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

through training. In 1993, the CDC Division
of TB Elimination released a request for
proposals for Model TB Prevention and
Control Centers as a competitive supplement
to the Surveillance, Prevention, and Control/
Elimination cooperative agreements. The
federal funds appropriated to support emergency
TB grants were targeted to the 13 states
and cities that had reported the largest numbers
of TB cases in 1992.
Model TB Centers were to be located in highincidence
urban areas. The recipient health
department was required to utilize a current,
or establish a new, relationship with a school
of medicine or public health for Center operation.
The Centers were to provide
1. Comprehensive, coordinated state-ofthe-art
diagnostic, treatment,
prevention, and patient education
services for TB cases, suspects, contacts,
and recipients of preventive therapy
(treatment for latent TB infection);
2. Innovative approaches for ensuring
adherence with drug therapy and for
carrying out other prevention and
control activities; and
3. Training for all levels of health care
workers providing TB screening,
prevention, and control services within
the targeted area.
Three sites were selected for Model Center
awards: Newark, NJ, New York City, NY,
and San Francisco, CA.
The New Jersey National Tuberculosis Center
is located at the University of Medicine and
Dentistry of New Jersey, serving Newark and
Essex County. The New York City operation
is located at the Harlem Hospital Center, and
serves Central and East Harlem. The San
Francisco Center is operated by the TB
control program of the San Francisco
Department of Public Health, and includes the
surrounding Bay Area counties as the target
area.
TB Control at the Millennium
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The programmatic emphasis of each Center
was designed to address the needs of each
respective target area. New Jersey developed
an integrated approach to managing high-risk
urban populations through interdisciplinary
teams and a nurse case management model,
telephone information services for health care
professionals and the general public, and a
comprehensive training program. The
Harlem Center featured enhanced clinical
services, a clinic-based DOT model, and
training of house-staff and community
physicians. The San Francisco program was
designed to replicate local successful program
components in surrounding jurisdictions in
the target area, as well as offer enhanced
regional surveillance, laboratory and
institutional “hazard evaluation” services,
clinical and epidemiologic consultation
services, and a comprehensive training
program.
In 1997, Kenneth Castro, MD, Director,
Division of TB Elimination, CDC, called a
meeting of the Model Center principals to
discuss a change in programmatic emphasis for
the Centers. While the expectation was that
activities would continue, efforts should be
made to “capture” the outcome of each major
effort in some sort of enduring product. This
would allow other TB Control programs in
the nation to make use of the strategies and
tools developed, tested and/or perfected by
each of the Centers. The Centers were asked
to redesign their programs in accordance with
the new directive and submit proposals with
exhibits organized under three headings: Stateof-the-Art
Care, Training, and Innovative
Activities. Effective January 1998, the Centers
shifted into “product” mode. In less than 2
years, the Centers have developed and
disseminated the following innovative
program products: