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TB Notes 1, 2000
Introduction
Where We've Been and Where We're Going: Perspectives from CDC's Partners in TB Control
Changes I've Seen
TB Control in New York City: A Recent History
Not by DOT Alone
Baltimore at the New Millennium
From Crickets to Condoms and Beyond
The Denver TB Program: Opportunity, Creativity, Persistence, and Luck
National Jewish: The 100-Year War Against TB
Earthquakes, Population Growth, and TB in Los Angeles County
TB in Alaska
CDC and the American Lung Association/ American Thoracic Society: an Enduring Public/Private Partnership
The Unusual Suspects
The Model TB Prevention and Control Centers: History and Purpose
My Perspective on TB Control over the Past Two to Three Decades
History of the IUATLD
Thoughts about the Future of TB Control in the United States
Where We've Been and Where We're Going: Perspectives from CDC
Early History of the CDC TB Division, 1944-1985
CDC Funding for TB Prevention and Control
Managed Care and TB Control - A New Era
Early Research Activities of the TB Control Division
The First TB Drug Clinical Trials
Current TB Drug Trials: The Tuberculosis Trials Consortium (TBTC)
TB Communications and Education
TB Control in the Information Age
Field Services Activities
TB's Public Health Heroes
Infection Control Issues
A Decade of Notable TB Outbreaks: A Selected Review
International Activities
The Role of CDC's Division of Quarantine in the Fight Against TB in the U.S.
The STOP TB Initiative, A Global Partnership
Seize the Moment - Personal Reflections
 
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This is an archived document. The links are no longer being updated.

TB Notes 1, 2000

CDC Funding for TB Prevention and Control

by Patricia Simone, MD
Chief, Field Services Branch, DTBE
and Paul Poppe
Deputy Director, DTBE

Federal fiscal support for TB control began with the passage of the Public Health Service Act, which was created to assist states in establishing and maintaining adequate measures for the prevention and control of TB. To enhance case-finding activities, the 1955 Appropriation Act (Public Law 83-472) directed federal grants with local matching funds to be used only for prevention and case-finding activities. In 1961, Congress provided for project grants that were to be used for improving services to known TB patients outside of hospitals, examination of contacts, and diagnosis of suspects. In December 1963, the Surgeon General's task force issued a report recommending a 10-year plan to enhance the federal role in national TB control through increased grants for services for unhospitalized cases and inactive cases, contact investigations, school skin test screening, and hospital radiograph screening programs. By 1967, there were 82 TB control programs in the United States, with federal appropriations of $3 million in formula grants and $14.95 million in TB project grants.

However, in 1966 the Public Health Services Act was amended, changing project grants to block grants. These new grants did not require that any funds be used for TB control, and many health departments eventually redistributed the funds to other programs. While categorical TB appropriations were restored in 1982, there were very modest amounts of federal funding (approximately $1 million to $9 million per year) available for TB control until fiscal year 1992.

Despite an overall decline in funds being spent for TB control, the number of reported TB cases continued to decline nationally through 1984. However, from 1985, the number of cases began increasing and continued to rise through 1992. Recognition of the outbreaks of multidrug-resistant TB, the high mortality associated with TB in HIV-infected persons, and transmission to health-care workers resulted in strong recommendations for enhanced funding for TB prevention and control programs and more stringent infection control practices. In fiscal year 1992 the appropriation was increased to $15 million from the previous year's funding of $9 million. It increased again in 1993 to $73 million, when Congress appropriated $34 million for the continuation and expansion of the TB cooperative agreements and $39.2 million in emergency funds for use in the areas of the country most heavily affected by the increased cases. Congress appropriated yet another increase for categorical TB grants in 1994, and the appropriation for TB project grants was increased to over $117 million. In addition, approximately $25 million in redirected HIV funds have been available for TB control activities each year since 1992, for a total of over $142 million in funding for CDC for TB-related activities. As a result of this infusion of funding, TB program infrastructures have been rebuilt and the results are evident with six consecutive annual decreases in the number of reported TB cases in the United States.

Image 1: TB Funding History vs. Reported Tuberculosis Cases, 1977-1996

Since 1994, however, CDC has received approximately level funding for TB-related activities. The Tuberculosis Elimination and Laboratory Cooperative Agreement was revised for FY2000 to ensure prioritization of the core TB activities (completion of therapy, contact investigation, surveillance, and laboratory) for all TB programs, with separate funding provided on a competitive basis for targeted testing and treatment of latent TB infection for high-risk groups in programs demonstrating good performance on the core activities.

Federal funds are intended to supplement the state and local activities for TB control and prevention, and in many states, federal funds represent only a small fraction of the total funds available to the TB program. However, in many other states, federal funds represent the majority of TB funding available. Furthermore, some areas are actually reporting a reduction in their state or local TB funding. Yet the level of federal funding is expected to again remain the same in fiscal year 2000 and 2001, which will result in a decreased amount of available funds when inflation factors are applied. Although cases have declined since 1993, the case rate of 6.8 per 100,000 in 1998 is still far short of the target of 3.5 per 100,000 by the year 2000 set by CDC, and aggressive TB prevention and control efforts must be sustained to continue on a successful course to elimination. This will require the continuation of our current efforts and the development of new or increased funding initiatives at every level, including federal, state, and local.

The Advisory Council for the Elimination of Tuberculosis (ACET) published "Tuberculosis elimination revisited: obstacles, opportunities, and a renewed commitment" in the MMWR, August 13, 1999/Vol. 48/No. RR-9, and also stated the need for additional resources to fully implement effective elimination strategies. In addition to fiscal resources, ACET recommended building a stronger advocacy at every level of government as well as engaging new partners at the local level, and strengthening coalitions by revitalizing the National Coalition for the Elimination of Tuberculosis (NCET) to garner more private support, and strategically utilizing the media to inform the general public and legislators regarding TB.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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