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ONLINE LEARNING CENTER

Recent Developments in Tuberculosis and Tuberculosis-HIV Co-Infection (15HC01)

Henry Shalom Fraimow, MD, Associate Professor of Medicine, UMDNJ-Robert Wood Johnson Medical School and Attending Physician, Cooper University Hospital

 
 
 

Release Date: June 1, 2013
Expiration Date: May 31, 2015
Activity Code: 15HC01

To receive CE credit for this activity you should:

  • Review the activity in its entirety.
  • Login to EventsPro and complete your free registration.
  • Pass the post-test with 70% or better.
  • Submit an activity evaluation.

Upon successful completion of these requirements, you will receive a printable credit statement.

If you have any questions about this process, please email the Center for Continuing and Outreach Education at ccoereg@ca.rutgers.edu or call CCOE Enrollment Services at (800) 227-4852.

As seen in the June 2013 edition of


ACTIVITY INFORMATION

Sponsor

Sponsored by François-Xavier Bagnoud Center, School of Nursing, University of Medicine and Dentistry of New Jersey and UMDNJ-Center for Continuing and Outreach Education.

Funding

This activity is supported by an educational grant from the New Jersey Department of Health (NJDOH)—Division of HIV, STD and TB Services, through an MOA titled “Education and Training for Physicians and other Healthcare Professionals in the Diagnosis and Treatment of HIV/AIDS.”

Statement of Need

Despite the fact that tuberculosis (TB) has become an increasingly uncommon disease in the United States, it still remains a public health problem of enormous importance, and this importance is amplified by the synergistic effects of latent TB infection (LTBI) in those who are HIV-infected (i.e., TB-HIV co-infection). TB contributes substantially to morbidity and mortality of people living with HIV who are foreign-born, who also comprise an increasing proportion of those newly diagnosed with HIV infection.

There have been important recent advances in tools to diagnose LTBI and active TB including interferon-gamma release assays (IGRAs). There are also new short course regimens available for the treatment of LTBI. However there have also been unforeseen challenges to treatment of LTBI and TB disease due to shortages of important anti-tuberculosis agents, including the current nationwide shortage of isoniazid (INH) tablets.

The greatest new challenge to recent progress in global control of TB has been the continuing emergence of multi-drug resistant (MDR) and extensively drug resistant (XDR) strains of TB. Treatment of drug resistant TB involves use of more prolonged, more toxic and less effective therapies and significantly increases the cost of TB care. The emergence of drug-resistant TB has spurred development and deployment of new, rapid tools for simultaneous identification of both TB disease and drug resistance, and has also sparked the development of new drugs for treatment of MDR strains.

Target Audience

This activity is designed for physicians, nurses, social workers, health educators, and other health care professionals in New Jersey who are involved in the care of people with HIV.

Method of Participation

Participants should read the learning objectives, review the activity in its entirety, and then complete the self-assessment test, which consists of a series of multiple-choice questions. Upon completing this activity as designed, achieving a passing score of 70% or more on the self-assessment test and submitting a course evaluation, participants will receive a printable credit statement.

Estimated time to complete this activity as designed is 1.00 hour for nurses, and 0.75 hour for physicians.

Learning Objectives

Upon completion of this activity, participants should be able to:

  1. Describe the tools used to diagnose TB disease and LTBI.
  2. Summarize the treatment options for LTBI.
  3. Summarize the new tools for diagnosing and new drugs for treating MDR and XDR TB.

Faculty

Activity Director(s)/CME Academic Advisor(s)

Patricia Kloser, MD, MPH, Professor of Medicine, UMDNJ-New Jersey Medical School and UMDNJ-School of Public Health

Margaret Evans, MSN, RN, Lead Nurse Planner, Nurse Manager for Education and Performance Improvement at Robert Wood Johnson Medical Group.

Planning Committee

Virginia Allread, MPH, AIDSLine Editor and Global Program Director, FXB Center, UMDNJ

Linda Berezny, RN BA Supervising Program Development Specialist Prevention and Education, NJDOH, Division of HIV, STD and TB Services

Alicia Gambino, MA, CHES, Director of Public Education, New Jersey Poison Information & Education System

Sindy Paul, MD, MPH, FACPM, Medical Director, NJDOH, Division of HIV, STD and TB Services

