Department of Health and Human Services 

Centers for Disease Control and Prevention 

TB Elimination 

TM 

Federal Tuberculosis Task Force Plan in 

Response to the Institute of Medicine Report, 

Ending Neglect: The Elimination of 

Tuberculosis in the United States 
Federal Tuberculosis Task Force Plan in 

Response to the Institute of Medicine Report, 

Ending Neglect: The Elimination of 

Tuberculosis in the United States 

Coordinated by
 

The Division of Tuberculosis Elimination
 

National Center for HIV, STD, and TB Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

on behalf of
 

The Federal Tuberculosis Task Force
 

(Contributors listed on pages 63-65)
 

September 2003
 

1
 
Contents

EXECUTIVE SUMMARY 3

Introduction 6

Chronology in the Development of This Report 8

Strategies and Action Steps 11

A. Strategies for Maintaining Control of TB 11

B. Strategies for Accelerating the Decline of TB 26

C. Activities for Developing New Tools 46

D. Global U.S. Actions 56

E. Assessing the Impact of Actions Taken 61

Federal TB Task Force Members and Others

Involved in the Development of This Report 63

Glossary 66

References 69

Federal TB Task Force Roster 70

Suggested Citation: 

The Federal Tuberculosis Task Force. Federal Tuberculosis Task Force Plan in 

Response to the Institute of Medicine Report, Ending Neglect: The Elimination of 

Tuberculosis in the United States. Atlanta, GA: US Department of Health and Human 

Services, Centers for Disease Control and Prevention; 2003. 

2
Executive Summary 

Introduction 

After years of decline in the United States, the number of reported tuberculosis (TB) cases 

increased 20% between 1985 and 1992. This resurgence was associated with a deterioration of 

the infrastructure for TB services; the human immunodeficiency virus (HIV) epidemic, which 

substantially increases the risk for active TB among persons with latent TB infection (LTBI); 

increased immigration of persons from countries where TB is endemic; TB transmission in 

congregate settings (e.g., hospitals and prisons); and development of multidrug-resistant TB 

(MDR TB). However, a renewed emphasis on TB control and prevention and a major commitment of resources in the mid- to late 1990s resulted in substantial declines in the disease. In 

2000, the number of TB cases decreased for the eighth straight year to an all-time low of 

16,377 cases, a 7% decrease over the 17,531 cases reported in 1999. 

In the summer of 2000, the National Academy of Sciences’ Institute of Medicine (IOM) issued 

a report, Ending Neglect: The Elimination of Tuberculosis in the United States.1

 The report 

states that the resurgence of TB in the United States was the price of neglect reflected in 

earlier funding reductions and concludes that, with proper funding, organization of prevention 

and control activities, and research for development of new tools, TB can be eliminated as a 

public health problem in the United States. 

In response, the Federal TB Task Force developed this plan to implement the IOM recommendations. The plan is organized around the five areas of IOM recommendations and provides a 

blueprint for a significant reduction in the remaining U.S. TB cases. The plan includes domestic 

and global strategies — planned for implementation in partnership with global agencies such as 

the World Health Organization (WHO) and the International Organization of Migration — as 

well as detailed action steps and specific agency roles. 

Chronology in the Development of This Report 

In responding to the IOM report, members of the Federal TB Task Force met to develop a 

coordinated federal action plan. Two meetings were convened in Bethesda, Maryland, on 

December 6-7, 2000, and February 8-9, 2001, to initiate the development of this plan. 

A consensus was reached in determining the lead agencies and collaborating agencies for each 

activity. Individual recommendations revolving around common activities were consolidated, 

and a consensus was reached on the resulting list by circulating drafts to the entire task force. 

In the next step, lead individuals were identified for the lead agencies. These persons worked 

with named co-leads and collaborating agencies to further develop the strategies by adding 

additional action steps where deemed necessary to implement the strategies. Subsequent drafts 

of the entire document were shared with the Federal TB Task Force participants who provided 

comments, where appropriate, for the next draft. The final draft was discussed at a Federal TB 

3
 
Task Force conference call in late August 2001, where remaining issues were resolved. This 

was followed by a series of additional participant reviews accomplished by circulation of the 

drafts to participants. Because of the unusual multiagency nature of this document, this final 

document went through high-level multiagency clearance before publication. 

Strategies for Eliminating Tuberculosis 

The IOM recommended five overarching strategies for eliminating TB. The first strategy, 

maintaining control of TB, is a necessary prerequisite to elimination of the disease and requires strengthening of labor-intensive activities that make optimal use of available tools to 

help find and cure all persons with active TB. The IOM’s second strategy is to accelerate the 

decline of TB. Maintaining control of TB is not sufficient to eliminate TB; individuals can 

unknowingly carry live bacteria that cause TB for years without getting sick (also known as 

latent TB infection). An estimated 10 to 15 million persons in the United States have latent TB 

infection, many of them in identifiable but hard-to-reach populations. Latent TB infection can 

suddenly turn active and contagious. Finding and treating high-risk persons with latent TB 

infection before they become sick — and infectious — is absolutely essential to eliminating 

TB. High-risk persons include those with recent infection, contacts of persons with infectious 

TB, persons with HIV or AIDS, substance abusers, persons who have immigrated to the United 

States from areas of the world with high rates of TB, prisoners, and the homeless. In addition, 

persons who reside or work in institutional settings (e.g., hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for patients with AIDS) may have an 

ongoing risk for acquiring TB infection and disease. 

Thirdly, the IOM recommends the development of new tools. The goal of TB elimination 

cannot be reached with the tools that are currently available. TB elimination will require an 

increased investment in TB research to develop a more effective vaccine, as well as new tools 

and drugs to more rapidly and reliably diagnose and shorten treatment for all persons with 

latent and active TB, including those afflicted with MDR TB. The fourth IOM strategy calls for 

increased global United States actions. The IOM report notes that the proportion of foreignborn TB cases in the United States has been steadily increasing and says it benefits the United 

States to help strengthen TB control programs globally. Specifically, page 11 of the IOM 

report states that “Tuberculosis will not be eliminated in the United States until the worldwide 

pandemic is brought under control.” Finally, the IOM recommends an assessment of the impact 

of actions taken in response to the IOM report. The Advisory Council for the Elimination of 

Tuberculosis (ACET) and the Federal TB Task Force will monitor the federal response to the 

IOM report. 

In response to these recommendations, the Federal TB Task Force developed the action steps 

contained in this document. Specific tasks and projects are described, and agencies with the 

lead responsibility for each step, along with estimated start and completion dates, are provided. 

4
 
Conclusion 

While the strategies and action steps complement ongoing federal TB prevention, control, and 

research activities, they cannot all be implemented with current funding. Federal TB Task Force 

agencies will implement the strategies and action steps contained in this report as resources 

become available. Federal TB Task Force members continue to confer via teleconference on a 

quarterly basis and remain ready to provide a coordinated federal response to the IOM recommendations and to progress toward TB elimination in the United States. 

5
 
Introduction
 

Following more than three decades of declining TB trends, TB cases in the United States 

soared 20% between 1985 and 1992. The Federal TB Task Force was established in December 

1991 in response to this unprecedented surge in TB cases. (The fourth chapter of this document lists the members of the Federal TB Task Force.) Some of the serious factors associated 

with the resurgence included -

¢	 The HIV epidemic, which increased the number of persons at extraordinary risk of TB 

disease progression 

¢	 Immigration from countries with a high prevalence of TB or where TB is a substantial 

public health problem; a reflection of the global nature of the disease 

¢ Outbreaks in congregate settings such as hospitals and correctional facilities 

¢	 The widespread occurrence and outbreaks of difficult-to-diagnose and treat MDR TB 

strains 

¢	 A deterioration and dismantling of TB services and of the related public health 

infrastructure during the earlier periods of TB declines, resulting in inadequate capacity 

to respond to increased demands during the resurgence 

By April 1992, the TB Task Force had responded with a National Action Plan to Combat 

Multidrug-Resistant Tuberculosis.1

 This plan complemented the 1989 ACET document, A 

Strategic Plan for the Elimination of Tuberculosis in the United States2, and guided the 

mobilization of new resources for responding to the TB crisis in the United States. 

Consequently, TB and MDR TB case rates declined annually from 1992 to 2000. However, 

several elements of the plan could not be implemented due to resource constraints. And 

although the number of TB cases has declined, achievement of the goal of TB elimination was 

deemed uncertain. 

In 1999, ACET reaffirmed its call for the elimination of TB in the United States3

 and the 

National Academy of Sciences’ Institute of Medicine was commissioned to evaluate the 

feasibility of TB elimination in the United States. In the summer of 2000, the Institute of 

Medicine issued its independent report Ending Neglect: The Elimination of Tuberculosis in 

the United States.

4

 This report suggests that the resurgence of TB in the United States was the 

price of neglect reflected in earlier funding reductions for both TB programs and research. The 

report states that elimination of TB in the United States is feasible but will require social 

mobilization plus maintenance of public interest and commitment necessary to provide 

resources for the effort. 

The Federal TB Task Force has undertaken the challenge of responding to this landmark IOM 

report by developing a coordinated federal action plan. The broad membership of the TB Task 

Force focused heavily on the first three (of five) areas of the IOM report that were considered 

amenable to federal activity: 

6
 
¢	 “Maintaining control of TB: The control of tuberculosis requires the ability to identify 

and cure individuals with active tuberculosis disease.” 

¢	 “Speeding the decline of TB: After ensuring the control of tuberculosis, the second 

priority is targeted tuberculin skin testing and treatment of latent TB infection, which 

includes identification and treatment of contacts.” 

¢	 “Developing new tools: Tuberculosis elimination is not possible with the tools that are 

available currently but will require an investment in basic and applied research to 

develop better diagnostic, treatment, and prevention tools as well as related behavioral 

and social research targeted toward understanding and improving patient adherence with 

therapy.” 

While the larger group of TB Task Force members did not focus heavily on the fourth and fifth 

areas of the IOM report, they were addressed. A smaller group of Federal TB Task Force 

members focused on the IOM global TB recommendations to decrease the number of foreignborn individuals with TB in the United States, to minimize the spread and impact of MDR TB, 

and to improve global health. In addition, the TB Task Force members briefly dealt with the 

fifth area of the IOM report by referring to the ACET and TB Task Force responsibilities for 

monitoring the federal responses to the IOM report. Furthermore, ACET has agreed to 

implement recommendation 7.3 and to monitor and evaluate this plan. To facilitate the process, 

CDC is working to generate a list of indicators for monitoring progress. 

This Federal TB Task Force report is a response to the IOM report Ending Neglect: The 

Elimination of Tuberculosis in the United States, and is intended to influence and guide 

federal decision makers charged with planning TB control and elimination activities. The report 

is organized with reference to the major IOM areas noted above, while recognizing there is 

potential overlap in the impact of some activities (e.g., improved education to health care 

providers and to patients will improve both control of current TB burden and accelerate the 

decline of the disease). The report lays out a series of strategies that need to be undertaken at 

the federal level. In addition, this report addresses activities to support the Occupational Safety 

and Health Administration (OSHA) compliance instruction, CPL 2.106, Enforcement 

Procedures and Scheduling for Occupational Exposure to Tuberculosis, which provides 

uniform inspection procedures and guidance for OSHA Compliance Officers to follow when 

conducting inspections and issuing citations under Section 5(a)(1) of the OSH Act. Priorities 

will vary from agency to agency, and activities should be undertaken within the time frames 

indicated, as resources permit. Some of the activities are underway; however, many of the 

proposed activities will require additional resources. Many activities should and will continue 

beyond 2003. The report is intended as a plan for action by federal agencies. However, 

implementation will depend on the cooperation of many sectors of society. Indeed, the success 

of the plan will depend on a concerted effort and commitment at all levels and will involve 

collaboration between public health and other government agencies, professional societies, 

voluntary agencies, health care providers, community and faith-based organizations, and many 

others. 

