October 1997

Grant Results

National Program

Old Disease, New Challenge: Tuberculosis in the 1990s

SUMMARY

Between 1994 and 1997, the Emory University School of Medicine, Atlanta, oversaw the Atlanta TB Prevention Coalition, a collaborative and coordinated effort by the various groups in Atlanta involved in education, care, and management of individuals with or at risk for TB.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Old Disease, New Challenge: Tuberculosis in the 1990s.

Key Results

  • The project has formed collaborative and cooperative partnerships among a variety of different types of organizations to address the tuberculosis problem.
  • There was a significant decline in the number of TB cases in Georgia and especially Atlanta between 1992 and 1995. Atlanta reported a 30 percent decline and one hospital, Grady Memorial Hospital, a public hospital affiliated with the Emory University School of Medicine, reported a 37 percent decline in TB cases.

Funding
RWJF supported the project with a grant of $1,155,000 between January 1994 and September 1997.

 See Grant Detail & Contact Information
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THE PROBLEM

The Atlanta TB Prevention Coalition is a collaborative and coordinated effort by the various groups in Atlanta involved in education, care, and management of individuals with or at risk for TB. Traditionally, many of these groups had worked in isolation from each other. The groups involved in the coalition include: Emory University School of Medicine and School of Public Health; hospitals; state and local health departments; the Centers for Disease Control and Prevention; and other non-profit and community-based organizations.

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THE PROJECT

The grantee's goal is to establish an innovative and coordinated education, screening, and control program to help reduce the rates of TB in Atlanta and the state of Georgia. In order to accomplish their goal, they have three specific objectives:

  • Establish a TB computer network/database to link the different groups involved in the management and care of TB patients in Atlanta.
  • Develop new and innovative approaches for screening and preventing TB in high risk populations in an urban setting and improve follow-up of patients with active TB.
  • Develop innovative strategies for educating patients and health care providers about TB.

A major accomplishment of the project has been the collaborative and cooperative partnership among a variety of different types of organizations to address the tuberculosis problem. There was a significant decline in the number of TB cases in Georgia and especially Atlanta between 1992 and 1995. Atlanta reported a 30 percent decline and one hospital, Grady Memorial Hospital, a public hospital affiliated with the Emory University School of Medicine, reported a 37 percent decline in TB cases. Factors contributing to the decrease in TB cases include an added prevention of hospital-acquired transmission of TB, increased proportion of TB patients in Atlanta on directly observed therapy, and increases in public funding for TB control in the early 1990s. Increased collaboration between agencies, especially among the Fulton and DeKalb county health departments and Grady Memorial Hospital, has led to a decrease in the median duration between discharge of TB patients from Grady Memorial Hospital and follow-up in the outpatient TB clinic at Fulton or DeKalb counties from 81 days in 1992 to 6 days in 1994.

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AFTER THE GRANT

The final six months of the grant are being spent addressing an anticipated increase in the number of TB cases in Atlanta and Georgia. The grantee plans to:

  • Update and maintain the TB network/database.
  • Draw conclusions and make recommendations about the efficacy of TB screening and prevention based on their collected data.
  • Educate and train health workers and medical students about TB and improving infection control.
  • Continue participation in an assessment of the impact of TB and of the Coalition's TB-related activities on the administration, curriculum, and clinical teaching of the Emory University School of Medicine.
  • Continue participation in the RWJF-sponsored evaluation of Old Disease, New Challenge.

The grantee will be able to continue work after the RWJF grant ends, with funding from the Robert W. Woodruff Foundation for essential personnel and computer network/database system updating.

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GRANT DETAILS & CONTACT INFORMATION

Project

Atlanta Tuberculosis Prevention Coalition

Grantee

Emory University School of Medicine (Atlanta,  GA)

  • Amount: $ 1,155,000
    Dates: January 1994 to September 1997
    ID#:  023609

Contact

Project Director: Henry M. Blumberg
(404) 616-6146

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Publications

Blumberg HM. "The "New Tuberculosis" and Its Changing Epidemiology. Nosocomial Transmission and Hospital Discharge Standards." Journal of the Medical Association of Georgia, 84(5): 209–214, 1995.

Blumberg HM, Moore P, Blanchard DK and Ray SM. "Transmission of Mycobacterium Tuberculosis Among Health Care Workers Infected with Human Immunodeficiency Virus." Clinical Infectious Diseases, 22(3): 597–598, 1996.

Blumberg HM, Watkins DL, Berschling JD, Antle A, Moore P, White N, Hunter M, Green B, Ray SM and McGowan JE Jr. "Preventing the Nosocomial Transmission of Tuberculosis." Annals of Internal Medicine, 122(9): 658–663, 1995. Abstract available online.

Bock NN, McGowan JE Jr., Ahn J, Tapia J and Blumberg HM. "Clinical Predictors of Tuberculosis as a Guide for a Respiratory Isolation Policy." American Journal of Respiratory and Critical Care Medicine, 154(5):1468–1472, 1996. Abstract available online.

Camins BC, Bock N, Watkins DL and Blumberg HM. "Acceptance of Isoniazid Preventive Therapy by Health Care Workers After Tuberculin Skin Test Conversion." JAMA, 275(13): 1013–1015, 1996. Abstract available online.

Georgia TB Reference Guide, July 1995 and July 1996.

McGowan JE Jr. "Nosocomial Tuberculosis: New Progress in Control and Prevention." Clinical Infectious Diseases, 21(3): 489–505, 1995. Abstract available online.

McGowan JE Jr. and Blumberg HM. "Inner-city Tuberculosis in the USA." Journal of Hospital Infection, 30(Suppl.): 282–295, 1995. Abstract available online.

McGowan JE Jr., Metchock B and Nolte FS. "Laboratory Diagnosis of Tuberculosis: Past, Present and Future." Journal of the Medical Association of Georgia, 84(5): 215–220, 1995. Abstract available online.

Porkert MT, Sotir M, Parrott-Moore P and Blumberg HM. "Tuberculous Meningitis at a Large Inner-City Medical Center." American Journal of the Medical Sciences, 313(6): 325–331, 1997. Abstract available online.

Zaza S, Blumberg HM, Beck-Sague C, Haas WH, Woodley CL, Pineda M, Parrish C, Crawford JT, McGowan J E Jr. and Jarvis WR. "Nosocomial Transmission of Mycobacterium Tuberculosis: Role of Health Care Workers in Outbreak Propagation." Journal of Infectious Diseases, 172(6): 1542–1549, 1995. Abstract available online.

Presentations and Testimony

Blumberg HM. "Atlanta TB Prevention Coalition." Southeastern TB Controllers' Annual Meeting. Atlanta, Ga., November 1994.

Blumberg HM. "Atlanta TB Prevention Coalition/The Robert Wood Johnson Foundation TB Initiative." National Coalition for the Elimination of Tuberculosis. Washington, D.C., January 1995.

Blumberg HM. "Reaching the High Risk Patient." An International View of TB in New York City. American Lung Association/American Thoracic Society, New York N.Y., April 1995.

Blumberg HM. "The "New" Tuberculosis: Clinical and Molecular Epidemiology." Tblisi, Republic of Georgia, August 1996.

Bock N. "M. Tuberculosis Infection and Disease." Current Topics in Women's Health: Infectious Diseases. Atlanta, Ga., October 1996.

Bock, N. "Participatory Research and Problem Solving with Health Care Providers." National TB Controllers Conference. Atlanta, Ga., September 1996.

Bock N. "TB in the Homeless." Task Force for the Homeless. Atlanta, Ga., September 1995.

Abstracts Presented at Meetings

Ahn J, Blumberg HM, Rosenberg L, Bock N. "Efficacy and Efficiency of a Respiratory Isolation Policy in Preventing Nosocomial Transmission of Tuberculosis." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1995.

Anderson CD, Blumberg HM, Ray SM. "Molecular Subtyping of Low Copy Number IS6110 Mycobacterium Tuberculosis Isolates in the Atlanta Area." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1997.

Blanchard DK, Halvosa S, Blumberg HM, Ray SM. "Transmission of an Isoniazid (INH)-Resistant Clone of Mycobacterium Ruberculosis (M.TB.) in Atlanta." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1996.

Blumberg HM, Bock NN, Sotir M, Moore P, Sumrall MA, McBride A, DeVoe B, Toomey KE, Ray S, McGowan JE Jr. "Efficacy of a TB Discharge Criteria Policy in Improving Follow-up among High Risk Patients with Active Disease." American Thoracic Society Annual Meeting. New Orleans, May 1996.

Blumberg HM, Erwin MP, Sotir M, Bachman R, Shulman JA. "Risk of Housestaff Tuberculin Skin Test Conversion in a High Incidence Area Following Implementation of Expanded TB Infection Control Measures." American Thoracic Society Annual Meeting. New Orleans, May 1996.

Blumberg HM, Miller LP, Bock N, Sotir M, Moore P, Vernon A, Metchock B, McGowan JE Jr. "The Epidemiology of Tuberculosis at an Inner-City Hospital, 1991–1994." Annual Meeting of the Infectious Diseases Society of America. San Francisco: Infectious Diseases Society of America, September 1995.

Blumberg HM, Miller LP, Sotir M, Ray S, Bock N, McGowan JE Jr. "The Epidemiology of Tuberculosis at an Inner-City Hospital in the USA, 1991–1995." Annual Meeting of the International Union Against Tuberculosis and Lung Disease. Paris: International Union Against Tuberculosis and Lung Disease, October 1996.

Blumberg HM, D , M Hunter, B Green, JD Berschling, P Moore, N White, McGowan, JE Jr. "Prevention of Nosocomial Transmission of Tuberculosis by Administrative Controls." Annual Meeting of the Infectious Diseases Society of America. Orlando: Infectious Diseases Society of America, 1994.

Bock NN, Ahn J, Rosenberg L, McGowan JE Jr., Blumberg HM. "Efficacy and Efficiency of a Respiratory Isolation Policy in Preventing Nosocomial Exposure to Tuberculosis." American Thoracic Society International Meeting. Seattle: American Thoracic Society, May 1995.

Bock NN, DeVoe B, Toomey KE, Blumberg HM. "The Atlanta TB Prevention Coalition: Old Disease, New Approaches." American Thoracic Society International Meeting. Seattle: American Thoracic Society, May 1995.

Bock NN, Dunbar C, Kim S, Mian S, Rosenberg L, Blumberg HM. "Inpatient Tuberculin Screening — No More Missed Opportunities for Tuberculosis Prevention." American Thoracic Society International Meeting. Seattle: American Thoracic Society, May 1995.

Bock NN, McGowan JE Jr., Blumberg HM. "Missed Opportunities for Tuberculosis Prevention in the Public Health System." Lancet Conference on Tuberculosis. Washington, D.C., September 1995.

Bock NN, McGowan JE Jr., Moore, P, Blumberg HM. "Utility of Tuberculin Skin Testing of Patients with Low Risk of Nosocomial Tuberculosis Exposure." San Francisco: Infectious Diseases Society of America, September 1995.

Bock NN, Toomey KE, DeVoe B, Tapia JR, Blumberg HM. "High Prevalence of Tuberculosis Infection Among Employees of an Urban Jail." American Thoracic Society Annual Meeting. New Orleans, May 1996.

Camins B, Watkins D, Bock N, Blumberg HM. "Acceptance and Adherence of Health Care Workers with Isoniazid Preventive Therapy." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1995.

Cohen AJ, Blumberg HM, Miner K, Thompson NJ. "An Assessment of Grady Memorial Hospital Employees' Knowledge and Attitudes About Tuberculosis." 123rd Annual Meeting of the American Public Health Association. San Diego: American Public Health Association, December 1995.

Erwin MP, Sotir M, Bachman R, Shulman JA, Blumberg HM. "Risk of Housestaff Tuberculin Skin Test (TST) Conversion in a High Incidence Area Following Implementation of Expanded TB Infection Control Measures." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1996.

Larson CE, Sotir MJ, Khan A, Bock NN, Blumberg HM. "Risk Factors for Tuberculin Skin Test Positivity and Conversion Among Employees at a Public Inner-City Hospital in a High Incidence Area." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1997.

McGowan, JE Jr., Blumberg HM, P Moore, C Parrish, B Bilek. "How Many Isolation Rooms for Tuberculosis Are Enough?" Annual Meeting of the Infectious Diseases Society of America. Orlando: Infectious Diseases Society of America, 1994.

Miller LP, Blumberg HM, Shinnick T. "A Molecular and Epidemiologic Study of Rifampin-Resistant Strains of Mycobacterium Tuberculosis at an Inner-City Hospital, 1991–1994." Lancet Conference on Tuberculosis. Washington, D.C., September 1995.

Porkert MT, Moore P, Blumberg HM. "Tuberculosis Meningitis at a Large Urban Medical Center, 1984–1995." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1996.

Ray SM, Blanchard DK, Blumberg HM. "Molecular Epidemiology of Mycobacterium Tuberculosis Isolates from Grady Health System: 1993 and 1995." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1997.

Ray S, Moore PP, Sotir M, White N, McGowan JE Jr., Blumberg HM. "Long-Term Impact of a Nosocomial Tuberculosis Exposure." American Thoracic Society Annual Meeting. New Orleans, May 1996.

Ray SM, Moore PP, Sotir M, White N, McGowan JE Jr., Blumberg HM. "Long-Term Impact of a Nosocomial Tuberculous Exposure." Annual Meeting of the International Union Against Tuberculosis and Lung Disease. Paris: International Union Against Tuberculosis and Lung Disease, October 1996.

Ray SM, Moore PP, Sotir M, White N, McGowan JE Jr., Blumberg HM. "Long-Term Impact of a Nosocomial Tuberculosis (TB) Exposure." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1996.

Vernon A, Blumberg HM, Mounib E, Sumrall MA, Page R, Simone P, Khan A. "Acquired Rifampin-Resistant TB: A New Problem in HIV Disease." Lancet Conference on Tuberculosis. Washington, D.C., September 1995.

Weil AC, Plikaytis BB, Woodley CL, Butler WR, Crawford JT, Shinnick TM. "MTP40 Is Not Present in All Strains of Mycobacterium Tuberculosis." Southern Section, American Federation for Clinical Research Annual Meeting. New Orleans: American Federation for Clinical Research, February 1996.

Zupp P, Miner K, Blumberg H, Thompson N. "TB-Related Knowledge, Attitudes, and Practices of Second Year Medical Students Before and After Participation in an Education Intervention." 123rd Annual Meeting of the American Public Health Association. San Diego: American Public Health Association, December 1995.

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Report prepared by: Marie P. Lyons
Reviewed by: Marian Bass
Program Officer: Marilyn Aguirre-Molina
Evaluation Program Officer: James Knickman

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