Committee Task Statement (1) Review and Assess Current State of TB in the US Challenge of TB in foreign-born State of TB research MDRTB and contributory factors US role in global TB control Institute of Medicine

Develop conclusions and recommendations Committee Task Statement (2) Develop conclusions and recommendations Framework for national elimination Region-specific action steps Research needs Information for providers and public Federal, state and local responsibilities Strategies for US contribution to global TB control leading to elimination Institute of Medicine

US Tuberculosis Case Reports 1978 - 1998 Institute of Medicine

US Counties Reporting Tuberculosis Cases 1998 Institute of Medicine

US Tuberculosis Cases Among the Foreign Born 1986 - 1998 Institute of Medicine

US Tuberculosis Case Reports and Federal Funding 1967 - 1999 Institute of Medicine

The result of neglecting TB Tuberculosis cases increased from 1988 - 1992 Outbreaks of multidrug resistant (i.e., often incurable) tuberculosis This resurgence of tuberculosis cost more than $1 billion in NYC alone Institute of Medicine

If aggressive efforts to control and eliminate TB are not maintained: TB rates will begin to rise again Multidrug resistant tuberculosis will increase Institute of Medicine

General Conclusions (1) 1. Elimination of TB is the goal 2. Maintain control while adapting to declining incidence 3. Speed decline through increased treatment of latent infection Institute of Medicine

General Conclusions (2) 4. Develop tools needed for ultimate elimination: diagnostic for latent infection new drugs, vaccine 5. Increase US engagement in global efforts 6. Mobilize support and measure progress Institute of Medicine

Federal Roles and Responsibilities (1) Provide categorical funding for TB Expand programs of targeted testing and treatment of latent infection 1. Screening of new immigrants from high rate countries, linking green card to completion 2. Intensified efforts to identify contacts of infectious cases Institute of Medicine

Federal Roles and Responsibilities (2) Expand research, especially latent infection Encourage industry to develop new products Promote/assist regionalization Support national training programs Institute of Medicine

Federal Roles and Responsibilities (3) Develop educational programs for patients and significant others Strengthen US role and support global TB control Institute of Medicine

Roles and Responsibilities (1) State and Local Roles and Responsibilities (1) Ensure resources available for TB, as cases decline (funding and management plans) Ensure laws require completion of therapy As appropriate: 1. Integrate TB with other programs 2. Contract with private providers 3. Regionalize (within/between states) Institute of Medicine

Roles and Responsibilities (2) State and Local Roles and Responsibilities (2) Use Medicaid/other insurance programs Evaluate performance regularly Institute of Medicine

Recommendations on TB Screening of Immigrants & Treatment (1) Initial screening in country of origin Screening not to delay entry to the US Diagnostic process completed in the US Institute of Medicine

Recommendations on TB Screening of Immigrants & Treatment (2) Treatment (disease and latent infection) completion required for “green card” Costs of diagnosis and treatment to be borne by federal government Institute of Medicine

US Role in Global TB Control Should expand and strengthen role Contributions include financial, technical, human resources and research Should be coordinated with other international agencies (e.g., Stop TB) initiative USAID/CDC/NIH should publish plan Institute of Medicine

For More Information and copies of the report National Academy Press: 800-624-6242 or or www.nationalacademies.org/includes/tb.html