Forging Partnerships To Eliminate Tuberculosis

Forging Partnershipsto EliminateTuberculosis:A Guide and Toolkit2007National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of Tuberculosis Elimination

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Forging Partnershipsto EliminateTuberculosis:A Guide and Toolkit2007Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of Tuberculosis Elimination

Ordering InformationCopies of the Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit, are availablefrom the Division of Tuberculosis Elimination’s online ordering system at www.cdc.gov/tb.The publication number is 00-6552.This document is also accessible via the Internet at www.cdc.gov/tb.

AcknowledgementsForging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit was prepared by theDivision of Tuberculosis Elimination, Communications, Education, and BehavioralStudies Branch of the Centers for Disease Control and Prevention (CDC). Scott McCoy,Maria Fraire, and Wanda Walton in the CDC’s Division of Tuberculosis Eliminationdirected the project, providing invaluable leadership and contributions. Special thanks toConstella Health Sciences, Inc. for overseeing the project and to project manager PatriciaA. President and primary consultant Janine Pryor.We gratefully acknowledge the following people who provided invaluable guidance inshaping this publication:Lisa GeorgeSandra BarnettMetropolitan Health DepartmentGarfield County Public HealthNashville, TNGlenwood Springs, ColoradoRajita BhavarajuNew Jersey Medical SchoolNational Tuberculosis CenterFernando GonzalezTexas Department of HealthRachel BlairHawaii State Department of HealthMary Anette GrayerDetroit Health DepartmentDetroit, MichiganPaul T. BrittonIndiana Department of HealthGenevieve GreeleyNew Mexico Department of HealthJeffrey B. CaballeroAssociation of Asian PacificCommunity Health OrganizationsKathleen HursenMassachusetts Department of Public HealthCynthia Glocker CrickNational Center for HIV, STD,and TB PreventionCDCMelissa HopkinsConsultant, Commonwealth of KentuckyOlga JoglarPuerto Rico Department of HealthFrancesca GanyCenter for Immigrant HealthNYU School of MedicineHarriet KayDeKalb County Board of HealthDecatur, GeorgiaVipra GhimireVirginia Department of HealthLaurel LittleGarfield County Public HealthRifle, Coloradoiii

John LozierNational Health Carefor the Homeless CouncilAllan LynchIowa Department of Public HealthVernon A. MaasHealth Resources andServices AdministrationEllen J. MangioneColorado Department of Public Healthand EnvironmentJose MonteroNew Hampshire Department of Healthand Human ServicesRoger MurrayNebraska Department of Healthand Human ServicesMindee ReeceKansas Department of Healthand EnvironmentKristen RoundsSouth DakotaDepartment of HealthDan RuggieroDivision of Tuberculosis EliminationCDCAlok SarwalColorado Asian TuberculosisElimination ProjectivBarbara SchultzColorado Department of Public Healthand EnvironmentEric A. F. SimoesChildren’s Hospital and Universityof Colorado Health Sciences CenterGary SimpsonNew Mexico Department of HealthVan SimsimanFilipino-American Communityof ColoradoSacsy SukcharounAmerican Lung Association ofSan Diego and Imperial CountySavitri J. TseringWisconsin Department of Healthand Family ServicesP.K.VedanthanUniversity of Colorado HealthSciences CenterCharles WallaceTexas Department of HealthMaureen WilceDivision of Tuberculosis Elimination CDCBarbara WeberCommunity Health ServicesBloomington, IndianaGloria WilliamsFilipino-American Communityof Colorado

DEPARTMENT OF HEALTH & HUMAN SERVICESPublic Health ServiceCenters for Disease Controland PreventionAtlanta, GA 30333Dear Colleague:Tuberculosis (TB) is one of the leading causes of death from infectious diseaseworldwide. An estimated 2 billion persons — one third of the world’s population — areinfected with the bacteria that cause TB. Each year, approximately 9 million personsbecome ill from TB; of these, almost 2 million die.Yet, many people in the United States think that TB is a disease of the past —an illnessthat no longer threatens us today. One reason for this belief is that, in the United States,we are at an all-time low in the number of new persons diagnosed with active TB disease.However, the rate of decline has slowed in the past two years, and inequities persistin racial, ethnic, and foreign-born groups. Will this success make us vulnerable to theneglect that has historically come with declining numbers of persons suffering with TB,or will it provide us with the opportunity to accomplish our goal, the elimination of TBin this country?Now is the time to take decisive actions, beyond our current efforts, that will ensure thatwe reach this attainable goal. Building and strengthening partnerships is one of thosedecisive actions. This country’s unprecedented progress in controlling TB in recent yearswill not be sustainable without strengthened collaborations with local, state, national,and international partners from all sectors of our society. This kind of partnership actionmust be taken in order to reach those at highest risk for TB, and to identify innovativestrategies to collaborate with them to improve testing and treatment among high-riskpopulations.There is a great deal of work that remains to be done: Despite the decreased case rate among foreign-born persons, more than half of theTB cases in the United States in 2005 occurred in this population, and the case ratewas almost nine times greater in this population than among U.S.-born persons. For substance abusers, the homeless, and others at risk who are often hard to reach,community‑based organizations, neighborhood health centers, and private providersneed to be enlisted to help identify undetected TB cases and latent TB infection aswell as encourage treatment. TB rates among people born in the United States differ remarkably by race. In 2005,rates among non-Hispanic blacks remained more than eight times higher than ratesv