Joanne Phillips, RN, MS, Education, Specialist, FXB Center, UMDNJ

Renee Powell, BS, RN, Clinical Coordinator Quality Management, FXB Center, UMDNJ

Sarah Quinless, BA, Program Coordinator, FXB Center, UMDNJ

Michelle Thompson, Program Manager, FXB Center, UMDNJ

Elizabeth Ward, MSJ, Executive Director, CCOE, UMDNJ

Activity Authors

Henry Shalom Fraimow, MD, Associate Professor of Medicine, UMDNJ-Robert Wood Johnson Medical School and Attending Physician, Cooper University Hospital

Accreditation

Physicians:
UMDNJ–Center for Continuing and Outreach Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

UMDNJ–Center for Continuing and Outreach Education designates this enduring material for a maximum of 0.75 AMA PRA Category Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses:
UMDNJ-Center for Continuing and Outreach Education is an approved provider of continuing nursing education by New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider Number TP173-12/12-15. Provider Approval is valid through December 31, 2015.

This activity is awarded 1.00 contact hour (60 minute CH).

Nurses should only claim those contact hours actually spent participating in the activity.

Approved provider status refers only to continuing education activities and does not imply ANCC COA or NJSNA endorsement of any commercial products.

CEUs:
UMDNJ-CCOE certifies that this continuing education offering meets the criteria for up to 0.1 Continuing Education Units (CEUs), provided the activity is completed as designed. One CEU equals 10 contact hours of participation in an organized continuing education experience under responsible sponsorship, capable direction and qualified instruction. Participants should only claim those contact hours actually spent participating in the activity.

Peer Review

In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, UMDNJ-CCOE has resolved all potential and real conflicts of interest through content review by a non-conflicted, qualified reviewer. This activity was peer-reviewed for relevance, accuracy of content and balance of presentation by Joanne Phillips, RN, MS.

Field Test:
This activity was pilot-tested for time required for participation by Bonnie R. Abedini, MSN, RN; David John Cennimo, MD; Jojy Cheriyan, MD, MPH, MPhil; Anna M. Haywood, RN, MSN; Mary C. Krug, RN, MSN, APN; Kinshasa Morton, MD; Shobha Swaminathan, MD; and Kara Winslow, BSN, RN.

Disclosure Disclaimer

In accordance with the disclosure policies of UMDNJ and to conform with ACCME and FDA guidelines, individuals in a position to control the content of this educational activity are required to disclose to the activity participants: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/ device not yet approved.

Disclosure Declarations

There were no relevant financial relationships to disclose reported by the activity directors, the author, planning committee members, the peer reviewer or field testers. However, the author’s spouse, Jacqueline French, MD, received grant funding from the Milken Foundation, the Epilepsy Therapy Project, and NINDS. She serves as the president of the Epilepsy Study Consortium, a nonprofit organization. NYU receives a fixed amount from the Epilepsy Study Consortium towards Dr. French’s salary for consulting and clinical trial-related activities. Dr. French receives no personal income for these activities. Within the past year the Epilepsy Study Consortium received payments from the following: Biotie, Cyberonics, Eisai Medical Research, Entra Pharmaceuticals, GlaxoSmithKline, Icagen, Inc., Johnson & Johnson, Mapp Pharmaceuticals, Marinus, Neurotherapeutics, Neuropace, NeuroVista Corporation, Ono Pharma USA, Inc., Lundbeck, Pfizer, Sepracor, Sunovion, SK Life Science, Supernus Pharmaceuticals, UCB Inc/Schwarz Pharma, Upsher Smith, Valeant, Vertex.

Off-Label Usage Disclosure

This activity provides an overview of Xpert MTB/RIF Assay, which — although endorsed by WHO — is not yet FDA approved. This activity also includes mention of delamanid, a drug for the treatment of MDR-TB that is currently in phase 3 trials. Delamanid is not yet FDA approved.

Content Disclaimer

The views expressed in this activity are those of the faculty. It should not be inferred or assumed that they are expressing the views of NJDOH – Division of HIV, STD and TB Services, any manufacturer of pharmaceuticals or devices, or UMDNJ. It should be noted that the recommendations made herein with regard to the use of therapeutic agents, varying disease states, and assessments of risk, are based upon a combination of clinical trials, current guidelines, and the clinical practice experience of the participating presenters. The drug selection and dosage information presented in this activity are believed to be accurate. However, participants are urged to consult all available data on products and procedures before using them in clinical practice.

Copyright © 2013 UMDNJ

All rights reserved including translation into other languages. No part of this activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval systems, without permission in writing from UMDNJ.

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Please direct CE related or technical questions to UMDNJ at 973-972-4267 or email ccoe@ca.rutgers.edu.


 

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