DTBE Strategic Planning
||DTBE Strategic Planning
The Centers for Disease Control and Prevention (CDC), Division of
Tuberculosis Elimination (DTBE) strategic planning focuses on the
following domestic and global goals:
Domestic - Elimination of tuberculosis (TB) in the United
States (defined as less than 1 case per million population); and
Global - Contribute to reductions in global TB incidence and
mortality (by 50% each compared to 1990 baseline, based on the
Global Plan to Stop TB 2006-2015.
DTBE has been carrying out strategic planning sessions periodically since 1989, using surveillance trends data and findings
from published scientific reports to identify directions for new project proposals. DTBE launches new projects through an internal
peer-review process, selecting those with the greatest potential for having an impact on eliminating TB in the United States and
contributing to global TB control efforts.
In January and February 2008, DTBE senior staff (branch chiefs, deputies, team leads, and office of the director employees) again
conducted strategic planning to refine and guide domestic and global TB efforts. This year’s sessions were carried out in the context of
the lowest TB rates in history, but with a slowing of the rate of decline, greater complexity in the identification and successful
treatment of cases, continued increases in foreign-born TB cases, excess rates in racial and ethnic minorities, concern over
HIV-associated TB and drug-resistant TB, and the United States Government’s growing role in addressing TB globally.
As a result of the 2008 planning sessions, DTBE established five priorities to guide efforts toward these goals:
- Interrupt transmission of Mycobacterium tuberculosis.
- Reduce tuberculosis (TB) in foreign-born persons residing or traveling in the United States.
- Reduce TB in U.S. racial and ethnic minority populations.
- Reduce global impact of multidrug-resistant and extensively drug-resistant TB.
- Reduce HIV-associated TB.
In addition, DTBE identified 12 core functions that are required for implementing priority activities. DTBE considers these core
functions as uniquely federal responsibilities, and critical for providing national and global leadership. DTBE core functions are
- Conduct routine surveillance (including drug susceptibility
surveillance) and periodic surveys.
- Provide funding and technical assistance to state and local
programs for case finding, contact investigation, and completion of
treatment, including support for care and treatment with assistance
provided by the Regional Training and Medical Consultation Centers (RTMCCs).
- Guide preparedness and outbreak responses.
- Conduct program evaluation (e.g., National TB Indicators
- Provide laboratory diagnostic services and help build
- Conduct critical, programmatically relevant operational
research to develop and evaluate new tools and interventions for
diagnosis, treatment, prevention, and control of TB (to help
programs work more effectively and more efficiently).
- Provide data management, statistical, and information
technology support (with the Strategic Science and Program Unit,
Coordinating Center for Infectious Diseases [CCID] and the National
Center for Public Health Informatics [NCPHI]).
- Support intramural services (salaries, travel, equipment, and
supplies) required for maintaining a strong infrastructure for TB
- Obtain external expert consultation and advice (e.g., Advisory
Council for the Elimination of TB, CCID Board of Scientific
Counselors, and ad-hoc consultations) to ensure DTBE research and
program activities are responsive to emergent public health
- Develop and evaluate evidence-based training and educational
materials, policies, and guidelines to ensure program and health
care competency in TB prevention, control, diagnosis, treatment, and
- Develop education, risk, and media communications (web and
print based) to aid in preparedness and public awareness of TB
prevention and control issues.
- Cultivate relevant external partnerships (e.g., Stop TB USA,
National TB Controllers Association, American Thoracic Society,
Infectious Diseases Society of America, American Academy of
Pediatrics, the Association of Public Health Laboratories, affected
individuals and their families, and others), as well as
collaborations within CDC and across other federal agencies.
In addition, DTBE uses strategic planning sessions to review
previously published Strategic Plans for the Elimination of TB.
These plans have been developed by CDC and partner organizations to
respond to changes in the TB epidemic over time. They include:
- “A Strategic Plan for the Elimination of Tuberculosis in the
United States,” published in the Mortality and Morbidity Weekly
Report (MMWR) in 1989.
Three steps of this strategic plan include:
National Action Plan to Combat Multidrug Resistant
Tuberculosis, published in the MMWR in 1992. This updated plan by
the Federal Tuberculosis Task Force (originally created by CDC
Director, Dr. William Roper, in 1991) responded to the unprecedented
resurgence of TB in the United States, along with several outbreaks
of HIV-associated multidrug-resistant tuberculosis (MDR TB). It
provides a blueprint for action by federal agencies, recognizing the
need for cooperation among many sectors of society.
Action steps outlined in this plan focus on of each of the following
- Step 1. More effective use of existing prevention and control
methods, especially in high-risk populations;
- Step 2. The development and evaluation of new technologies for
diagnosis, treatment, and prevention; and
- Step 3. The rapid assessment and transfer of newly developed
technologies into clinical and public health practice.
The Institute of Medicine (IOM) report “Ending Neglect” with
specific recommendations for the control and elimination of
tuberculosis in the United States, published by the National Academy
of Sciences Press in 2000. These recommendations formed the basis
for updated strategic planning for the elimination of tuberculosis
in the United States by the Federal Tuberculosis Task Force, with
the resultant “Federal Tuberculosis Task Force Plan in Response to
the Institute of Medicine Report, Ending Neglect: The Elimination of
Tuberculosis in the United States,” (PDF) produced in “desktop publishing”
format in 2003.
- Surveillance and epidemiology to determine the magnitude and
extent of the problem;
- Laboratory diagnosis, to make the laboratory diagnosis of MDR
TB more rapid, sensitive, and reliable;
- Patient management, to prevent patients with drug-susceptible
TB from developing drug-resistant disease and effectively manage
those patients with MDR TB;
- Screening and preventive therapy, to identify persons infected
with or at risk of developing MDR TB and prevent them from
developing clinically-active TB;
- Infection control, to minimize the risk of transmission of MDR
TB to patients, workers, and others in institutional settings;
- Outbreak control, to limit transmission of MDR TB;
- Program evaluation, to ensure effective management of patients
and preventing the development of MDR TB;
- Information dissemination, training, and education to
effectively disseminate information about MDR TB and its prevention
and control; and
- Research to identify better methods for combating MDR TB.
Additional strategic planning at CDC yielded the companion plan “CDC’s
Response to Ending Neglect: The Elimination of Tuberculosis in the
United States,” (PDF) produced in
“desktop publishing” format in 2002 with specific goals, objectives,
and action steps.
This plan is organized around six goals framed in the context of
The Federal Tuberculosis Task Force conducted updated
strategic planning in 2007, in response to the global description
and occurrence of persons with virtually untreatable extensively
drug-resistant tuberculosis in 2006. This recently-developed
coordinated response plan is presently undergoing inter-agency
clearance, for publication in a future issue of the MMWR. The plan’s
nine sections cover the most critical components of an action plan:
- Goal I. Maintain control of TB through timely diagnosis and
management of TB patients and their contacts;
- Goal II. Accelerate the decline of TB through targeted testing
and treatment of persons with latent TB infection;
- Goal III. Develop new tools for the diagnosis, treatment, and
prevention of TB;
- Goal IV. Reduce the global burden of TB by increasing the
United States involvement in global TB control activities;
- Goal V. Mobilize and sustain support for TB elimination by
engaging policy and opinion leaders, health care providers, affected
communities, and the public; and
- Goal VI. Track progress toward the goal of TB elimination.
- Diagnostic Laboratory;
- Surveillance, Epidemiology, and Outbreak Investigations;
- Infection Control;
- Clinical and Programmatic Interventions;
- Ethical and Legal Issues;
- Communication and Education;
- Biomedical Research;
- Partnerships; and
- Cost Analysis.