut and threatened further. We need to stand together and call for funding for things that will benefit the entire nation. Updated guidelines are necessary. Cuts expected to continue. We need coordinated messages with focused targets. We need it be a priority to create them.
CDC leadership believes elimination is still achievable. There are many reasons to believe this is not possible. We need to keep our eye on this goal.
He would like to see an Epidemiologist Section of NTCA next year. Share your concerns with Donna Wagner to develop NTCA.
RESULTS and their conference mentioned. They do not have any groups in Tennessee yet. Last year he had 11 meetings on Capitol Hill during the RESULTS conference. We need people to go to Capitol Hill regularly like Bob Benjamin did earlier this year. Jenny Flood will be NTCA President. She will be the NTCA liaison to ACET in 2013-2014. We need to find and develop a concerted effort to stabilize TB control in this country.
V. TB Caucus and Legislative Initiatives (Julie Higashi) – unanimous approval of the platform presented for Rep. Mike Honda and the TB Caucus: Posted
Media Event with Rep. Mike Honda
Steve French, TB Prevention Partnership and Breathe California introduced Marty Fenstersheib, SCC Health Officer. Marty introduced Rep. Mike Honda, Western San Jose and the Silicon Valley. Rep. Honda is a champion of TB Control in Congress both international and domestic prevention and control investments.
Rep Honda talked about his background being of recent immigrants and how we need to make an investment in the health and welfare of everyone. He spoke of SCC TB, global TB. Immigration, heavy international travel, visa allocation and health protocol associated with visa to educate them.
He advises that we need to create an environment of education and prevention globally and domestically to prevent TB here.
We need to help the Territories we claim are often not provided the resources they need and is fair.
We need to engage our current leadership as we are doing now and to encourage public health minded young people into the political careers. It is important to engage with our leaders and to be a part of the leadership team in D.C. He also recommended preparing a paragraph of information about TB and control efforts regularly for our leaders in D.C.
Julie Higashi, CTCA President, presented the earlier voted on by TB Controllers policy priorities request to Rep. Honda and the House TB Caucus. (full attached)
1. Restore the CDC funds previously cut.
2. Require a national strategy to ensure access to TB treatment drugs
3. Make TB diagnosis and treatment preventive health services, to remove cost barrier of copayments.
Award of Appreciation presented to Rep. Honda for his leadership on TB Control in Congress.
Poster Contest Awards presented by TPP, RESULTS and QIAGEN Inc. 3 Winners presented with checks for themselves and their schools.
VI. State Update (continued)
C. Outbreak surveillance: What's New? (Amit Chitnis)
Talking points with info from TBCB about outbreaks so media can be reached out to, ready talking points would help.
School exposures are common. TBCB has sample media packets that they have ready to share for future media events.
Homeless outbreak media packet.
3 person outbreak events can be prevented from being a 6 person outbreak event.
Question
Need better PR for TB, building advocacy, communicate about what is happening around the state, using potential outbreaks to highlight the need for ongoing control efforts. It would be helpful to learn about outbreaks going on.
A: If we generate talking points about an outbreak highlighting the important points.
This is what defining an outbreak is partially about. Having media points would be helpful.
Comment: CTCA is trying to fill this void. We put together a media release and passed that along to you. We also did this around World TB Day. It would be great to get feedback on these efforts.
School outbreaks are common. TBCB has gathered examples of school exposures fact sheets and media releases, materials. There are models available. We now also have quite a bit on homeless population outbreak media materials. think about outbreak events as opportunities to prevent transmission. put this into the media. tell this story. show the diversity of the transmission events, could be used as an opportunity to show where we are at work preventing transmission.