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
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):
- Maintain control of TB
- Accelerate the decline
- Develop new tools
- Increase involvement in global efforts
- Mobilize and sustain support
- 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
- Maintain and enhance local, state, and national public
health surveillance for TB.
- Support the infrastructure needed for laboratory-based
identification and treatment of TB.
- Ensure that patient-centered case management and monitoring
of treatment outcomes are the standard of care for all TB
- Develop community partnerships, and strengthen community
involvement in TB control.
- Improve the timely investigation and appropriate evaluation
and treatment of contacts with active TB disease and latent
- Ensure appropriate care for patients with MDR TB, and
monitor their response to treatment and their treatment
- Ensure that health care facilities maintain infection-control
- Develop improved engineering and personal protective techniques
to prevent TB transmission.
- Improve TB control in foreign-born populations entering
or residing in the United States.
- Educate the public and train health care providers to
maintain excellence in TB services.
Goal II: Accelerate the decline
- Increase the capacity of TB control programs to implement
targeted testing and treatment programs for high-risk persons.
- Promote the appropriate regionalization of TB control
activities in high, intermediate, and low TB-incidence areas
of the United States.
- Characterize circulating M. tuberculosis strains
using DNA fingerprinting methods.
- Develop national, state, and local capacity to respond
to outbreaks of TB.
Goal III: Develop new tools
- Develop a coordinated plan for TB research.
- Develop new methods to diagnose persons with latent TB
infection and to identify infected persons who are at high
risk for developing active TB.
- Develop and assess new drugs to improve TB treatment and
- Develop a new and effective TB vaccine.
- Develop and implement a program of research on behavioral
factors related to TB treatment and prevention.
- Rapidly transfer findings from research studies into practice.
Goal IV: Increase involvement in global efforts
- Provide leadership in public health advocacy for TB prevention
- Provide technical support and build capacity for implementation
of DOTS, especially in those countries that contribute significantly
to the U.S. TB burden.
- Develop models for the diagnosis and treatment of patients
with MDR TB.
- 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
- Develop and implement a health communications campaign
focusing on the resources and support needed to eliminate
- Help communities foster nontraditional, multisectoral,
public-private partnerships to improve the effectiveness
of their communications activities, with particular attention
to culturally appropriate materials.
- 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
- Develop innovative analyses for examining surveillance
data to help focus elimination efforts.
- Develop novel indicators of progress toward elimination.
- Conduct periodic evaluations of TB program performance
at federal, state, and local levels.
- 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 - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333