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CDC's Response to Ending Neglect

Who Will Lead? - CDC's Response

In collaboration with divisions in the National Center for Infectious Diseases, the Public Health Practice Program Office, and the National Institute for Occupational Safety and Health, the Division of TB Elimination of the National Center for HIV, STD, and TB Prevention, CDC, is the functional equivalent of a national TB program in the United States.47 As such, CDC is the federal government's lead agency for TB prevention, control, and elimination. Several other federal agencies share crucial roles in contributing to TB prevention and control and its eventual elimination. For example, the FDA approves new drugs and diagnostics and ensures drug quality, the Health Resources and Services Administration (HRSA) and Health Care Financing Administration (HCFA) facilitate access to and financing of health care, and the NIH conducts and supports biomedical research and health care worker training. These and several other agencies form part of the Federal TB Task Force, the members of which coordinate federal TB activities in the United States.

Although current activities to control TB are yielding significant results nationwide, CDC recognizes that TB elimination will require sustained effort, long-term commitment, new tools, and strong partnerships with other federal health agencies and state and local health departments. This document, CDC's Response to Ending Neglect, describes CDC's new strategy for achieving TB elimination, taking into account the challenges, advances, and collaborations of the past and building on them.

The plan reflects the scientific, programmatic, and health-sector developments of the last decade and supersedes the 1989 Strategic Plan for the Elimination of Tuberculosis in the United States. The response details the CDC priority activities required for the elimination of TB in the United States in the context of the recommendations issued by the IOM report Ending Neglect and is organized around six goals and corresponding objectives (Table 1):

  1. Maintain control of TB
  2. Accelerate the decline
  3. Develop new tools
  4. Increase involvement in global efforts
  5. Mobilize and sustain support
  6. Track progress toward elimination

CDC's Response to Ending Neglect complements a more comprehensive federal plan to respond to the IOM's recommendations. Implementation of these plans should set in motion the activities needed to arrest TB in the United States.

Table 1. CDC's Response to Ending Neglect: The Elimination of Tuberculosis in the United States. Summary of Goals and Objectives

Goal I: Maintain control of TB

  1. Maintain and enhance local, state, and national public health surveillance for TB.
  2. Support the infrastructure needed for laboratory-based identification and treatment of TB.
  3. Ensure that patient-centered case management and monitoring of treatment outcomes are the standard of care for all TB patients.
  4. Develop community partnerships, and strengthen community involvement in TB control.
  5. Improve the timely investigation and appropriate evaluation and treatment of contacts with active TB disease and latent TB infection.
  6. Ensure appropriate care for patients with MDR TB, and monitor their response to treatment and their treatment outcomes.
  7. Ensure that health care facilities maintain infection-control precautions.
  8. Develop improved engineering and personal protective techniques to prevent TB transmission.
  9. Improve TB control in foreign-born populations entering or residing in the United States.
  10. Educate the public and train health care providers to maintain excellence in TB services.

Goal II: Accelerate the decline

  1. Increase the capacity of TB control programs to implement targeted testing and treatment programs for high-risk persons.
  2. Promote the appropriate regionalization of TB control activities in high, intermediate, and low TB-incidence areas of the United States.
  3. Characterize circulating M. tuberculosis strains using DNA fingerprinting methods.
  4. Develop national, state, and local capacity to respond to outbreaks of TB.

Goal III: Develop new tools

  1. Develop a coordinated plan for TB research.
  2. Develop new methods to diagnose persons with latent TB infection and to identify infected persons who are at high risk for developing active TB.
  3. Develop and assess new drugs to improve TB treatment and prevention.
  4. Develop a new and effective TB vaccine.
  5. Develop and implement a program of research on behavioral factors related to TB treatment and prevention.
  6. Rapidly transfer findings from research studies into practice.

Goal IV: Increase involvement in global efforts

  1. Provide leadership in public health advocacy for TB prevention and control.
  2. Provide technical support and build capacity for implementation of DOTS, especially in those countries that contribute significantly to the U.S. TB burden.
  3. Develop models for the diagnosis and treatment of patients with MDR TB.
  4. Provide technical, programmatic, and research support aimed at reducing the incidence of TB as an opportunistic disease in high HIV-burden countries.

Goal V: Mobilize and sustain public support

  1. Develop and implement a health communications campaign focusing on the resources and support needed to eliminate TB.
  2. Help communities foster nontraditional, multisectoral, public-private partnerships to improve the effectiveness of their communications activities, with particular attention to culturally appropriate materials.
  3. Support the development of state- or area-specific TB elimination plans that contain communications activities to build support for TB elimination.

Goal VI: Track progress toward elimination

  1. Develop innovative analyses for examining surveillance data to help focus elimination efforts.
  2. Develop novel indicators of progress toward elimination.
  3. Conduct periodic evaluations of TB program performance at federal, state, and local levels.
  4. Conduct an annual progress review.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333