Institute of Medicine

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 Institute of Medicine

3. 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

4. US Tuberculosis Case Reports 1978 - 1998 Institute of Medicine

5. US Counties Reporting Tuberculosis Cases 1998 Institute of Medicine

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

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

8. 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

9. 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

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 Institute of Medicine

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 Institute of Medicine

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 Institute of Medicine

13. 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

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

15. 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

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

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 Institute of Medicine

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 Institute of Medicine

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 Institute of Medicine

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