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This information is provided for historical purposes only. For updated CDC performance planning information, see the Performance and Accountability page on this website.

IV. Infectious Diseases

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Tuberculosis

Tuberculosis (TB) is an example of an infectious disease that did undergo a sustained decades-long decline until the mid 1980s only to reemerge strongly in the late 1980s and early 1990s with drug-resistant strains. In 1989, the Secretary of the Department of Health and Human Services stated the goal of eliminating TB: "It is time to commit to a tuberculosis-free society." But a resurgence was associated with a deterioration of the public health infrastructure and complicated by the AIDS epidemic, increased numbers of cases among the foreign born, and transmission of tuberculosis in institutions, particularly in hospitals and prisons. During the 1970s and 1980s, many health departments around the country redirected TB control funds to other activities; key elements of some TB control programs were dismantled. Progress toward the control of TB slowed in the years 1985 to 1992 when the downward TB trend reversed, TB cases increased by 20 percent, and outbreaks of multidrug-resistant tuberculosis (MDR-TB) and deaths among health care workers occurred. In 1992-1993, additional resources helped to rebuild the crumbling public health TB infrastructure permitting health departments to address these problems, and TB declined again from 1993-1998. Achievement of this long term strategic objective requires a continued commitment of resources to prevent additional deterioration of the necessary infrastructure at the local, state, and/or federal levels. Reducing the case rate of tuberculosis will put the Nation back on track toward eliminating TB from the U.S.

Performance Goals and Measures

Performance Goals:

Reduce the tuberculosis case rate through the following strategies:

  • Collect TB morbidity data and important surveillance variables from states.
  • Fund state/local health agencies for implementing CDC treatment/control recommendations, community outreach, and TB patient cohort reviews; expanding contact examination; screening and treatment of TB infection for high risk groups; and implementing state-of-the-art TB laboratory services.
  • Collect, analyze, and disseminate TB program evaluation data.
  • Complete TB outbreak investigations and issue recommendations where applicable within 30 days.
  • Provide TB diagnostic, treatment, and process training for civil surgeons and panel physicians responsible for screening refugees and immigrants.
  • Develop a national TB training strategic plan and support and report on TB-related applied and operational research.
  • Implement the Tuberculosis Information Management System (TIMS) for state and local health departments for surveillance and case management.
  • Update the national "Strategic Plan for Elimination of Tuberculosis in the United States."

Performance Measures:

FY Baseline FY 1999 Appropriated FY 2000 Estimate
66.8% (1993)
(FY 1999 data will be available mid- 2001).
At least 85% of TB patients will complete a course of curative TB treatment within 12 months of initiation of treatment (some patients require more than 12 months treatment).

 

At least 85% of TB patients will complete a course of curative TB treatment within 12 months of initiation of treatment (some patients require more than 12 months treatment).
87.4% (1994).
(FY 1999 Data available mid-2000).
At least 92% of TB patients with initial positive cultures will also have drug susceptibility results. At least 92% of TB patients with initial positive cultures will also have drug susceptibility results.

68.4 % (1993)
(FY 1999 Data available late 2001).

At least 75% of contacts of infectious cases and At least 75% of contacts of infectious cases and

64.8% (1993).
(FY 1999 Data available late 2001).

70% of other high risk infected persons who are placed on preventive therapy will complete a regimen. 70% of other high risk infected persons who are placed on preventive therapy will complete a regimen.

Priority Variables have been selected and the 1993 baselines for complete reporting of these variables are:

DOB (99.9%); Country of origin (99.3%); Sex (100.0%); Race (99.8%); Month-year arrived in U.S. (71.8%); Status at diagnosis of TB (99.7%); Major site of disease (99.9%); AFB Smear (99.3%); AFB Culture (99.7%); TB skin test (83.4%); Initial drug regimen (99.9%); Initial drug susceptibility results (96.1%);Previous TB (99.2%); Year of diagnosis (93.3%); HIV status-all ages (27.5%); HIV status-ages 25-44 (41.4%); Resident of correctional facility (95.4%) and long term facility (82.8%); Sputum conversion (90.4%); Reason stopped therapy (99.8%); DOT used/not used (97.9%); Date therapy stopped (99.6%). (Note: the percentages reported are the percent with complete reporting results for each variable.) Data are collected electronically as part of the national TB surveillance system.

(FY 1999 Data available mid-2000).

States will report information to CDC on identified priority variables.

States will report information to CDC on identified priority variables.

Total FY Funding $119,962 $119,962

Verification/Validation of Performance Measures: All confirmed cases of TB are regularly listed in the Report of Verified Case of Tuberculosis (RVCT) and follow-up information is submitted electronically to CDC via Tuberculosis Information Management System software. Verification of performance will be conducted through a review of data collected by these two systems. Additionally for the third measure listed above, state and metropolitan area health departments will assist with performance verification.

Links to DHHS Strategic Plan

These performance measures relate to DHHS Goal 1: Reduce major threats to the health and productivity of all Americans. In addition to state and major city health departments, the Division of Tuberculosis Elimination also works with the Advisory Committee for the Elimination of TB, the National TB Controllers Association, and the American Lung Association/American Thoracic Society to set guidelines, recommendations, and policies related to TB prevention and control.

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