among non-Hispanic whites. Non-Hispanic blacks and foreign-born individualsaccounted for three-fourths of TB cases in 2005. Narrowing this gap in TB rates is acritical factor in achieving TB elimination. Low-incidence areas in the United States need continued support to ensure that theymaintain the capacity and expertise to respond to TB outbreaks when they occur.The Centers for Disease Control and Prevention (CDC) and the Advisory Council forthe Elimination of Tuberculosis (ACET), an external advisory group to the Secretaryof Health and Human Services and the Director of the CDC, have long recognized themoral obligation as well as the public health benefit of eliminating TB in this country.Supported by the conclusions in the Institute of Medicine (IOM) report Ending Neglect:The Elimination of Tuberculosis in the United States, ACET and CDC believe eliminatingTB in the United States is a realistic goal and have a plan by which to do so. Both groupsare committed to this goal and recognize that success will require collaborating withothers.We hope this document, Forging Partnerships to Eliminate Tuberculosis: A Guide andToolkit, will foster the kinds of collaborations needed to make TB elimination a reality.Sincerely,Kenneth G. Castro, M.D.Assistant Surgeon GeneralDirectorDivision of Tuberculosis EliminationNational Center for HIV/AIDS, Viral Hepatitis, STD,and TB Preventionvi

Table of Contents1. About the Guide and Toolkit.1What’s Inside the Guide. 1Making the Guide and Toolkit Work for You. 22. What Your Colleagues Say about TB Partnerships.5TB Partnership Benefits. 5Things to Keep in Mind. 6Relationship Building: Lessons Learned. 63. What Successful Health-Related Community PartnershipsHave in Common.9Use a Mutual Selection Process when Recruiting Partners. 9Encourage Size and Value Diversity. 10Recruit Partners Who Are Leaders within Stakeholder Populations. 10Understand and Address Motivational Issues of Potential Partners. 11Establish Ground Rules (Codes of Conduct). 12Embrace a Common Vision. 12Develop Commitment through Leadership. 13Committed Core Leadership. 13Organizational Driver. 14Leadership Delegation. 14Create Decisionmaking Protocols. 14Social Control. 15Project Selection. 15Credible Commitment. 15Building Ownership. 16Anticipate and Manage Conflict. 16Conclusion. 174. How Well Do You Know Your Environment?.19Demographic Information on Your Program Area. 19Epidemiological Profile of Your Program Area. 19Information on Your Program Area’s At-Risk Populations. 22Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkitvii

General Background Information.22Information Specific to Your Program Area.23Understanding Primary Care Providers in Your Program Area.25Comparing Your Data to Your Area’s TB Program.26Identifying and Understanding Additional Stakeholders.27Related Resources.28Cultural and Linguistic Competence Tools and Resources.28TB Program Assessment and Training Resources.29Additional Publications.305. Determining Your Purpose and Choosing Partners. 31Your Partnership’s Overall Purpose.31Types of Partnerships You Will Use.31Level of Support for Partnering within Your Agency.34Tips and Strategies.34Things to Keep in Mind.34Resources You Can Dedicate to Your Partnering Efforts.34Tips and Strategies.34Characteristics of Effective Partners.35What Is a Good Partner?.35Things to Keep in Mind.36Recruitment of Effective Partners.36Things to Keep in Mind.37Related Resources.386. Creating a Sense of Ownership. 41Step 1: Create Your Partnership’s Culture.41Research Suggests.41Tips and Strategies.42Step 2: Consistently Share Information.42Research Suggests.42Tips and Strategies.43Things to Keep in Mind.43viiiForging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit

Step 3: Create a Common Vision.46Research Suggests.46Tips and Strategies. 47The Vision: A Guide for Effective Action.48Things to Keep in Mind. 49Related Resources.497. Making Progress and Making Decisions: Structure andDecisionmaking Issues. 51Partnership Structure: An Overview.51Research Suggests. 51Things to Keep in Mind. 52Creating Partnership Structures That Fit Your Needs.52Creating Decisionmaking Processes that Fit Your Needs.53A Step-by-Step Approach for Collaborative Decisionmaking. 54Anticipating and Managing Differences.55Tips and Strategies. 57Related Resources.598. Sustaining Longer-Term Partnerships. 61Recognize and Reward Partners.61Things to Keep in Mind. 62Combine Planning with Action.62Things to Keep in Mind. 62Create a Learning Partnership.63Related Resources.639. Sharing the Message: Working with the Media and TB Stakeholders. 65Common Formats for Accessing the Media.66Meetings with Editorial Boards. 66Press Briefings. 67Press Conferences. 67Media Advisories. 68Press Releases. 68Public Service Announcements (PSA). 68Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkitix

Feature Stories.69Op-Ed Pieces.69Letters to the Editor.69Public Access TV Stations.70Media Interviews (Television, Radio, and Print Media).70Checklist for Conducting a Press Conference.70Articulate a Compelling Reason for the Press Conference.70Identify, Recruit, and Prepare Press Conference Speakers.70Assemble the Necessary Materials.71Ensure Journalists Attend.71Follow Up and Follow Through. 72Social Marketing with TB Stakeholders.72Related Resources.7310. Preparing Your Partnership to Communicate During a TB Outbreak. 75Communication Planning for TB Outbreaks.75The Pre-Event Phase.75Conducting a TB Outbreak Communication Needs Assessment.76Developing a TB Outbreak Communication Plan.77Determine the Resources Needed to Carry Out the Plan.80Preparing the Partnership to Carry Out the Plan.81The Event Phase.82The Post-Event Phase.82Related Resources.84Risk Communication Websites.84Risk Communication Training. 8411. Evaluating and Measuring Success. 85The CDC’s Recommended Evaluation Framework.85What is the CDC Framework for Program Evaluation?.86A Coll

Oct 04, 2002 · Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit was prepared by the Division of Tuberculosis Elimination, Communications, Education, and Behavioral Studies Branch of the Centers for Disease Control and Prevention (CDC). Scott McCoy, Maria Fraire, and Wanda