7
 
Chronology in the Development of This Report 

In responding to the IOM report, members of the Federal TB Task Force met to develop a 

coordinated federal action plan. Two meetings were convened in Bethesda, Maryland (on 

December 6-7, 2000, and February 8-9, 2001), to initiate the development of this plan. At the 

December 6-7 TB Task Force meeting, each agency provided a summary of its TB-associated 

activities as they relate to the IOM report’s recommendations. Then, using facilitated breakout 

workgroups made up of scientific and program experts, the participants drafted action steps to 

be included in a federal action plan response to the IOM recommendations. Participants agreed 

to initially focus on the first three (of five) broad recommendations of the IOM report that 

were considered amenable to federal activity: 

1. Maintaining control of TB 

2. Accelerating the TB decline 

3. Developing new tools 

Three breakout groups were organized according to participant areas of interest and expertise: 

1) services, financing, and quality; 2) targeted testing and treatment of latent TB infection; and 

3) needed research. The groups considered topics in the context of the three IOM 

recommendations and the following related issues: 1) defining the necessary federal activities 

related to these areas; 2) determining which agencies should take the lead in developing and 

implementing the identified activities; and 3) determining which agencies should be involved as 

collaborators in developing and implementing these activities. The breakout groups developed a 

comprehensive series of recommended activities for the federal government to undertake. At 

the February 8-9 meeting, the TB Task Force representatives further developed the 

recommended activities, and assigned a priority to each of them. A consensus was reached in 

determining the lead agencies and collaborating agencies for each activity. Common activities 

and themes became obvious in many of the recommendations of the separate breakout groups. 

Following the meeting, individual recommendations revolving around common activities were 

consolidated, and a consensus was reached on the resulting list by circulating drafts to the 

entire task force. 

In the next step, lead individuals were identified for the lead agencies. These persons worked 

with named co-leads and collaborating agencies to further develop the strategies by adding 

additional action steps where they were deemed necessary to implement the strategies. 

Subsequent drafts of the entire document were shared with the Federal TB Task Force 

participants who provided comments, where appropriate, for the next draft. The final draft was 

discussed at a Federal TB Task Force conference call in late August 2001, during which 

remaining issues were resolved. This was followed by a series of additional participant reviews 

accomplished by circulation of the drafts to participants. Because of the unusual multiagency 

nature of this document, it went through high-level multiagency clearance before publication. 

The names of participating representatives of TB Task Force federal agencies and organizations 

are included in the fourth chapter of this report. The agencies represented include (1) agencies 

of the Department of Health and Human Services: the Office of Minority Health of the Public 

8
 
Health Service (OMH/PHS), the Agency for Healthcare Research and Quality (AHRQ), the 

Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), 

the Health Care Financing Administration (HCFA), the Health Resources and Services 

Administration (HRSA), the Indian Health Service (IHS), the National Institutes of Health 

(NIH), Regional Health Administrators (RHAs), and the Substance Abuse and Mental Health 

Services Administration (SAMHSA); (2) other Federal agencies: the Department of Veterans 

Affairs (VA), the Federal Bureau of Prisons (FBOP), the U.S. Marshals Service, the Office of 

HIV/AIDS Housing in the Department of Housing and Urban Development (HUD); the Office 

of Occupational Medicine, Occupational Safety and Health Administration (OSHA), the U.S. 

Agency for International Development (USAID); the Immigration and Naturalization Service 

(INS),1 the Department of State (DOS); the CDC Advisory Council for the Elimination of 

Tuberculosis (ACET); and (3) the American Lung Association and the National TB Controllers 

Association (NTCA). 

This report is organized with reference to the major IOM recommendation areas with 

acknowledgment of potential overlap in the impact of some activities (e.g., improved education 

to health care providers and to patients will both improve control of the current TB burden and 

accelerate the decline of the disease). 

Note: The following outline lists the specific IOM recommendations followed by the related 

proposed strategies and action steps, as well as the lead and collaborating agencies. 

1

INS functions are now subsumed by the Department of Homeland Security, Directorate of Border 

and Transportation Security, Bureau of Immigration and Customs Enforcement. 

9
 
10
Strategies and Action Steps 

Domestic Federal Actions in Response to the Institute of Medicine Report on TB: 

Ending Neglect: The Elimination of Tuberculosis in the United States 

A. Strategies for Maintaining Control of TB 

Maintaining control is a necessary prerequisite to elimination of the disease and requires strengthening labor-intensive activities 

that make optimal use of available tools to help find and cure all persons with active TB. 

IOM Recommendation 3.1: “To permanently interrupt the transmission of tuberculosis and prevent the emergence of 

multidrug-resistant tuberculosis...” 

Strategies Action Steps 

1. Ensure available clinical and a) Ensure that patient-centered case management and monitoring of treatment outcomes are implemented 

public health services to provide universally and are the standard of care for all patients. 

continuous quality care for TB 

patients. Lead: NCHSTP Collaborators: 

Lead Agency: CDC Start Date: prior to FY 2002 Completion Date: Ongoing 

Collaborating Agencies: IHS, VA, b) Ensure appropriate care for patients with MDR TB and monitor their response to treatment and treatment 

DOJ, SAMHSA, HRSA, NTCA outcomes. 

Start Date: FY 2002 Lead: NCHSTP Collaborators: 

Completion Date: Start Date: prior to FY 2002 Completion Date: 

c) Support the infrastructure needed for laboratory-based identification and treatment of TB and ensure the 

provision of quality and timely laboratory services with appropriate safety facilities. 

Lead: Collaborators: PHPPO, BPHC, NTCA 

Start Date: prior to FY 2002 Completion Date: 

IHS, VHA, HAB, FBOP, SAMHSA, BPHC, NTCA 

IHS, VHA, HAB, FBOP, BPHC, NTCA 

Ongoing Ongoing 

NCHSTP 

Ongoing 

11
 
 2. Improve and optimize follow-up 

of immigrants and refugees 

arriving in the U.S. with suspected 

TB. 

Lead Agency: CDC 

Collaborating Agencies: DOJ 

ORR, DOS, NTCA, DHS/BICE 

Start Date: FY 2002 

Completion Date: FY 2005 

a) Implement electronic surveillance of TB notifications for immigrants and refugees arriving in the U. S. 

with suspected TB in order to effectively communicate data between local, state, and federal programs and 

ensure appropriate domestic follow-up, and quality and continuity of care. 

Lead: NCID Collaborators: NCHSTP, CA, PRM, SITD, ORR, NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2005 

(1) Build the software and infrastructure to electronically transmit the data to state health departments. 

Identify and enlist a representative group of 8 state health departments (State TB Control Programs and 

State Refugee Health Programs) and 2 metropolitan health departments, and pilot the system. 

Lead: NCID, NCHSTP, NTCA Collaborator: None 

Start Date: prior to FY 2002 Completion Date: Ongoing 

(2)With input from U.S. TB controllers, establish national performance measures, objectives, and data 

collection to enable assessment and improvement of domestic follow-up. 

Lead: NCID, NCHSTP Collaborator: NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2003 

(3) Fully implement the electronic surveillance for TB notification to 50 state health departments and 

remaining metropolitan health departments. 

Lead: NCID Collaborators: NCHSTP, CA, PRM, NTCA 

Start Date: FY 2003 Completion Date: FY 2005 

(4) Build the software to collect and consolidate data from the overseas examining physicians (i.e., 

panel physicians) at panel physicians’ facilities or at the U.S. ports of entry. Establish the infrastructure 

to collect the data at a centralized Immigration and Naturalization Service (INS) collection point (e.g., 

Mesquite, Texas) or to interface with the existing data collection system with the Department of State. 

Once software is operational, data will be transmitted directly to CDC, Division of Global Migration and 

Quarantine (DGMQ), for dissemination to the receiving health departments. 

Lead: NCID Collaborators: NCHSTP, SITD, CA, PRM, NTCA 

12
 
 2. Continued from above. (5) Identify and enroll a selected group of overseas examining physicians (panel physicians) to collect 

and transmit the medical data to DGMQ. 

Lead: Collaborators: 

Start Date: FY 2002 Completion Date: 

3. Improve and ensure the quality a) Develop and implement a standardized, fully operational quality assessment program to evaluate the 

of tuberculosis examinations performance and effectiveness of overseas TB screening by panel physicians for immigrants and 

conducted by overseas panel refugees. 

physicians and domestic civil 

surgeons. Lead: Collaborators: , NTCA, CA 

Lead Agencies: CDC, DOJ 1) Expand the overseas quality assessment program and focus initially on countries with high 

prevalence of tuberculosis and HIV and/or high volume of immigration to the U.S. 

Collaborating Agencies: 

DOS Lead: NCID Collaborators: , PHPPO, CA, 

Start Date: FY 2002 Start Date: FY 2002 Completion Date: 

Completion Date: Ongoing (2 ) Reestablish overseas posts to have responsibility for overseeing and ensuring the quality 

assessment , and/or heavy 

volume of immigration to the U.S. 

Lead: NCID Collaborators: CA, PRM, PHPPO 

Start Date: FY 2002 Completion Date: FY 2003 

NCID SITD, CA, PRM 

FY 2005 

NCID NCHSTP 

NTCA, 

NCHSTP PRM, NTCA 

FY 2003 

program in selected regions with high prevalence of tuberculosis, HIV 

13
 
3. Continued from above (3) Maintain a successful global quality assessment program. 

Lead: NCID Collaborators: CA, PRM, NTCA 

Start Date: FY 2004 Completion Date: Ongoing 

b) Implement a domestic quality assessment program to evaluate the effectiveness of screening by 

domestic civil surgeons for TB disease and latent TB infection among foreign-born persons already 

residing in the U.S. (i.e., adjustment of status applicants). This quality assessment program will (1) 

review and revise existing INS regulations governing the civil surgeon program; (2) create new forms and 

revise existing ones; (3) implement protocols for tracking the status of civil surgeon designations; (4) 

implement a standard protocol for CDC and health departments to evaluate the performance of civil 

surgeons; (5) use tools and resources developed by CDC for quality improvement of TB control 

programs; and (6) ensure that civil surgeon examination procedures and findings are integrated into 

effective targeted testing and treatment programs at state and local levels. 

Lead: AND, NCID Collaborators: NCHSTP, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

c) Develop reliable and systematic linkages between local health departments and civil surgeons to 

ensure referral and treatment of latent TB infection among persons adjusting status. The linkage will 

require implementation of local strategies to improve communications between civil surgeons and local 

health departments to streamline the referral process, assist patients in accessing local health 

departments (LHDs), and ensure adequate resources for the LHD’s evaluation and treatment of 

adjustment of status applicants referred. 

Lead: AND, NCID, NCHSTP Collaborator: NTCA 

Start Date: FY 2003 Completion Date: Ongoing 

14
 
4. Facilitate continuity of care for 

prisoners and INS detainees across 

correctional facilities and 

communities in the U.S. and 

Mexico and elsewhere. 

Lead Agencies: DOJ, USMS, 

HRSA 

Collaborating Agencies: CDC 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Resurvey state laws for provisions regarding case transfers across correctional facilities, release and 

quarantine of persons with TB, and TB-related screening. 

Lead: NCHSTP Collaborator: CDC/OD (OGC) 

Start Date: prior to FY 2002 Completion Date: FY 2002 

b) Develop reporting and discharge planning infrastructure for newly diagnosed and prevalent cases and 

suspects. 

Leads: FBOP, USMS, NCHSTP, DIHS Collaborator: None 

Start Date: prior to FY 2002 Completion Date: Ongoing 

c) Implement Health Resources and Services Administration/Division of Immigration Health Services 

(DIHS) program for continuity of care for persons detained by the INS and subsequently released or 

paroled in the U.S., in order to facilitate the continuity of care in the community and have TB completion of 

treatment monitored on a national level; share data with TB controllers and with tracking organizations 

such as Cure TB and TBNet. 

Lead: DIHS Collaborators: D&R, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

(1) Develop a model for the implementation and maintenance of a continuity of care program for 

released or paroled INS detainees and establish/strengthen partnerships between INS, DIHS, TB 

controllers in other countries, state and local health departments, and community TB service 

providers. The program should include a uniform method of data collection, including uniform 

tracking numbers and data elements across programs and services (e.g., DIHS, INS, state health 

departments, CDC, TBNet, Cure TB, etc.), and access to databases by TB providers and TB 

controllers across programs. 

Lead: DIHS Collaborators: D&R, NTCA 

Start Date: FY 2002 Completion date: Ongoing 

(2) Coordinate tracking of patients released from INS custody to link paroled aliens to services in 

the U.S., to link deported aliens to services in the country of origin, and to monitor inplementation 

of infectious disease guidelines. 

Lead: DIHS Collaborators: D&R, NTCA 

Start Date: FY 2002 Completion date: Ongoing 

15
 
5. Continue to ensure TB 

medications are available and at 

federal pricing via the Department 

of Veterans Affairs national contract. 

Lead Agency: CDC 

Collaborating Agency: FDA, 

HRSA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Facilitate State TB program utilization of the existing Department of Veterans Affairs contract for federal 

pricing of TB medications. 

