Regionalization bid gets warm response

Low-incidence states mull wish lists

Some TB controllers in low-incidence states have resisted the idea of regionalizing TB services, fearing that would mean that already modest resources and budgets might, in the name of efficiency, be pared down even more.

That seems to have changed, given that four low-incidence states have happily signed up to be subjects in a new federal project that aims to look at the issue. The Centers for Disease Control and Prevention’s Division of TB Elimination is looking for a contractor to carry out a $4 million, five-year project to identify features of low-incidence programs that lend themselves to regional solutions. States that have volunteered to submit to site visits and needs assessments, and then implement whatever turn out to be the recommended changes, include Montana, Utah, Wyoming, and Idaho.

Needed: an expert, a plan, and a manual

"We all decided if this helps our programs by providing them with resources they don’t have, we’ve got nothing to lose by participating," says Denise Ingman, TB controller of Montana. It’s not yet known who will snag the CDC contract, but she says that if the contractor asks, she’s already has a wish list in mind:

An expert consultant: "It would be great to have an expert who’d always be available. As with any disease, the last cases tend to be the hardest and most complicated. General practitioners trying to manage an alcoholic with no liver function, for example, need to have someone to call."

A policy manual: "Most big cities all have their own policy manuals. The idea isn’t to repeat the whole core curriculum, but to take the salient elements and apply them to your state. These manuals are typically written by a TB program member working with a big group of experts — something we don’t have."

A TB elimination plan: "The CDC says we ought to have one, but I certainly have time to write it. Give us someone with the extra expertise and time to take that on, so we’ll have a better sense of whether elimination is even possible — can you really go from 20 cases a year to just five? And if so, how we’re supposed to get there?"

Molecular fingerprinting lab: "The buzz now is that you should fingerprint every specimen and compare them. If we’re going to regionalize anything related to laboratories, why not that?"