CDC History of Tuberculosis Control - Medical and Public Health ...

What is the role of New York City in the
global fight against TB? Many people migrate
to places such as New York City to better
their economic lot, and many of these people
come from areas of the world where TB is
endemic. New York City’s TB cases represent
a microcosm of TB around the world; in 1998,
these cases came from 91 countries, led by
China, the Dominican Republic, Haiti, Ecuador,
India, and Mexico. In some instances,
people (including those with MDR TB) come
to New York City specifically to be treated,
having heard of the program’s success.
One of New York City’s contributions to the
global battle against TB is to support international
colleagues’ TB control efforts, to advocate
for more funding for these programs, and
to be gracious hosts and teachers when officials
from different countries visit to learn
about New York City’s success. In 1900, the
TB control program of the New York City
Department of Health, under the leadership of
Herman Biggs, was an international model.
Today, New York City’s experience provides
global hope and evidence that even in the
context of an HIV epidemic and a high rate of
multidrug resistance, the battle against TB can
be won and the disease can be controlled.
Not by DOT Alone
by J. Michael Holcombe, MPPA, CPM
Mississippi TB Controller
Mississippi proved directly observed therapy
(DOT) to be a great tool toward TB elimina-
TB Control at the Millennium
12
tion. However, DOT is not a programmatic
cure-all, a stand-alone solution, or the proverbial
yellow-brick road. Not what you expected
to hear from Mississippi, is it?
We know that DOT is the best way to treat
TB. It might not always be the most convenient
or the easiest, but with the correct drugs,
dosing, monitoring, and delivery, it is unsurpassed
at present. When it comes to DOT and
its impact, we must remember the Chinese
proverb, “Hear and forget; see and remember;
do and understand.”
With full implementation of universal DOT
on a statewide basis in the mid-1980s, TB
program performance indicators began to
improve. Patients’ sputum converted faster,
reducing the potential period of infectiousness;
a greater percentage of patients completed
therapy; a greater percentage completed
therapy in a timely manner; the number of
patients acquiring drug resistance decreased
rapidly; the number of program admissions
for inpatient care dropped dramatically; the
average length of an inpatient stay dropped;
and the number of new TB cases began to fall.
The reduction in morbidity allowed more
time for contact follow-up, the expansion of
targeted testing, and the implementation of
directly observed preventive therapy in select
high-risk populations. This increased the
number of patients on preventive therapy and
the percentage of patients completing preventive
therapy.
To further support the strengthened efforts,
laws were modified to improve our ability to
protect the public from patients who fail to
cooperate with treatment or isolation, and
rules were changed to improve reporting. We
placed emphasis on outpatient care and privatized
elements of the program best and most
efficiently provided by private providers —
radiology services, for example — to expand
availability, improve quality, and ameliorate
cost.