Lead: NCHSTP Collaborators: CDER, BPHC, HAB 

Start Date: FY 2002 Completion Date: Ongoing 

16
 
6. Develop improved engineering 

techniques to prevent TB 

transmission. 

Lead Agencies: CDC, NIH 

Collaborating Agency: OSHA 

Start Date: FY 2006 

Completion Date: FY 2006 

a) Encourage and support research to develop improved engineering techniques for preventing transmission 

of M. tuberculosis in high-risk environments. 

Lead: NIOSH, NIAID Collaborator: OSHA 

Start Date: FY 2002 Completion Date: FY 2006 

b) Use computational fluid dynamics to assess the efficacy of engineering controls supplemental to room 

ventilation. 

Lead: NIOSH Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2004 

c) Use computational fluid dynamics to evaluate the ability of various ventilation configurations/designs 

to prevent the migration of TB microbes from one room to another. 

d) Assess adequacy of personal protective equipment: (i) determine if the current user-seal checks as described 

by the manufacturers of N95 filtering facepiece respirators actually help to ensure an adequate fit; (ii) develop a 

no fit-test high-protection factor respirator performance test; (iii) conduct workplace study of how well N95 

filtering facepiece respirators perform in actual health-care settings, including determining penetration and 

service time restraints; (iv) conduct surveillance of how respirators are used for protection against TB in healthcare settings (types, duration of use, types and frequency of fit-tests used, etc.); and (v) conduct testing of 

newly certified N95 respirators to determine how well each certified respirator performs, enabling health care 

workers to make an informed and proper respirator selection. 

Lead: NIOSH Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2003 (i, iii, iv) FY2004 (ii, v) 

17
 
IOM Recommendation 3.2: “To ensure the most efficient application of existing resources...” 

Strategies Action Steps 

1. Evaluate existing policies and a) Conduct a systematic review of existing policies and referral systems for TB patients who may move 

referral systems for TB patients within and between localities, states, and/or countries. 

who may move within and between 

localities, states, and/or countries. Lead: NCHSTP Collaborator: NTCA 

Lead Agency: CDC Start Date: FY 2002 Completion Date: FY 2002 

Collaborating Agency: NTCA b) Conduct a study of the outcomes of moved TB patients to determine if there are any adverse 

implications for continuity of care and treatment. 

Start Date: FY 2002 

Lead: NCHSTP Collaborators: NCID, NTCA 

Completion Date: FY 2003 

Start Date: FY 2002 Completion Date: FY 2002 

c) Convene a meeting of state and local TB controllers, or their designees, to develop a comprehensive process 

for referral of TB patients who move within and between localities, states, and/or countries. 

Lead: NCHSTP Collaborators: NCID, NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2003 

d) Determine the need to revise the Report of a Verified Case of Tuberculosis (RVCT) to expand data on patients 

who move. 

Lead: NCHSTP Collaborators: NCID, NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

18
 
2. Develop tools for improving the 

quality of public health TB control 

programs and related evaluation. 

Lead Agency: CDC 

Collaborating Agencies: NTCA, VA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Establish an evaluation section in the Division of Tuberculosis Elimination (DTBE) to develop tools for 

evaluating and improving the quality of TB control programs. 

Lead: NCHSTP Collaborators: VHA, PHPPO 

Start Date: FY 2003 Completion Date: Ongoing 

b) Periodically review for accuracy the nation’s TB surveillance (case reporting) system, case 

management and contact data collection systems, and related protocols and guidelines; update as 

appropriate. 

Lead: NCHSTP Collaborators: PHPPO, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

c) Develop training for program evaluation and conduct training on-site at state and local TB control 

programs, regional meetings, and national meetings involving TB control program staff. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2003 

d) Provide resources through the federal Cooperative Agreements to state and local TB control programs so 

that evaluation of TB program activities can be implemented. Incorporate results of evaluation in decisions 

regarding the allocation of federal funds. 

Lead: NCHSTP Collaborators: NTCA, NCID 

Start Date: FY 2002 Completion Date: Ongoing 

e) Evaluate the effectiveness of screening for TB and latent TB infection in foreign-born persons in the 

United States. 

Lead: NCHSTP Collaborators: NCID, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

19
 
3. Develop short- and long-term 

plans for integrated information 

systems that are crossjurisdictional and facilitate 

surveillance, case management, 

and program evaluation. 

Lead Agency: CDC 

Collaborating Agencies: VA, HRSA, 

IHS, NTCA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Survey state and local TB control programs to determine current status of their information systems, 

which programs are currently using TIMS for case management and program evaluation, other 

systems being used by programs for case management and program evaluation, programs’ data needs 

for case management and program evaluation, and what data items are currently being collected. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2002 

b) Develop an integrated information system that is both strong enough and flexible enough to facilitate 

surveillance, case management, and program evaluation and accommodate the needs of the various TB 

control programs. This system should have the capacity to expand as needed and be flexible enough for 

programs to customize the system to meet their needs. 

Lead: NCHSTP Collaborators: BPHC, HAB, VHA, IHS, NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

c) Assist state and local TB control programs to implement the new information system. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2004 Completion Date: FY 2006 

d) Annually evaluate Veterans Health Administration TB-related activities and policies; revise as appropriate. 

Lead: VHA Collaborator: None 

Start Date: FY 2002 Completion Date: Ongoing 

20
 
IOM Recommendation 3.4: “To maintain quality in TB care and control services in an era of increased use of 

managed care systems and privatization of services...” 

Strategies Action Steps 

1. Encourage states to adopt the a) Encourage states to adopt the TB option described in 1902(z) of the State Medicaid Manual at the 

Medicaid eligibility option for National Eligibility Training Conference held in Atlanta (November 6-8, 2001) and the 2003 National TB 

coverage of individuals infected with Controllers Workshop in Washington, DC (June 10-11, 2003). 

TB as described in section 1902(z) 

of the Social Security Act. Leads: CMS, NCHSTP Collaborator: 

Lead Agencies: Start Date: FY 2002 Completion Date: FY 2003 

Collaborating Agency: 

Start Date: 

Completion Date: FY 2003 

None 

CMS, CDC 

NTCA 

FY 2002 

21
 
2. Evaluate funding sources 

(including public and private 

third-party payers) and explore 

ways to increase third-party 

reimbursement for TB services. 

Lead Agency: CDC 

Collaborating Agency: NTCA 

Start Date: FY 2002 

Completion Date: FY 2004 

a) Identify funding sources for outpatient TB services in a sample of TB cases. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2003 

b) Determine facilitating factors and barriers to third-party billing and reimbursement. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2003 

c) Determine the current programmatic and fiscal impact of reimbursement. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2003 

d) Using study results, develop recommendations for strategies to maximize and improve third-party 

reimbursement for TB control activities. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2003 Completion Date: FY 2004 

22
 
3. For TB care in the private sector, 

including managed care 

organizations (MCOs), evaluate 

the capacity of public health 

programs to monitor care. 

Lead Agency: CDC 

Collaborating Agency: NTCA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Identify and/or develop recommendations to (1) improve collaboration between health departments and 

providers as recommended in CDC’s Essential Components of a Model TB Program (this may include model 

MCO policies, TB Health Plan Employer Data and Information Set (HEDIS) indicators, and/or CDC public health 

performance standards) and (2) emphasize health departments’ major responsibilities for monitoring and 

ensuring the quality of all TB-related activities in the community as part of their responsibility to protect the 

public health. 

Lead: NCHSTP Collaborators: PHPPO, NTCA 

Start Date: FY 2002 Completion Date: FY 2002 

b) Establish and implement methodologies to review, evaluate, and improve ability of public health 

programs to monitor care, based on identified standards, indicators, and policies. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

23
 
IOM Recommendation 3. 5: “To promote a well-trained medical (in a broad sense) workforce and educated public...” : 

Strategies Action Steps 

1. Prioritize and implement a a) Engage in a participatory review of the 1998 “Strategic Plan for Tuberculosis Training and Education” 

strategic plan for TB training/ document; convene meeting of original workgroup members and additional key partners, including 

education designed to educate representatives from targeted stakeholder audiences; review progress; update plan; disseminate revised 

patients, workers, and providers, document; monitor and evaluate progress; reconvene partners on a yearly basis to review findings and 

particularly of high-risk populations. adjust the plan, as appropriate. 

Lead Agency: Lead: NCHSTP Collaborators: PHPPO, NIOSH, 

Collaborating Agencies: IHS, VA, Start Date: prior to FY 2002 Completion Date: Ongoing 

DOJ, SAMHSA, NIH, HRSA, FDA, 

NTCA, DOL b) After review/revision of the “Strategic Plan,” conduct needs assessment with appropriate stakeholder 

audiences to assess currently available tools and guidelines, utilization, and level of implementation. 

Start Date: FY 2002 Based on information gathered, conduct a gap analysis to determine development needs for products and 

infrastructure. Use this information to supplement objectives/goals of “Strategic Plan for Training and 

Completion Date: Education.” 

Lead: NCHSTP Collaborator: NTCA 

Start Date: prior to FY 2002 Completion Date: Ongoing 

c) Evaluate existing educational materials and communication products; evaluate usefulness of guidelines and 

recommendations for target audiences; plan for updates where necessary. 

Leads: NCHSTP, NIOSH Collaborators: CDRH, NTCA, OSHA 

Start Date: prior to FY 2002 Completion Date: Ongoing 

d) Working in collaboration with patient and provider representatives (including potentially exposed workers), as 

well as technical and communication experts, develop patient and provider education materials that are culturally 

and linguistically appropriate for target audiences. 

Leads: NCHSTP, NIOSH Collaborators: NTCA , OSHA 

Start Date: prior to FY 2002 Completion Date: FY 2005 

CDC NHLBI, NTCA , OSHA, VHA 

FY 2005 

24
 
1. Continued from above e) Identify culturally appropriate incentives and enablers to help ensure completion of therapy for infection and 

disease. 

Lead: Collaborators: 

Start Date: prior to FY 2002 Completion Date: FY 2004 

f) Enhance training and education of providers by (i) increasing cultural competency among health care workers; 

(ii) working with agency Offices of Minority Health in developing appropriate resources and interventions; (iii) 

training health care workers regarding contact investigations; and (iv) developing additional education/training 

materials addressing skills for persons conducting the contact investigation. 

Leads: NCHSTP, NIOSH Collaborator: NTCA 

IHS, BPHC, DIHS, FBOP, OSHA 

Startt Date: Completion Date: FY 2005 

2. Sustain support of existing a) Monitor progress of ongoing training and consultative activities by Model TB Centers. 

Model TB Centers and consider 

development and expansion of Lead: NCHSTP Collaborators: NHLBI, NTCA 

Model TB Centers in order to ensure 

better access to training and Start Date: prior to FY 2002 Completion Date: Ongoing 

education resources regionally for 

both high- and low-incidence areas. b) Convene Model TB Center representatives yearly to revise and update work plans. 

Lead Agency: Lead: NCHSTP Collaborators: NHLBI, NTCA 

Collaborating Agencies: Start Date: prior to FY 2002 Completion Date: Ongoing 

Start Date: FY 2002 c) Announce availability of new resources for expansion of Model TB Centers. 

Completion Date: Lead: NCHSTP Collaborators: NHLBI, NTCA 

Startt Completion Date: Ongoing 

NCHSTP NTCA, OSHA 

FY 2002 

CDC 

NIH, NTCA 

Ongoing 

Date: 2003 

25
 
B. Strategies for Accelerating the Decline of TB 

Maintaining control of TB is not sufficient to eliminate TB. Individuals can unknowingly carry live bacteria that cause TB for years without getting 

sick (also known as latent TB infection). An estimated 10 - 15 million persons in the U.S. have latent TB infection, many of them in identifiable but 

hard-to-reach populations. Latent TB infection can suddenly turn active and contagious. Finding and treating high-risk persons with latent TB 

infection before they become sick - and infectious - is absolutely essential to eliminating TB. High-risk persons include those with recent infection, 

contacts of persons with infectious TB, persons with HIV or AIDS, substance abusers, persons who have immigrated to the U.S. from areas of the 

world with high rates of TB, prisoners, and the homeless. In addition, persons who reside or work in institutional settings (e.g., hospitals, homeless 

shelters, correctional facilities, nursing homes, and residential homes for patients with AIDS) may have an ongoing risk for acquiring TB infection 

and disease. 

IOM Recommendation 4.1: “To limit the spread of TB from infectious patients to their contacts...” 

