2. 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
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3. 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
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4. US Tuberculosis Case Reports
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5. US Counties Reporting Tuberculosis Cases 1998
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6. US Tuberculosis Cases Among
the Foreign Born
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7. US Tuberculosis Case Reports
and Federal Funding
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8. The result of neglecting TB
Tuberculosis cases increased from
Outbreaks of multidrug resistant
(i.e., often incurable) tuberculosis
This resurgence of tuberculosis cost
more than $1 billion in NYC alone
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9. If aggressive efforts to control and eliminate TB are not maintained:
TB rates will begin to rise again
Multidrug resistant tuberculosis
will increase
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10. 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
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11. 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
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12. 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
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13. Federal Roles and Responsibilities (2)
Expand research, especially latent infection
Encourage industry to develop new products
Promote/assist regionalization
Support national training programs
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14. Federal Roles and Responsibilities (3)
Develop educational programs for patients
and significant others
Strengthen US role and support global
TB control
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15. 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)
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16. Roles and Responsibilities (2)
State and Local
Roles and Responsibilities (2)
Use Medicaid/other insurance programs
Evaluate performance regularly
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17. 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
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18. 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
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19. 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
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20. For More Information and copies of the report National Academy Press: or or