1. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting

2. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Evaluation and Treatment Workflows and the 2007 DS Forms 2 2

3. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Tuberculosis Evaluation Screening medical examination for tuberculosis may consist of: Medical history Physical examination Chest radiography Tuberculin skin testing / IGRA HIV testing Sputum smear, culture and DST testing

4. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Screening Workflow Source: CDC TB Technical Instructions 2007 *In countries with WHO-estimated TB incidence of >20 cases per 100,000

5. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting < 10 mm> 10 mm TB Screening Workflow

6. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting LTBI Evaluation Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009 TST < 10mmTST > 10mm

7. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting LTBI Before No field specified for entering TST result in current DS form TST result captured in WRx module WRx data entryWRx printout

8. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting LTBI After (2007 DS) LTBI evaluation data must be entered in DS-2054

9. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Contact Evaluation Source: US Panel Physician’s Training Summit Workbook, April 2009

10. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Contact Before No field specified for entering contact evaluation results Use WRx Contact Evaluation Form

11. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Contact After (2007 DS) Contact evaluation data must be entered in DS- 2054

12. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Current vs New (2007) DS Forms OLD 1991 DS UPDATED 1991 DS 2007 DS Classification / Summary Sheet DS-2053DS-2053 (updated)DS-2054 (new) CXR Worksheet DS-3024DS-3024 (updated)DS-3030 (new) Vaccination Worksheet DS-3025DS 3025 (updated) History and PE Worksheet DS-3026DS 3026 (updated)

13. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting DS-3030 (New CXR Form) – 1 What’s New?  Positive TST result is listed as an indication for CXR

14. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting What’s New?  Table is provided for entering sputum culture results DS-3030 (New CXR Form) – 2

15. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting What’s New?  Classification list is expanded and includes LTBI and Contact DS-3030 (New CXR Form) – 3

16. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Class: 1991 vs 2007 Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009

17. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Class: 1991 vs 2007 Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009

18. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Classification Before (DS 2053) Limited classification options Use WRx Pre- departure TB Classification Form

19. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Classification After (DS 2054)

20. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Validity Periods: 1991 TI Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009

21. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Validity Periods: 2007 TI Source: Presentation of Dr. Mary Naughton, CDC, during US Panel Physician’s Summit, April 2009

22. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Rx, Patients (DS) Class A-Applicants who have positive sputum smears should not be cleared for travel and should be treated for TB, unless culture is found to be negative. -Applicants who have negative sputum smears and positive cultures should not be cleared for travel and should be treated for TB. Class B1 with advanced findings Must complete DOT prior to immigration Class B2 ( LTBI) In general, preventive treatment should not be initiated overseas (unless pediatric contact or impaired immunity) Class B3 ( Contact) -Contacts diagnosed with TB disease will need to complete treatment prior to immigration. -If negative for TB disease: In general, preventive treatment should not be initiated overseas (unless pediatric contact or impaired immunity)

23. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Rx, patients (WHO) New TB case – A/B1 – LTBI Rx – Contact Rx Rx after default Rx after failure Transfer In Relapse Other

24. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Treatment, Overview TB Dx Cat-ry TB patients TB treatment regimens Initial phase Continuation phase INew smear-positive patients. New smear-negative PTB Severe concomitant HIV disease or severe forms of ext- PTB. 2HRZEb4HR (or 6HE daily) IIRelapse, treatment after default, treatment failure. 2HRZES/ 1HRZE 5HRE IIINew smear-negative pulmonary TB (other than in Category I). Less severe forms of ext-PTB. 2HRZEe4HR (or 6HE dailyc) IVChronic and MDR-TB cases (still sputum-positive after supervised re-treatment)f. Specially designed individualized or standardized regimens are suggested (WHO guidelines, Ch. 5)

25. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Rx, Monitoring – 1 Side effects captured in WRx follow-up exam form

26. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Rx, Monitoring – 2 Laboratory tests captured in WRx module WRx data entry WRx printout WRx data entry

27. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Rx Recording – 1 DS-2053 / DS-2054 captures treatment regimen

28. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting TB Rx Recording – 2 Rx outcome captured in WRx exit exam form

29. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting Pre-departure Exam Performed on applicants with equivocal results (history, PE, CXR suggestive of TB but no positive sputum smear or culture) Consists of history, PE, CXR and 3 sputum smear specimens (no cultures required) Conducted within 3 weeks prior to departure If results are negative, Class B1 TB, Pulmonary

30. MiMOSA Training 1. Opening 2. TB WRx and the 2007 DS Forms 3. Data entry and report generation for the new DS forms 4. Mission settings for DS Forms 5. Exercises (new DS) 6. Issues with new DS 7. Overview of WRx module 8. Data entry for TB WRx scenarios 9. WRx reports 10. Exercises (WRx) 11. WRx module admin & maint. 12. Exercises (WRx admin & maint) 13. Issues with WRx 14. Other MiMOSA features 15. Program evaluation indicators 16. Other systems 17. Change request 18. Final meeting References American Thoracic Society, CDC and Infectious Diseases Society of America. Treatment of Tuberculosis. June 2003 Centers for Disease Control and Prevention. CDC Immigration Requirements: Technical Instructions for Tuberculosis Screening and Treatment Using Cultures and Directly Observed Therapy (DRAFT). June 2009 US Panel Physicians Training Summit Workbook. April 2009