Strategies Action Steps 

1. Develop national a) Complete ongoing prospective study of contact investigations, which will provide the scientific basis 

recommendations or/guidelines for developing recommendations/guidelines for contact investigations. 

for contact investigation, 

addressing the challenges of Lead: NCHSTP Collaborator: NTCA 

investigations among the 

foreign-born and in various social Start Date: prior to FY 2002 Completion Date: FY 2002 

networks, and define terms such 

as “close contact.” b) Conduct prospective study aimed at improving contact investigations among foreign-born populations 

in the U.S. Specific objectives of this study are 1) to improve contact identification for foreign-born TB 

Lead Agency: patients, and 2) to improve interpretation of skin test results in foreign-born contacts. For objective 1), 

interviewing tools will be developed in multiple languages, input from an ethnographer will be sought in 

Collaborating Agencies: designing the study, and social networking approaches will be used. For objective 2), epidemiologic, 

SAMHSA, HRSA, NIH, NTCA, DOL immunologic, and non-tuberculous antigen test results will be correlated to develop an epidemiologic 

profile associated with increased risk of recent M. tuberculosis infection. Results of this prospective 

Start Date: FY 2002 study will augment the scientific basis for developing recommendations and guidelines for contact 

investigations in foreign-born populations. 

Completion Date: 

Lead: Collaborators: 

Start Date: Completion Date: FY 2004 

CDC 

FY 2010 

NCHSTP NIAID, NTCA 

FY 2002 

26
 
1. Continued from above. c) Evaluate intervention in 10 sites using social networking results and the epidemiologic profile associated with 

increased risk of infection, developed in the foreign-born contact study described in b) above. The evaluation will 

include the measurement of the impact of the intervention. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2005 Completion Date: FY 2006 

d) Based on findings from a pilot intervention aimed at improving foreign-born contact investigations described in 

step c) above, modify intervention as needed and implement nationwide. 

Lead: NCHSTP Collaborators: NCID, NTCA 

Start Date: FY 2007 Completion Date: FY 2009 

e) Develop process indicators for monitoring the quality of contact investigations. Preliminary achievement 

targets for each indicator will also be established by the panel. It is envisioned that these indicators will be an 

important tool for identifying contact investigation steps which need improvement, and for monitoring trends in 

investigation quality over time. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2002 

f) Pilot intervention, introducing process indicators identified in step e) above to establish baseline quality and 

timeliness of sequential contact investigation steps at 20-30 pilot study sites. Trends in investigation quality will 

be monitored over time. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

g) Study the impact of pilot intervention described in step f) above with proposed process indicators. Outcomes 

will be 1) indicator results and 2) number and proportion of new TB cases prevented pre vs. post intervention. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2003 Completion Date: FY 2004 

27
 
1. Continued from above. h) Implement nationwide the process indicators identified, pilot tested, and evaluated in steps e)-g) above, and 

monitor the following outcomes from all reporting sites on an annual basis: 1) indicator results; 2) number and 

proportion of new TB cases prevented pre vs. post intervention; and 3) TB case rates pre vs. post intervention. 

Indicator achievement will also be correlated with other outcomes. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2004 Completion Date: FY 2006 

i) Develop and distribute recommendations/guidelines for contact investigations. The final product will include 

guidelines for contact investigations in U.S.-born populations, guidelines for contact investigations in foreign-born 

populations, and guidelines for use and interpretation of process indicators. 

Lead: NCHSTP Collaborators: NCID, NIAID, NTCA, OSHA 

Start Date: FY 2002 Completion Dates: See below 

FY 2003: Guidelines for contact investigations in U.S.-born populations 

FY 2005: Guidelines for use of process indicators 

FY 2006: Guidelines for contact investigations in foreign-born populations 

j) Conduct nationwide program evaluation to determine the extent to which state and local TB control programs 

have implemented the national recommendations/guidelines for contact investigations and determine the extent 

to which implementation has improved the quality of these changes. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2004 Completion Dates: See below 

FY 2005: US-born contact investigation guidelines 

FY 2007: Process indicators for monitoring contact investigations 

FY 2010: Foreign-born contact investigation guidelines 

k) Develop an electronic contact investigation surveillance system with national standards for data elements and 

definitions, giving health department TB programs the ability to modify databases to (1) manage contacts 

through examinations and appropriate treatment, and (2) more effectively monitor and improve program 

performance. 

Lead: NCID Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

28
 
2. Implement CDC TB outbreak 

response plan for the U.S. 

Lead Agency: CDC 

Collaborator: NTCA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Develop a computer-based methodology to improve the identification of acute outbreaks and assist 

state and local TB programs to implement it; clearly define what situations should be reported. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: FY 2003 

b) Expand assistance to state TB control programs to improve their ability to respond to outbreaks. 

Develop flexible tools to be used during outbreak investigations, develop outbreak response training 

courses, develop a set of best practices that outline the most cost-effective options for conducting largescale investigations, and provide templates of existing outbreak response plans as guidance to ensure 

that at least 75% have outbreak response plans. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2003 

c) Expand capacity of CDC and state TB programs to respond to increasing number of reported outbreaks. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

d) Establish a new, computer-based, nationwide outbreak detection system, based on data from the national TB 

surveillance system. Determine under what conditions outbreaks are occurring and provide prevention 

recommendations. Hire and train staff at CDC to provide technical assistance for new system. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

e) Provide emergency outbreak assistance to states and localities experiencing outbreaks of tuberculosis that 

overwhelm existing public health capacity. 

Lead Agency: NCHSTP Collaborator: NTCA 

Start Date: prior to FY 2002 Completion Date: ongoing 

29
 
3. Conduct epidemiologic studies 

and behavioral research on contact 

investigations (e.g, social network 

analysis, study of why people do 

not complete LTBI therapy, 

identification of appropriate 

incentives/enablers); develop/test 

behavioral interventions for at-risk 

populations, including substance 

abusers. 

Lead Agency: CDC 

Collaborating Agencies: NIH, IHS, 

HRSA, SAMHSA, NTCA 

Start Date: FY 2002 

Completion Date: FY 2007 

a) Design, implement, and evaluate strategies improving the effectiveness of contact investigation 

activities (e.g., social network analysis, incentives/enablers). 

Lead: NCHSTP Collaborators: NIAID, HAB 

Start Date: prior to FY 2002 Completion Date: FY 2007 

b) Determine what behavioral and social risk factors among contacts best predict adherence to testing and 

treatment. 

Lead: NCHSTP Collaborators: NIAID, NHLBI 

Start Date: prior to FY 2002 Completion Date: FY 2005 

c) Assess the knowledge, skills, beliefs, and abilities of health care providers serving TB patients and 

their contacts and determine optimal practices to promote cooperation with the contact investigation 

process and completion of treatment for LTBI. 

Lead: NCHSTP Collaborator: NHLBI 

Start Date: prior to FY 2002 Completion Date: FY 2005 

d) Ascertain the perspectives and special needs of TB patients and contacts (especially high-risk and vulnerable 

populations) to identify barriers to contact identification, testing, and treatment for LTBI. 

Lead: NCHSTP Collaborators: IHS, NIDA, SAMHSA 

Start Date: prior to FY 2002 Completion Date: FY 2005 

e) Explore the cultural and socioeconomic context in which contact investigations are conducted and determine 

the impact that communities, service providers and systems, policy makers, and fiscal decision makers have on 

the successful identification of contacts and the prevention of disease. 

Lead: NCHSTP Collaborators: BPHC, SAMHSA 

Start Date: prior to FY 2002 Completion Date: FY 2005 

30
 
3. Continued from above. f) Assess existing behavioral research across all fields of inquiry that may be relevant to contact investigations 

and determine how to apply this information. 

Lead: NCHSTP Collaborator: NIH 

Start Date: prior to FY 2002 Completion Date: FY 2004 

g) Train investigators in applying effective strategies and optimal techniques to contact investigation practice. 

Lead: NCHSTP Collaborator: NHLBI 

Start Date: FY 2005 Completion Date: FY 2007 

4. Ensure that health care facilities a) Update and disseminate guidelines for the prevention of TB transmission in health care settings. 

maintain infection control activities. 

Lead: NCHSTP Collaborators: NCID, NIOSH, OSHA, NTCA 

Lead Agency: CDC 

Start Date: prior to FY 2002 Completion Date: FY 2002 

Collaborating Agencies: 

OSHA, NTCA b) Conduct operational research on completeness of implementation of nationwide guidelines. 

Start Date: FY 2002 Lead: NCHSTP Collaborators: NCID, NIOSH, OSHA, NTCA 

Completion Date: FY 2005 Start Date: prior to FY 2002 Completion Date: FY 2005 

31
 
5. Characterize circulating TB 

strains using DNA fingerprinting 

results. 

Lead Agency: CDC 

Collaborating Agency: NTCA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Establish regional genotyping centers to perform molecular characterization of all isolates of Mycobacterium 

tuberculosis from patients in the U.S. Effort will require high-throughput DNA sequencers to be placed at Atlanta 

and one in each of five regional laboratories. 

Lead: NCHSTP Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2003 

b) Receive, process, and analyze M. tuberculosis isolates from an estimated 12,000 patients per year. 

Lead: NCHSTP Collaborator: None 

Start Date: FY 2002 Completion Date: Ongoing 

c) Establish and support a national DNA fingerprinting registry to compare fingerprinting results from different 

geographic regions. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

32
 
IOM Recommendation 4.2: “To prevent development of TB among persons with latent TB infection...” 

Strategies Action Steps 

1. Ensure implementation of CDC a) Increase the capacity of TB control programs and other governmental and non-governmental agencies 

guidelines for preventing and to implement targeted testing and appropriate treatment for high-risk populations (including HIV at risk, 

controlling TB in high-risk American Indians/Alaska Natives, other minorities, prisoners and staff in correctional systems, homeless, 

populations/environments. immigrants, migrant workers, IDU contacts, and workers who provide health care or other services to these 

populations). 

Lead Agency: CDC 

Lead: NCHSTP Collaborators: NTCA, NIOSH, IHS, BPHC, DIHS, FBOP, 

Collaborating Agencies: HRSA, HAB, NIDA, SAMHSA, OSHA, VHA 

INS, SAMHSA, IHS, VA, NIH, 

NTCA, DOL Start Date: prior to FY 2002 Completion Date: Ongoing 

Start Date: FY 2002 

Completion Date: Ongoing 

33
 
1. Continued from above b) Identify (i) incentives and barriers to seeking out services or completion of treatment; (ii) enablers to the 

receipt of services; and (iii) appropriate messages to motivate seeking care. 

Lead: NCHSTP Collaborators: DIHS, IHS, BPHC, HAB, NHLBI, OSHA 

Start Date: prior to FY 2002 Completion Date: FY 2002 

c) Ensure that federal agency RFAs include information on the need for TB education to health care providers. 

Lead: All Federal TB Collaborator: None 

Task Force Agencies 

Start Date: prior to FY 2002 Completion Date: Ongoing 

d) Develop and implement a plan to ensure compliance with CDC TB recommendations and establish grantee 

and contractor performance measures, contractual agreements, regulations, and links with health departments. 

Lead: NCHSTP Collaborators: All Federal TB Task Force Agencies 

Start Date: prior to FY 2002 Completion Date: Ongoing 

34
 
2. For HIV—Use Ryan White 

Care Act guidance, and establish 

standards for TB-related clinical 

practices; identify active cases and 

opportunity to treat latent TB 

infection; and update AIDS 

educational training center material. 

Lead Agency: HRSA 

Collaborating Agencies: CDC, 

SAMHSA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Coordinate announcements of Ryan White Care Act to include quality-of-care indicators and standards for TB. 

Lead: HAB Collaborators: NCHSTP, SAMHSA 

Start Date: FY 2002 Completion Date: Ongoing 

b) Evaluate the number of active TB cases and latent TB infections identified and treated by Ryan White Care 

Act Clinics. 

Lead: HAB Collaborators: NCHSTP, SAMHSA 

Start Date: FY 2002 Completion Date: Ongoing 

c) Develop periodic updates of AIDS education training center materials. 

Lead: HAB Collaborators: NCHSTP, SAMHSA 

Start: FY 2002 Completion Date: Ongoing 

35
 
3. For Corrections—Establish an 

acquisition process in which all 

federal contracts negotiated 

between state, local, and private 

correctional facilities require 

health care services that are 

consistent with current CDC 

guidelines regarding infection 

control, TB-related examination, 

treatment of disease and latent 

infection, contact investigation, 

and referral for continuity of care. 

Lead Agencies: DOJ, INS 

Collaborating Agency: DOL 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Develop periodic communication between FBOP’s contract team and the Federal TB Task Force to 

facilitate increased awareness of the agency’s needs and role in the prevention and control of TB, based 

on CDC guidelines, in relation to contracting with external correctional facilities. 

Lead: DOJ Collaborator: None 

Start Date: FY 2002 Completion Date: Ongoing 

b) Assess pre-existing federal contracts to identify those which lack (1) sufficient content language to 

acquire the needed health care services that require screening, identification, evaluation, and treatment of 

TB disease and latent TB infection, and (2) criteria that will determine if appropriate services are fulfilled. 

Lead : DOJ Collaborator: DIHS 

Start Date: FY 2002 Completion Date: Ongoing 

c) Ensure ongoing coordination in the development of agency acquisition planning which supports the 

renewal, modifications, and/or initiation of contracts to obtain the needed TB health care services, 

consistent with current CDC TB guidelines and containing quality assurance provisions to evaluate the 

delivery of the services. 

Lead: DOJ Collaborators: DIHS, OSHA 

Start Date: FY 2002 Completion Date: Ongoing 

36
 
4. For Corrections—Establish 

networks and relationships with 

health departments and other key 

agencies (i.e., health care providers, 

for the homeless, migrant centers, 

community-based organizations) to 

enable continuity of services and 

follow-up for prisoners and INS 

detainees upon release or parole. 

Lead Agencies: DOJ, HRSA 

Collaborating Agencies: DOJ, CDC, 

NTCA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Identify barriers (geographic, technical, and legal) to patients treatment, health department access to 

essential health care records, and communication between corrections and health department staff. 

Leads: FBOP, DIHS Collaborators: NCHSTP, D&R, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

b) Ensure TB continuity of care for prisoners leaving the correctional system and INS detainees leaving 

the detention system while still on treatment for TB or latent TB infection. 

Leads: FBOP, DIHS Collaborators: NCHSTP, D&R, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

37
 
5. For American Indians/Alaska a) Evaluate training needs of health care providers, mid-level practitioners, and public health staff. 

Natives (AI/AN)—Provide training Identify most effective methods of delivering information. 

and education of health care workers 

and strive to maximize related Lead: IHS Collaborators: NCHSTP, NIOSH, BPHC, OSHA 

cultural competency among health 

care workers who serve American Start Date: FY 2003 Completion Date: FY 2003 

Indians and Alaska Natives. 

b) Based on results of step a) above, develop training modules and formal plan for disseminating training 

Lead Agency: IHS throughout IHS, tribal, and urban facilities serving AI/AN. Implement training in pilot sites to evaluate 

effectiveness. 

Collaborating Agencies: HRSA, 

CDC, DOL Leads: IHS, NCHSTP, Collaborator: None 

NIOSH, BPHC, OSHA 

Start Date: FY 2003 

Start Date: FY 2003 Completion Date: FY 2003 

Completion Date: Ongoing 

c) Fully implement national training plan for all IHS, tribal, and urban facilities serving AI/AN. 

Lead: IHS Collaborators: NCHSTP, NIOSH, OSHA 

Start Date: FY 2004 Completion Date: Ongoing 

6. For American Indians/Alaska a) Identify most effective methods of delivering information. 

Natives—Disseminate information/ 

education about systems of care Lead: IHS Collaborator: NCHSTP 

and include AI/AN in education/ 

information dissemination. Start Date: FY 2003 Completion Date: FY 2003 

Lead Agency: IHS b) Collect, develop, and package information relevant to IHS, tribal, and urban health program practitioners. 

Collaborating Agencies: CDC, NTCA Lead: IHS Collaborator: NCHSTP 

Start Date: FY 2003 Start Date: FY 2003 Completion Date: FY 2003 

Completion Date: Ongoing c) Disseminate information to IHS, tribal, and urban health program practitioners. 

Lead: IHS Collaborator: NCHSTP 

Start Date: FY 2003 Completion Date: Ongoing 

38
 
7. For American Indians/Alaska 

Natives—Improve contacts between 

IHS providers and state TB control 

programs to make work 

complementary rather than 

competitive; identify and address 

gaps in services between IHS and 

public health agencies; and share 

assets. 

Lead Agency: IHS 

Collaborating Agencies: CDC, 

NTCA 

Start Date: FY 2003 

Completion Date: FY 2005 

a) Evaluate effectiveness, using formal program reviews, of IHS/state TB control program interactions in 

each state with a sizable number of AI/ANs. Identify most effective methods of delivering information. 

Lead: IHS Collaborators: NCHSTP, NTCA 

Start Date: FY 2003 Completion Date: FY 2004 

b) Address gaps in services identified above. 

Lead: IHS Collaborators: NCHSTP, NTCA 

Start Date: FY 2003 Completion Date: FY 2005 

39
 
8. For American Indians/Alaska a) Develop a plan to reach all IHS, tribal, and urban AI/ANs with diabetes. Secure adequate tribal and 

Natives—Provide tuberculin IHS consultation to ensure success of any plan implemented. 

testing and related treatment for 

persons with diabetes. Lead: IHS Collaborator: None 

Lead Agency: IHS Start Date: FY 2003 Completion Date: FY 2005 

Start Date: FY 2003 b) Implement plan to test all IHS, tribal, and urban AI/ANs with diabetes for latent TB infection. 

Completion Date: Ongoing Lead: IHS Collaborator: None 

Start Date: FY 2003 Completion Date: Ongoing 

c) Implement plan to treat all IHS, tribal, and urban AI/ANs with diabetes found to have latent TB infections 

that have not had documented adequate treatment. 

Lead: IHS Collaborator: None 

Start Date: FY 2004 Completion Date: Ongoing 

9. For persons who may move a) Review policies and processes for tracking TB-related health care records and convene a meeting of 

between localities, states and/or interested parties to develop comprehensive recommendations for tracking of TB-related health care 

countries—enable tracking of records among U.S. health departments and health care providers. 

TB-related health care records 

(including detainees, prisoners) Lead: NCHSTP Collaborators: DIHS, USMS, D&R, SITD, NCID, FBOP, NTCA 

among U.S. health departments 

and health care providers. Start Date: prior to FY 2002 Completion Date: FY 2003 

Lead Agency: CDC 

Collaborating Agencies: HRSA, 

DOJ, USMS, INS, NTCA 

Start Date: FY 2002 

Completion Date: FY 2003 

40
 
10. For INS detainees who are 

under treatment for TB, form a 

DHHS and DOJ workgroup to 

review policy issues that may 

improve the completion of TB 

treatment rates among detainees 

who are released before their 

treatment regimen is completed. 

Lead Agency: CDC 

Collaborating Agencies: HRSA, 

DOJ, USMS, INS, NTCA 

Start Date: FY 2002 

Completion Date: FY 2003 

a) Review and analyze available data on INS detainees identified with active TB while in custody and 

review policies and practices that could be modified to help ensure that all INS detainees with TB who are 

released prior to completion of treatment actually have continuity of care and drugs to improve their 

chances for completing treatment for TB. 

Lead: NCHSTP Collaborators: DIHS, USMS, D&R, SITD, NCID, 

FBOP, NTCA 

Start Date: FY 2002 Completion Date: FY 2003 

41
 
11. For persons outside the 

U.S.—educate and train panel 

physicians and civil surgeons to 

ensure provision of quality service, 

and develop educational materials 

for immigrants and refugees undergoing TB screening during the 

U.S. visa application process. 

Lead Agency: CDC 

Collaborating Agencies: DOS, 

DOJ, NTCA 

Start Date: FY 2002 

Completion Date: FY 2004 

a) Develop and implement a multi-platform training program with training materials and modules to 

educate and train panel physicians and civil surgeons in the new Technical Instructions for screening for 

TB disease and latent TB infections. 

Leads: NCID, NCHSTP Collaborators: AND, CA, NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

(1) After completion and approval of the TB component of the revised Technical Instructions, complete 

and finalize the print-based training modules for the revised instructions, new medical forms and 

worksheets, and specific clinical, radiologic, and laboratory training in the area of TB screening, 

diagnosis, and treatment. 

Leads: NCID, NCHSTP Collaborators: CA, AND 

Start Date: FY 2002 Completion Date: FY 2004 

(2) Develop and implement a multi-platform educational program for immigrant visa applicants abroad, 

refugees, and adjustment-of-status applicants in the U.S. who are being screened by panel physicians 

and civil surgeons to ensure that they can clearly understand the objectives and benefits of the medical 

screening components of the examination and the importance and methods of follow-up evaluations and 

treatment options. This step should include development of educational material for immigrants and 

refugees undergoing TB screening by panel physicians and civil surgeons about their TB status, and 

their responsibilities, options, and benefits of follow-up and treatment in the U.S. Educational material 

will include written and videotaped materials in appropriate languages explaining the process in a nonthreatening manner. Development will begin by focusing on high-prevalence countries that significantly 

impact on U.S. morbidity (Mexico, Philippines, Vietnam, China, Haiti, and India). 

Leads: NCID, NCHSTP Collaborators: AND, CA, NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

42
 
12. For persons born outside the a) Explore the feasibility of targeted testing for latent TB infection among U.S. overseas visa applicants (i.e., 

U.S.—explore feasibility of immigrants) with plans for long-term U.S. residence by developing pilot studies in crucial regions of the world 

targeted testing of immigrants, with high TB prevalence rates (as identified by WHO. ites for 

refugees, and selected groups screening for tuberculosis and ensuring appropriate therapy. 

of temporary visa holders. 

Leads: NCID, NCHSTP, CA Collaborator: None 

Lead Agencies: CDC, DOS 

Start Date: FY 2002 Completion Date: FY 2005 

Start Date: FY 2002 

b) Evaluate the feasibility of screening for TB disease and latent TB infection among selected groups of 

Completion Date: FY 2006 temporary visa holders. 

Leads: NCID, NCHSTP, CA Collaborator: None 

Start Date: FY 2003 Completion Date: FY 2006 

13. For persons born outside the a) Conduct a study of immigration status of foreign-born TB patients, how they came to medical attention, 

U.S.—determine the immigration insurance coverage, and how their cases may have been prevented. 

status of foreign-born TB patients, 

how they came to medical attention, Lead: NCHSTP Collaborator: NCID 

and how their cases may have been 

prevented; and develop follow-up Start Date: FY 2002 Completion Date: FY 2003 

recommendations. 

b) Develop comprehensive recommendations for surveillance (including immigration status), 

Lead Agency: CDC recommended follow-up diagnostic evaluations, treatment, contact investigations, and prevention of TB 

in foreign-born persons. 

Collaborating Agency: NTCA 

Leads: NCHSTP, NCID Collaborator: NTCA 

Start Date: FY 2002 

Start Date: FY 2003 Completion Date: FY 2004 

Completion Date: FY 2004 

Determine the most effective methods and s 

43
 
14. For homeless 

populations—enable tracking 

of health care records between 

health department TB programs 

and health care providers. 

Lead Agencies: HRSA, CDC 

Collaborating Agencies: HUD, 

NTCA 

Start Date: FY 2003 

Completion Date: FY 2004 

a) Evaluate outcomes of treatment completion, contact investigation, and treatment of latent TB infection 

in selected homeless populations. 

Lead: BPHC Collaborators: NCHSTP, HUD, NTCA 

Start Date: FY 2002 Completion Date: FY 2004 

15. For homeless 

populations—ensure that 

homeless persons have 

access to low- or no-cost 

skilled TB-related screening, 

treatment, and prevention 

services provided by 

culturally competent providers. 

Lead Agencies: HRSA, CDC 

Collaborating Agencies: HUD, 

NTCA 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Evaluate outcomes and cost effectiveness of targeted tuberculin skin test activities and completion of 

treatment of latent TB infection in selected homeless populations. 

Lead: BPHC Collaborators: NCHSTP, HUD, NTCA 

Start Date: FY 2002 Completion Date: Ongoing 

44
 
16. For homeless 

populations—provide incentives 

to homeless persons to ensure 

completion of treatment for 

latent TB infection. 

Lead Agencies: HRSA, CDC 

Collaborating Agencies: HUD, 

NIH, SAMHSA, NTCA 

Start Date: FY 2003 

Completion Date: Ongoing 

a) Provide housing as an incentive. 

Leads: NCHSTP, HUD Collaborators: BPHC, NTCA 

Start Date: FY 2003 Completion Date: Ongoing 

b) Reduce barriers for homeless persons to substance abuse treatment and relapse prevention programs. 

Leads: NIDA, SAMHSA Collaborator: NCHSTP, NTCA 

Start Date: FY 2003 Completion Date: Ongoing 

45
 
C. Activities for Developing New Tools 

The goal of TB elimination cannot be reached with the tools that are currently available. TB elimination will require an increased investment in TB 

research to develop a more effective vaccine, as well as new diagnostic tools and drugs to more rapidly and reliably diagnose and shorten 

treatment for all persons with latent and active TB, including those afflicted with MDR TB. 

IOM Recommendation 5.1: “To advance the development of tuberculosis vaccines...” 

Strategies Action Steps 

1. Implement the Blueprint for a) Conduct basic science research aimed at understanding host and bacterial factors associated with 

Tuberculosis Vaccine Development. mycobacterial dormancy and disease, and identifying protective antigens and virulence genes. 

Lead Agency: NIH Leads: NIAID, NHLBI Collaborators: NCID, CBER 

Collaborating Agencies: CDC, FDA Start Date: FY 2002 Completion Date: FY 2002-2009 

Start Date: FY 2002 b) Expand the TB vaccine candidate screening program. 

Completion Date: FY 2012 - 2027 Lead: NIAID Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2012 

c) Standardize vaccine production and testing, including identification and validation of correlates of 

protective immunity for potential use in clinical trials. 

Lead: NIAID Collaborators: NHLBI, NCHSTP 

Start Date: FY 2002 Completion Date: FY 2012 

d) Coordinate and conduct vaccine safety and immunogenicity studies. 

Lead: NIAID Collaborator: NHLBI 

Start Date: FY 2002 Completion Date: FY 2014 

46
 
1. Continued from above. e) Facilitate the development of vaccine efficacy endpoints. 

Lead: CBER Collaborators: NIAID, NCHSTP 

Start Date: FY 2002 Completion Date: FY 2012-2017 

f) Facilitate and support public/private partnerships. 

Lead: NIAID Collaborator: NCHSTP 

Start Date: FY 2002 Completion Date: FY 2017-2022 

g) Establish an international network of field sites for vaccine testing, including characterization of the target 

populations. 

Lead: NIAID Collaborator: NCSHTP 

Start Date: FY 2002 Completion Date: FY 2007 

h) Conduct clinical efficacy trials of new vaccines. 

Lead: NIAID Collaborator: NCHSTP 

Start Date: FY 2007 Completion Date: FY 2012-2027 

i) Coordinate vaccine development efforts with other agencies and stakeholders. 

Lead: NIAID Collaborators: NCHSTP, NHLBI, CBER 

Start Date: FY 2002 Completion Date: 2017-2022 

47
 
2. Facilitate related U.S. 

regulatory review and introduction 

of improved TB vaccines for use 

in the U.S. 

Lead Agencies: FDA, CDC 

Collaborating Agency: NIH 

Start Date: 2002 

Completion Date: 2012-2022 

a) Assist researchers and manufacturers in the development of new TB vaccines that are pure, potent, 

safe, and effective; develop potency assays to test biologic activity of TB vaccines; provide guidance for 

the preclinical testing of TB vaccines; organize regulatory workshops to promote good manufacturing 

practices (GMPs) in vaccine production; and help develop protocols and standardized assays for human 

clinical investigation of TB vaccines. 

Lead: CBER Collaborators: NCSHTP, NIAID 

Start Date: FY 2002 Completion Date: FY 2012-2022 

b) Undertake steps to introduce new vaccine(s) for use in target populations; conduct demonstration 

projects to identify impediments to uptake of new vaccine(s); issue guidelines on the use of new TB 

vaccine(s) through the CDC Advisory Committee for Immunization Practices and Advisory Council for the 

Elimination of Tuberculosis; support vaccine programs through CDC TB cooperative agreements; and support 

vaccine implementation programs in target populations. 

Leads: NCSHTP, NIP Collaborators: CBER, NIAID 

Start Date: Post vaccine Completion Date: 5 years post-approval 

approval 

48
 
IOM Recommendation 5.2: “To advance the development of diagnostic tests and new drugs for both latent infection 

and active disease, action plans should be developed and implemented...” 

Strategies Action Steps 

1. Develop new diagnostics for a) Explore and support mechanisms to increase private sector participation in developing improved TB 

latent TB infection including more diagnostics. 

specific tests to counter the 

problems of bacillus Calmette- Lead: NIAID, NCHSTP Collaborators: CDRH, USAID 

Guerin (BCG) vaccination and 

nontuberculous mycobacteria Start Date: FY 2002 Completion Date: FY 2010-2012 

(NTM) sensitization and methods 

to identify those infected persons b) Improve and develop better molecular epidemiological tools for use in contact investigation. 

at highest risk of progression to 

active TB, including persons Lead: NCHSTP, NIAID Collaborator: CDRH 

co-infected with HIV. 

Start Date: FY 2002 Completion Date: FY 2007 

Start Date: FY 2002 

Completion Date: 2010-2012 

49
 
2. Develop and evaluate new and 

improved diagnostics for rapid 

and sensitive diagnosis of active 

TB, including the identification 

of drug-resistant strains and 

TB in HIV-infected persons. 

Lead Agencies: NIH, CDC 

Collaborating Agencies: FDA, 

USAID 

Start Date: FY 2002 

Completion Date: FY 2010-2012 

a) Enable expedited FDA review of new diagnostics for latent and active TB and MDR TB, including those 

for use in different risk groups. 

Lead: CDRH Collaborator: CBER 

Start Date: FY 2002 Completion Date: Ongoing 

b) Develop “standard” animal models of latent and active TB infection. 

Leads: NIAID, NHLBI Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2007-2009 

c) Conduct epidemiologic studies on immunologic and genetic markers of disease progression and protection. 

Leads: NIAID, NHLBI, NCHSTP Collaborator: None 

Start Date: FY 2002 Completion Date: 2007-2010 

d) Conduct research aimed at the improvement of currently available diagnostic tests (e.g., smear microscopy, 

culture and susceptibility testing). 

Leads: NCHSTP, PHPPO, Collaborator: USAID 

NIAID 

Start Date: FY 2002 Completion Date: FY 2007 

e) Support and conduct research and development (up to and including field tests and regulatory approval/ 

clearance) of diagnostic tools for latent and active TB, including MDR TB, with improved sensitivity and 

specificity in adults and children in both high and low endemic rate settings. 

Leads: NIAID, NCHSTP Collaborators: NCID, NIOSH, CDRH, USAID 

Start Date: FY 2002 Completion Date: FY 2010-1012 

50
 
2. Continued from above. f) Assess and promote the most effective combinations/algorithms of new diagnostic tests for smear, culture, 

direct detection, and drug susceptibility testing. 

Lead: PHPPO Collaborators: NCID, NCHSTP, CDRH, USAID 

Start Date: FY 2002 Completion Date: Ongoing 

3. Expand clinical research and a) Identify shorter regimens to facilitate completion of treatment for TB disease and latent TB infection. 

evaluate the overall effectiveness 

of current and novel treatments for Leads: NCHSTP, NIAID Collaborators: NIDA, USAID 

latent TB, active TB, and MDR TB 

Start Date: prior to FY 2002 Completion Date: FY 2010 

Lead Agencies: NIH, CDC 

b) Expand use of non-human primates for research into vaccines and treatment of infection/disease. 

Collaborating Agencies: FDA, 

USAID Lead: NIAID Collaborators: CBER, NHLBI, NCHSTP 

Start Date: FY 2002 Start Date: FY 2003 Completion Date: FY 2010 

Completion Date: FY 2012 c) Develop improved regimens for treatment of MDR TB and explore new and available agents not currently being 

used for TB (e.g., immunoregulation therapy and other delivery vehicles), including new indications for existing 

medications in the treatment of MDR TB. 

Leads: NIAID, NHLBI, NCHSTP Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2010 

d) Expand and support basic, preclinical and clinical development, and testing of novel TB therapeutic 

candidates. 

Leads: NIAID, NCHSTP Collaborators: NIDA, NHLBI, CBER, CDER 

Start Date: FY 2002 Completion Date: FY 2012 

51
 
IOM Recommendation 5. 3: “To promote better understanding of patient and provider nonadherence with 

tuberculosis treatment recommendations and guidelines, a plan for a behavioral and social science research agenda 

should be developed and implemented” 

Strategies Action Steps 

1. Conduct research to determine a) Conduct research/demonstration projects with private and public health care providers to determine the 

the best methods of educating most effective and efficient methods of education/intervention to lead to early/correct identification of TB cases. 

health care providers to recognize 

TB cases. Leads: NCHSTP, NHLBI Collaborators: NIOSH, VHA, OSHA, NIAID, NIDA, Fogarty 

International Center, IHS, BPHC, HAB, SAMHSA, USAID 

Lead Agency: CDC 

Start Date: FY 2002 Completion Date: FY 2005 

Collaborating Agencies: VA, OSHA, 

NIH, IHS, HRSA, SAMHSA, USAID 

Start Date: FY 2002 

Completion Date: FY 2005 

52
 
2. Conduct research on methods 

to maximize completion of therapy 

(and minimize relapse) for TB 

disease and maximize completion 

of treatment for latent TB infection. 

Lead Agencies: NIH, CDC, INS 

Collaborating Agencies: HRSA, 

USAID, DHHS/OGC/PHD 

Start Date: FY 2002 

Completion Date: FY 2004 

a) Conduct cost effectiveness studies of utility/benefits of targeted tuberculin skin test (TST) programs in 

different populations. 

Lead: NCHSTP Collaborators: NIAID, NIDA, BPHC, DIHS, NCID 

Start Date: FY 2002 Completion Date: Ongoing 

b) Conduct operational research of case management systems that take into account hard-to-reach 

populations, such as drug and other substance users, patients and contacts that move across jurisdictional 

boundaries, etc. 

Lead: NCHSTP Collaborator: NTCA 

Start Date: prior to FY 2002 Completion Date: Ongoing 

c) Conduct public health law research on methods to maximize completion of therapy (and minimize relapse) 

for TB disease and to maximize completion of treatment for latent TB infection. 

Leads: NCHSTP, Collaborators: DHHS/OGC/PHD; D&R 

HQCOU, PHPPO 

Start Date: FY 2002 Completion Date: FY 2002 

(1) Consult with DHHS and INS legal counsel on existing policies regarding mandatory TB treatment 

for immigrants seeking admission through legal processes. 

Leads: CDC/OD/OGC, Collaborators: DHHS/OGC/PHD; NCID 

NCHSTP, HQCOU 

Start Date: FY 2002 Completion Date: FY 2002 

(2) Conduct legal and ethical research on issues related to mandatory completion of TB treatment of 

the detention populations and possibly other selected populations in the future. 

Lead: HQCOU Collaborators: DHHS/OGC/PHD, CDC/OD/OGC, NCHSTP, 

D&R 

Start Date: FY 2003 Completion Date: FY 2004 

53
 
3. Conduct feasibility research 

to determine the costs, benefits, 

effectiveness, and utility of 

Targeted Testing and Treatment 

of Latent TB (TTTLTB) programs 

in different TB high-risk populations. 

Lead Agency: CDC 

Collaborating Agencies: NIH, 

HRSA, IHS, SAMHSA, DOJ, HUD 

Start Date: FY 2002 

Completion Date: FY 2004 

a) Conduct evaluation of INS/DIHS teleradiology screening program for illegal aliens in INS detention facilities. 

Lead: DIHS Collaborator: None 

Start Date: FY 2002 Completion Date: FY 2003 

b) Evaluate methods and cost effectiveness of TB/HIV screening and related treatment of latent TB 

infection in populations at risk for both HIV and TB. 

Lead: NCHSTP Collaborators: HAB, SAMHSA, NIDA, NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2003 

c) Evaluate methods and cost effectiveness of TTTLTB programs for homeless populations. 

Lead: NCHSTP Collaborators: BPHC, HUD, SAMHSA, NHLBI 

Start Date: prior to FY 2002 Completion Date: FY 2003 

d) Evaluate methods and cost effectiveness of TTTLTB programs for correctional facilities. 

Lead: NCHSTP Collaborator: FBOP 

Start Date: prior to FY 2002 Completion Date: FY 2003 

e) Evaluate methods and cost effectiveness of TTTLTB programs among the following foreign-born populations at 

risk for TB: asylum applicants, newly arrived immigrants and refugees, students, and other TB at-risk foreignborn populations (to be identified). 

Lead: NCHSTP Collaborators: NCID, D&R 

Start Date: FY 2002 Completion Date: FY 2004 

54
 
3. f) Evaluate methods and cost effectiveness of TTTLTB programs in drug treatment centers. 

Leads: NCHSTP, SAMHSA Collaborators: NIDA, NTCA 

Start Date: prior to FY 2002 Completion Date: FY 2004 

g) Evaluate methods and cost effectiveness of TTTLTB programs in other high-risk populations including 

American Indians/Alaska Natives, migrant workers, and other minorities. 

Leads: NCHSTP, IHS, Collaborators: Other agencies as appropriate. 

BPHC 

Start Date: 2003 Completion Date: 2004 

4. Develop and implement a) Convene meeting of researchers in tuberculosis and related areas to develop implementation strategies 

strategies to immediately translate based on evidence-based research. 

evidence-based knowledge from 

research into clinical and public Leads: NCHSTP, NIAID, Collaborator: None 

health practice. NHLBI, NIDA 

Lead Agency: CDC Start Date: prior to FY 2002 Completion Date: FY 2002 

Collaborating Agencies: All b) Develop 5-year strategic plan for implementation of strategies (strategies defined in researchers 

Federal TB Task Force Agencies meeting); include ongoing monitoring of implementation activities and yearly reconvening of lead researchers. 

Start Date: FY 2002 Leads: NCHSTP, NIAID, Collaborators: All Federal TB Task Force members 

NHLBI 

Completion Date: FY 2007 

Start Date: FY 2002 Completion Date: FY 2007 

c) Develop criteria for evaluation and funding of key priority projects to implement identified strategies. 

Leads: NCHSTP, NIAID Collaborator: None 

NHLBI 

Start Date: FY 2003 Completion Date: FY 2007 

Continued from above. 

55
 
5. Support a career track for new 

TB investigators. 

Lead Agency: NIH 

Collaborating Agency: CDC 

Start Date: FY 2003 

Completion Date: 2013 

a) Expand training support for early- and mid-career investigators pertinent to improving TB care. 

Lead: NIAID Collaborators: NHLBI, NCHSTP 

Start Date: FY 2003 Completion Date: 2013 

D. Global U.S. Actions in Response to the Institute of Medicine Report on TB: Ending Neglect: The Elimination of 

Tuberculosis in the United States. 

This brief but important section has been developed by a smaller group that includes representation from the U.S. Agency for International 

Development, the National Institutes of Health, and the Centers for Disease Control and Prevention. 

56
 
IOM Recommendation 6.1: “To decrease the number of foreign-born individuals with tuberculosis in the United 

States, to minimize the spread and impact of multidrug-resistant tuberculosis, and to improve global health...” 

Strategies Action Steps 

1. In collaboration with the World a) Implement and expand model directly observed treatment, short course (DOTS) programs to prevent 

Health Organization (WHO), further creation of MDR TB caused by improper treatment of new TB patients. 

develop models for diagnosis and 

treatment of MDR TB in countries Leads: NCHSTP, USAID Collaborator: NIAID 

with high MDR TB rates. 

Start Date: prior to FY 2002 Completion Date: Ongoing 

Lead Agencies: CDC, USAID 

b) Develop and implement pilot DOTS-Plus projects to treat existing MDR TB patients and prevent MDR TB. 

Collaborating Agency: NIH 

Leads: NCHSTP, NCID, USAID Collaborator: None 

Start Date: FY 2002 

Start Date: FY 2002 Completion Date: Ongoing 

Completion Date: Ongoing 

c) Assist in the development of “Centers of Excellence” to ensure that MDR TB is addressed, to build highgrade local capacity, and to serve as regional training centers for professionals from other countries. 

Leads: NCHSTP, USAID Collaborators: 

Fogarty International Center 

Start Date: prior to FY 2002 Completion Date: Ongoing 

d) Evaluate the cost effectiveness and appropriate use of rapid methods for diagnosis of MDR TB. 

Leads: NCHSTP, NIAID, USAID Collaborator: None 

Start Date: prior to FY 2002 Completion date: FY 2005 

e) Conduct drug resistance surveillance to measure the extent of MDR TB and to determine 

optimal approaches to treatment, specific to given locations. 

Leads: NCHSTP, USAID Collaborator: NIAID 

Start Date: prior to FY 2002 Completion date: Ongoing 

NIOSH, NCID, PHPPO, NCID, NIAID, 

57
 
2. Provide international technical 

and programmatic assistance 

aimed at reducing the impact of 

TB globally. 

Lead Agencies: CDC, USAID, NIH 

Start Date: FY 2002 

Completion Date: Ongoi ng 

a) Provide technical assistance to countries for TB surveillance. 

Leads: NCHSTP, GAP, USAID Collaborators: NCID, PHPPO 

Start Date: prior to FY 2002 Completion Date: Ongoing 

b) Provide technical assistance to improve and enhance TB laboratory capabilities. 

Leads: NIAID, NCHSTP, Collaborators: Fogarty International Center, GAP, NCID 

PHPPO, USAID 

Start Date: prior to FY 2002 Completion Date: Ongoing 

c) Develop and promote WHO/IUATLD/CDC national external quality assessment guidelines to monitor and 

improve the quality of AFB microscopy. 

Lead: PHPPO Collaborators: NCHSTP, USAID 

Start Date: FY 2002 Completion Date: Ongoing 

58
 
2. Continued from above. d) Conduct operational research to improve diagnosis and treatment of HIV-associated TB. 

Leads: NCHSTP, GAP, Collaborators: Fogarty International Center, NTCA, PHPPO 

USAID, NIAID 

Start Date: prior to FY 2002 Completion Date: Ongoing 

e) Conduct large-scale feasibility and cost-effectiveness studies of various regimens for the treatment of latent 

TB infection in HIV-infected persons. 

Leads: NIAID, NCHSTP, Collaborator: None 

GAP, USAID 

Start Date: prior to FY 2002 Completion Date: Ongoing 

f) Provide technical assistance for developing and implementing institutional infection control strategies. 

Leads: NCHSTP, USAID Collaborator: NCID 

Start Date: prior to FY 2002 Completion Date: Ongoing 

g) Provide onsite technical assistance to national TB control programs. 

Leads: NCHSTP, GAP, USAID Collaborator: None 

Start Date: prior to FY 2002 Completion Date: Ongoing 

59
 
3. Strengthen TB research capability 

in high-burden countries to 

enhance ability to develop and 

test improved treatment, prevention, 

and control strategies. 

Lead Agencies: CDC, NIH, 

USAID 

Collaborating Agency: None 

Start Date: FY 2002 

Completion Date: Ongoing 

a) Expand and conduct training and technology transfer in high-burden countries. 

Leads: NCHSTP-GAP, Collaborators: NCID, PHPPO 

NIAID, USAID, 

Fogarty International Center, NHLBI 

Start Date: prior to FY 2002 Completion Date: Ongoing 

b) Enhance needed infrastructure, including laboratory facilities and Internet connectivity. 

Leads: NCHSTP-GAP, Collaborators: GAP, NCID, PHPPO, 

USAID, NIAID Fogarty International Center 

Start Date: prior to FY 2002 Completion Date: Ongoing 

c) Conduct clinical trials of novel therapeutic, diagnostic, and prevention strategies in 

partnership with high-burden countries. 

Leads: NIAID, Collaborator: None 

NCHSTP-GAP, USAID 

Start Date: prior to FY 2002 Completion Date: Ongoing 

60
 
E. Assessing the Impact of Actions Taken 

IOM Recommendation 7.3: “To assess the impacts of these recommendations and to measure progress toward 

accomplishing the elimination of tuberculosis....” 

Strategies Action Steps 

1. ACET has agreed to implement recommendation 7.3 and to monitor and evaluate this plan (see page 5). 

Elimination of Tuberculosis (ACET) To facilitate the process CDC is working to generate a list of indicators for monitoring progress. 

and the Federal TB Task Force will 

annually monitor the federal 

response to this IOM report. In 

addition to regular conference 

calls, the TB Task Force will meet 

annually for a face-to-face meeting 

to review progress toward 

achievement of the planned 

activities listed in this report. 

The Advisory Council for the 

61
 
62
Federal TB Task Force Members and Others Involved in 

the Development of This Report 

A. TB Task Force Members: 

Amy Bloom, MD, USAID
 

Michael Brennan, PhD, CBER, FDA, DHHS
 

Georgia Buggs, OMH, PHS, DHHS
 

James Cheek, MD, IHS, DHHS
 

Ann Ginsberg, MD, PhD, NIAID, NIH, DHHS
 

Mark Goldberger, MD, CDER, FDA, DHHS
 

David Harre, HUD, OHAH
 

Harry Haverkos, MD, CDER, FDA, DHHS
 

Mel Henderson, AHCRQ, DHHS
 

Warren W. Hewitt, Jr, CSAT, SAMHSA, DHHS
 

Joe Iser, MD, DrPH, Region VIII PHS, DHHS
 

Michael Johnson, MD, HAB, HRSA, DHHS
 

Newton Kendig, MD, FBOP, DOJ
 

Jag Khalsa, PhD, NIDA, NIH, DHHS
 

Gene Migliaccio, DrPH, DIHS, BPHC, HRSA, DHHS
 

Sheldon Morris, PhD, CBER, FDA, DHHS
 

Hannah Peavy, MD, NHLBI, NIH, DHHS
 

Angela Presson, MD, OSHA, DOL
 

Gary Roselle, MD, VHA, VA
 

Roxanne Shively, CDRH, FDA, DHHS
 

Theresa Watkins-Bryant, MD, BPHC, HRSA, DHHS
 

Jerry Zelinger, MD, HCFA, DHHS
 

B. Consultants to the TBTF 

in This Effort: 

Sarah Royce, MD, NTCA, California TB Program 

Charles Wallace, DrPH, ACET, NTCA, and the 

Texas TB Program 

C. CDC TB Task Force Participants 

Kenneth Castro, MD, NCHSTP, CDC, DHHS 

Michael Iademarco, MD, MPH, NCHSTP, CDC, 

DHHS 

Harold Jaffe, MD, NCID, CDC, DHHS 

Susan Maloney, MD, MHSc, NCID, CDC, DHHS 

Bess Miller, MD, NCHSTP, CDC, DHHS 

Tom Navin, MD, NCHSTP, CDC, DHHS 

Rick O’Brien, MD, NCHSTP, CDC, DHHS 

Paul Poppe, NCHSTP, CDC, DHHS 

John Ridderhof, DrPH, PHPPO, CDC, DHHS 

John Seggerson, NCHSTP, CDC, DHHS 

Tom Shinnick, PhD, NCID, CDC, DHHS 

Zach Taylor, MD, NCHSTP, CDC, DHHS 

Greg Wagner, MD, MPH, NIOSH, CDC, DHHS 

Wanda Walton, NCHSTP, CDC, DHHS 

63
 
D. Other Agency Collaborators in the Development of This Report 

Ken Bridbord, MD, Fogarty Int. Center, NIH, DHHS Karen Near, MD, NIAID, NIH, DHHS 

Jeffery Burgos, SITD, INS, DOJ
 

Kathy Ciaccopalatianos, IHS, DHHS
 

Frank Collins, PhD, CBER, FDA, DHHS
 

Sophia Cox, AND, INS, DOJ
 

Woody DuBois, PhD, CDRH, FDA, DHHS
 

Karen Elkins, PhD, CBER, FDA, DHHS
 

M. Garotte, Consular Affairs, DOS
 

Steve Gutman, MD, CDRH, FDA, DHHS
 

Sandra Hatch, MD, NHLBI, NIH, DHHS
 

Michael Hrinyak, SITD, INS, DOJ
 

Gail Jacobs, NIAID, NIH, DHHS
 

Elizabeth Lambert, NIDA, NIH, DHHS
 

Barbara Laughon, NIAID, NIH, DHHS
 

Joanna London, HQCOU, INS, DOJ
 

Abe Miranda, MD, DIHS, BPHC, HRSA, DHHS
 

Amy Nelson, PRM, DOS 

Donna Olive, FBOP, DOJ 

Guadalupe Pacheco, OMH, PHS, DHHS 

Anna Mary Portz, MA, ORS, INS, DOJ 

Terry Ruesch, PRM, DOS 

Christine Sizemore, PhD, NIAID, NIH, DHHS 

Diana Schneider, DrPH, DIHS, HRSA, DHHS 

David Stevens, MD, BPHC, HRSA, DHHS 

Arthur Strathurn III, HQCOU, INS, DOJ 

Amy M. Taylor, MD, BPHC, HRSA, DHHS 

Bob Tomlinson, CMS, DHHS 

Laurie Trost, PRM, DOS 

Patricia Ward, SITD, INS, DOJ 

Marcia Withiam-Wilson, U.S. Marshals Service, 

DOJ 

64
 
E. Other CDC Collaborators �

Marty Cetron, MD, NCID, CDC, DHHS
 

Susan Cookson, MD, NCID, CDC, DHHS
 

Teresa Durden, NCHSTP, CDC, DHHS
 

Elsa Villarino, MD, NCHSTP, CDC, DHHS
 

Paul Jensen, PhD, NIOSH, CDC, DHHS
 

Jose Becerra, MD, NCHSTP, CDC, DHHS
 

Greg Loos, NIOSH, CDC, DHHS
 

Marisa Moore, MD, NCHSTP, CDC, DHHS
 

Maureen Wilce, MS, NCHSTP, CDC, DHHS
 

John Miles, MPH, NCHSTP, CDC, DHHS
 

Teri Palermo, NIOS, CDC, DHHS 

Noreen Qualls, PhD, NCHSTP, CDC, DHHS 

Mary Reichler, MD, NCHSTP, CDC, DHHS 

Renee Ridzon, MD, NCHSTP, CDC, DHHS 

Anita Schill, PhD, NIOSH, CDC, DHHS 

Robin Shrestha-Kuwahara, MPH, NCHSTP, 

CDC, DHHS 

Carol Stephenson, PhD, NIOSH, CDC, DHHS 

Tonya Thrash (secretary), NCHSTP, CDC, DHHS 

David Weissman, MD, NIOSH, CDC, DHHS 

65
 
Glossary �

ACET Advisory Council for the Elimination of Tuberculosis (DHHS) 

