Notes from the Director

Dear Colleague:

The past couple of months have been full of exciting updates from DTBE staff. Patient enrollment has begun for the “eDOT Study.” This study will assess whether directly observed therapy (DOT) that employs electronic communication methods, such as video via computer or cellphone, is a non-inferior approach to monitor TB treatment adherence, compared to traditional DOT. The study is a collaboration between the New York City Department of Health and Mental Hygiene, Columbia University, and DTBE. CDC’s Antibiotic Resistance Solutions Initiative funds the project.

On July 20th, DTBE presented the results of a systematic literature review and meta-analysis on the regimen of isoniazid and rifapentine (often referred to as “3HP”) to subject matter experts representing various fields, settings, and geographic locations in the United States. The meeting was intended to increase the transparency of DTBE’s guidance development, and to strengthen the quality of recommendations.

Another exciting advancement is CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement, which will fund a new national laboratory equipped to perform whole genome sequencing for all isolates of Mycobacterium tuberculosis received from newly diagnosed patients in the United States. The National Tuberculosis Molecular Surveillance Center will advance CDC, state, and local TB control programs’ abilities to identify and investigate outbreaks of TB, and strengthen surveillance of drug-resistant TB. This technology will help to target public health interventions and better respond to emerging resistance.

In other news, DTBE is exploring new ways to communicate relevant and timely information about TB prevention and control. The Division recently launched a new video for general audiences, “5 Things to Know about TB.”

Congratulations to the Tuberculosis Trials Consortium Drug Management Module Team, winner of the August 2017 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Director’s Recognition Award! The team studies drug logistics and data collection for Study 31, a Phase III treatment-shortening trial for drug-susceptible TB being conducted at 22 domestic and international clinical trial sites, which are managed through an online system known as TBTC2.

Finally, I want to thank all of you for your hard work, resilience, and commitment to the important mission of TB elimination.

Philip LoBue, MD, FACP, FCCP
Director,
Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Communications, Education, and Behavioral Studies Branch Updates

New Video: 5 Things to Know About TB

DTBE is excited to debut a new video, “5 Things to Know About TB.” The video highlights the continuing problem of TB in the United States and the importance of addressing latent TB infection through targeted testing and treatment. The video was created for a general audience and can be shared on websites and social media platforms. Since August 1, the video has been viewed over 4,000 times on YouTube, Twitter, and Facebook!

Laboratory Branch Updates

DTBE is pleased to announce the establishment of the National Tuberculosis Molecular Surveillance Center (NTMSC) at the Michigan Department of Health and Human Services (MDHHS) Bureau of Laboratories. The center will be equipped to perform both conventional genotyping and whole genome sequencing (WGS) for all isolates of Mycobacterium tuberculosis. The NTMSC is supported by funding available through CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (ELC) and is a new activity for CDC’s Antibiotic Resistance Laboratory Networkaimed at strengthening national TB surveillance for outbreak detection and drug resistance.

Clinical Research Branch Updates

TB Trials Consortium (TBTC) Study 31 (also known as ACTG A5349; “Rifapentine-containing treatment shortening regimens for pulmonary tuberculosis: A randomized, open-label, controlled phase 3 clinical trial”) continues to enroll. As of July 24, 2017, the study had enrolled 1,085 participants. The AIDS Clinical Trials Group (ACTG) network is collaborating with TBTC, contributing substantially to enrollment with 15 sites open for enrollment. The TBTC Study 32 (Opti-Q) has completed enrollment and is beginning data analysis.

Surveillance, Epidemiology, and Outbreak Investigations Branch Updates

CDC/DTBE Announcement of Plans for Universal Whole Genome Sequencing

The CDC Division of Tuberculosis Elimination, in collaboration with colleagues in the CDC Antimicrobial Resistance Coordination and Strategy Unit, will be supporting the use of Whole Genome Sequencing (WGS) for all new isolates of Mycobacterium tuberculosis referred for genotyping beginning in spring 2018. The use of WGS is an exciting advancement that enhances the discriminatory power for cluster identification and investigation, which should allow for a more focused investment of public health interventions.

Field Services Branch Updates

The “eDOT Study”

On June 23rd the New York City Department of Health and Mental Hygiene’s Bureau of Tuberculosis Control (NYC DOHMH BTBC) held an in-service for program staff to initiate a study to evaluate traditional directly observed therapy (DOT) and electronic forms of DOT (eDOT) for TB treatment. The short title is the “eDOT Study.” Funded through the CDC’s Antibiotic Resistance Solutions Initiative, the study will assess whether eDOT that employs electronic communication methods, such as video via computer or cellphone, is a non-inferior approach to monitor TB treatment adherence, compared to traditional in-person DOT (ipDOT), in which a trained person is in the physical presence of patients as anti-TB drugs are ingested.

New CDC Publications

July 2017

Barrett DH, Ortmann LW, Brown N, DeCausey BR, Saenz C, Dawson A. Public health research [Chapter 9]. In: Barrett DH, Ortmann LW, Dawson A, Saenz C, Reis A, Bolan G, eds. Public Health Ethics: Cases Spanning the Globe. Cham, Switzerland: Springer; 2016.

Hall EW, Morris SB, Moore BK, Erasmus L, Odendaal R, Menzies H, van der Walt M, Smith SE. Treatment Outcomes of Children with HIV Infection and Drug-Resistant TB in Three Provinces in South Africa, 2005-2008. Pediatr Infect Dis J. 2017 Jul 19. doi: 10.1097/INF.0000000000001691. [Epub ahead of print] PMID: 28746263.