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

decades. The development of liaisons with
Maryland Department of Health and Mental
Hygiene, Maryland Division of Corrections,
and private providers has improved case
reporting, case management, case follow-up,
and case prevention efforts. Forging a treatment,
prevention, and research collaboration
with nearby Johns Hopkins University’s
(JHU) Center for TB Research has also contributed
to improved BCHD TB control
measures. BCHD/ECC’s Medical Director,
clinician staffing, and radiology support are all
provided through a contractual agreement
with JHU. In addition, this cooperative relationship
has resulted in several exciting TB
research projects, including neighborhoodbased
TB screening, TB prevention studies in
injection drug users, and DNA fingerprinting
studies. BCHD and JHU have also collaborated
to form a contract site for the TBTC
(Tuberculosis Trials Consortium).
The challenges for Baltimore City TB Control
in the new millennium will involve continuing
the successful case reduction efforts of the
past century through new initiatives. A main
priority will be focusing efforts on the treatment
of latent TB infection (LTBI). Efforts to
evaluate the possibilities of even shorter course
therapy and additional treatment options for
both active cases and LTBI will also be paramount.
Another key interest will be participating
in the efforts to develop a more efficacious
TB vaccine. All of these new initiatives
will depend upon the development of national
and international collaborative networks in
TB research. For TB elimination to finally
take its place in history, a global approach is
an absolute necessity.
As the new millennium begins, Baltimore City
TB Control is ready to join the world in
meeting its challenges. Patients like Mr. C will
continue to benefit from the dedication of a
City Health Department committed to the
ultimate goal: treating the last case of TB.
Notable Events in TB Control
15
From Crickets to Condoms and Beyond
by Carol Pozsik, RN, MPH
South Carolina TB Controller
It’s history now but people still chuckle about
the story of the man who was given crickets
for fishing as an incentive when he couldn’t be
located to take his TB medications. Clearly,
fishing was more important that his TB treatment.
His public health nurse recognized that
it was going to take an unusual motivator to
get him to meet her for directly observed
therapy, and thus was born the story of the
crickets given to the fisherman. It wasn’t the
first time that nurses or other health care
workers had given incentives to encourage
patients to comply and it certainly wasn’t
going to be the last. For TB nurses in South
Carolina, incentives and enablers became
something that they could not do without.
The concept has spread nationwide, and is
now an accepted intervention in the treatment
of TB infection and disease.
Enablers and Incentives
TB
Tuber culosis
Contr ol
For many years the American Lung Association
of South Carolina (ALASC) had given
money for patient needs to the State Tuberculosis
Sanatorium. As the sanatorium population
dwindled in 1981, the Executive Director
of the Lung Association began to wonder how
the Patient Needs Funds could be used to help
TB patients who were not in the hospital. It
was at that time that the fisherman’s TB nurse
approached the ALASC and appealed for
funds to provide incentives to more patients
who needed them. That was the beginning of
the use of incentives and enablers in the South
Carolina TB Program.