AND Office of Adjudications (INS) 

AHCRQ Agency for Health Care Research and Quality (DHHS) 

BCG Bacillus Calmette-Guérin 

BICE	 Bureau of Immigration and Customs Enforcement (DHS), 

formerly INS (DOJ) 

BPHC Bureau of Primary Health Care (HRSA/DHHS) 

CA Consular Affairs (DOS) 

CBER Center for Biologics Evaluation and Research (NIH/DHHS) 

CDC Centers for Disease Control and Prevention (DHHS) 

CDER Center for Drug Evaluation and Research (FDA/DHHS) 

CDRH Center for Devices and Radiological Health (FDA/DHHS) 

CMS Centers for Medicare and Medicaid Services (DHHS) 

CSAT Center for Substance Abuse Treatment (SAMHSA/DHHS) 

DASTLR	 Division of AIDS, STD, and TB Laboratory Rsearch (NCHSTP/ 

CDC/DHHS) 

DGMQ or DQ Division of Global Migration and Quarantine (NCID/CDC/DHHS) 

DHHS Department of Health and Human Services 

DHS Department of Homeland Security 

DIHS Division of Immigration Health Services (BPHC/HRSA/DHHS) 

D&R Office of Detention and Removal (INS/DOJ) 

DOJ Department of Justice 

DOL Department of Labor 

DOS Department of State 

DOT Directly observed therapy 

DOTS Directly observed treatment, short course 

DTBE Division of Tuberculosis Elimination (NCHSTP/CDC/DHHS) 

FBOP Federal Bureau of Prisons (DOJ)

66
 
FDA Food and Drug Administration (DHHS) 

GAP Global AIDS Program (CDC/DHHS) 

GMPs Good manufacturing practices 

HAB HIV/AIDS Bureau (HRSA/DHHS) 

HEDIS Health Plan Employer Data and Information Set 

HQCOU Office of General Counsel (INS) 

HIV Human immunodeficiency virus 

HRSA Health Resources and Services Administration (DHHS) 

HUD Department of Housing and Urban Development 

IHS Indian Health Service (DHHS) 

INS Immigration and Naturalization Service (DOJ) 

IOM Institute of Medicine 

IUATLD International Union Against Tuberculosis and Lung Disease 

LHDs Local health departments 

LTBI Latent tuberculosis infection 

MDR TB Multidrug-resistant TB 

NCHSTP National Center for HIV, STD, and TB Prevention (CDC/DHHS) 

NCID National Center for Infectious Diseases (CDC/DHHS) 

NHLBI National Heart Lung and Blood Institute (NIH/DHHS) 

NIAID National Institute of Allergy and Infectious Diseases (NIH/DHHS) 

NIDA National Institute on Drug Abuse (NIH/DHHS) 

NIOSH	 National Institute for Occupational Safety and Health 

(CDC/DHHS) 

NIP National Immunization Program (CDC/DHHS) 

NTCA National Tuberculosis Controllers Association 

NTM Nontuberculous mycobacteria 

OGC/PHD Office of the General Counsel, Public Health Division (DHHS) 

OHAH Office of HIV and AIDS Housing 

OMH/PHS Office of Minority Health, Public Health Service (DHHS) 

67
 
ORR Office of Refugee Resettlement (INS) 

OSHA Occupational Safety and Health Administration (DOL) 

PHPPO Public Health Practice Program Office (CDC/DHHS) 

PRM Bureau of Population, Refugees and Migration (DOS) 

RHA Regional Health Administrator (PHS/DHHS) 

RVCT Report of Verified Case of Tuberculosis 

SAMHSA	 Substance Abuse and Mental Health Services 

Administration (DHHS) 

SITD	 Office of Strategic Information and Technology 

Development (INS/DOJ) 

TIMS	 Tuberculosis Information Management System 

(CDC TB software) 

TST Tuberculin skin test 

TTTLTB Targeted testing and treatment of latent TB 

USAID U.S. Agency for International Development (DOS) 

USMS U.S. Marshals Service 

VA Department of Veterans Affairs 

VHA Veterans Health Administration 

68
 
References
 

1. CDC. National action plan to combat multidrug-resistant tuberculosis. MMWR 1992; 

41(RR-11):1-48. 

2. CDC. A strategic plan for the elimination of tuberculosis in the United States. MMWR 

1989;38 (suppl. No. S-3):1-25. 

3. CDC. Tuberculosis elimination revisited: obstacles, opportunities, and a renewed 

commitment -- Advisory Council for the Elimination of Tuberculosis (ACET). MMWR 

1999;48 (RR09): 1-13. 

4. Institute of Medicine. Ending Neglect: The Elimination of Tuberculosis in the United 

States. Washington, DC:National Academy Press; 2000. 

5. CDC. Development of new vaccines for tuberculosis: recommendations of the Advisory 

Council for the Elimination of Tuberculosis (ACET). MMWR 1998;47(No. RR-13):1-6. 

69
 
Federal Tuberculosis Task Force Roster
 

OFFICIAL AGENCY REPRESENTATIVES 

September 2003 

BERTIN, Marcella
 

Manager, Biotechnology Engagement
 

Program Project
 

Office of Global Health Affairs
 

Office of Europe and Northern Eurasia
 

Department of Health and Human Services
 

5600 Fishers Lane
 

Parklawn Building, Room 18-90
 

Rockville, MD 20857
 

Tel: (301) 443-3332
 

Fax: (301) 443-0742
 

Email: mbertin@osophs.dhhs.gov
 

BLOOM, Amy, MD
 

TLRD/OHIV/BGH
 

US Agency for International Development
 

US Department of State
 

5.10.45, 5th Floor, RRB
 

Washington, DC 20523
 

Tel: (202) 712-0693
 

Fax: (202) 216-3015
 

E-mail: abloom@usaid.gov
 

BRENNAN, Michael, PhD
 

Research Biologist
 

Center for Biologics Evaluation and Research
 

Food and Drug Administration
 

Department of Health and Human Services
 

29 Lincoln Drive
 

Building 29, Room 502, FHM-431
 

Bethesda, MD 20892
 

Tel: (301) 496-9559
 

Fax: (301) 435-5675
 

E-mail: BRENNAN@CBER.FDA.GOV
 

CHEEK, James, MD, MPH
 

Principal Epidemiologist
 

Infectious Diseases
 

Indian Health Service
 

Department of Health and Human Services
 

Albuquerque Headquarters West
 

5300 Homestead Road, NE
 

Albuquerque, NM 87110
 

Tel: (505) 248-4226
 

Fax: (505) 248-4393
 

E-mail: james.cheek@mail.his.gov
 

KHALSA, Jag, PhD
 

Pharmacologist & Health Scientist
 

Administrator
 

Center on AIDS and Other Medical
 

Consequences of Drug Abuse
 

National Institute on Drug Abuse
 

National Institutes of Health
 

Department of Health and Human Services
 

6001 Executive Boulevard, Suite 5098
 

MSC 9593
 

Bethesda, MD 20892-5953
 

Tel: (301) 443-1801
 

Fax: (301) 480-4544
 

E-mail: jk98p@nih.gov
 

HARRE, David
 

Director
 

Technical Assistance and Federal
 

Collaborations
 

Office of HIV and AIDS Housing
 

Department of Housing and Urban
 

Development
 

451 7th Street, SW, Room 7212
 

Washington, DC 20410
 

Tel: (202) 708-1934, Ext 2474
 

Fax: (202) 401-0805
 

E-mail: David_S._Harre@HUD.GOV
 

70
 
AGENCY REPRESENTATIVES (Continued)
 

HAVERKOS, Harry, MD
 

Medical Officer
 

Center for Drug Evaluation and Research
 

Food and Drug Administration
 

Department of Health and Human Services
 

5600 Fishers Lane, HFD-530
 

Rockville, MD 20857
 

Tel: (301) 827-2330
 

Fax: (301) 827-2510
 

E-mail: haverkosh@cder.fda.gov
 

HENDERSON, Melford J
 

Center for Cost and Financing Services
 

Agency for Health Care Research and Quality
 

Department of Health and Human Services
 

2101 East Jefferson Street, Suite 605
 

Rockville, MD 20852
 

Tel: (301) 594-0653
 

Fax: (301) 594-2166
 

E-mail: mhenders@ahrq.gov
 

HEWITT, Warren W, Jr.
 

Centers for Substance Abuse Treatment
 

Substance Abuse and Mental Health Services
 

Administration
 

Department of Health and Human Services
 

5600 Fishers Lane
 

Rockwall II Building, Suite 6A25
 

Rockville, MD 20857
 

Tel: (301) 443-8387
 

Fax: (301) 480-6077
 

E-mail: whewitt@samhsa.gov
 

JACOBS, Gail, MA, MS
 

Program Officer
 

Tuberculosis, Leprosy and Other
 

Mycobacterial Diseases Program
 

National Institute of Allergy and Infectious
 

Diseases
 

National Institutes of Health
 

Department of Health and Human Services
 

6610 Rockledge Drive, Room 5028
 

MSC 6603
 

Bethesda, MD 20892-6603
 

Express: use 20817 zip code
 

Tel: (301) 496-5305
 

Fax: (301) 496-8030
 

E-mail: gg6z@nih.gov
 

KENDIG, Newton, MD
 

Medical Director
 

Federal Bureau of Prisons
 

Department of Justice
 

320 First Street, NW, Suite 1054
 

Washington, DC 20534
 

Tel: (202) 307-3055
 

Fax: (202) 307-0826
 

E-mail: nkendig@bop.gov
 

MIGLIACCIO, Gene, DrPH
 

Captain, U.S. Public Health Service
 

Director, Division of Immigration Health
 

Services
 

Bureau of Primary Health Care
 

Health Resources and Services
 

Administration
 

Department of Health and Human Services
 

1220 L Street, NW, Suite 500
 

Washington, DC 20005
 

Tel: (202) 514-3339
 

Fax: (202) 514-0095 and (202) 307-1850
 

E-mail: gene.migliaccio@dhs.gov
 

71
 
AGENCY REPRESENTATIVES (Continued)
 

PEAVY, Hannah H, MD
 

Health Scientist Administrator
 

National Heart, Lung, and Blood Institute
 

National Institutes of Health
 

Department of Health and Human Services
 

2 Rockledge Center, Suite 1018
 

MSC 7952
 

Bethesda, MD 20892-7952
 

Tel: (301) 435-0222
 

Fax: (301) 480-3557
 

E-mail: peavyh@nih.gov
 

PRESSON, Angela, MD
 

Occupational Safety and Health
 

Administration
 

Department of Labor
 

200 Constitution Avenue, NW
 

Room N3653
 

Washington, DC 20210
 

Tel: (202) 693-2323
 

Fax: (202) 693-1647
 

E-mail: angela.presson@dol.gov
 

ROSELLE, Gary A, MD
 

Program Director
 

Infectious Diseases
 

Veterans Health Administration
 

Department of Veterans Affairs Medical
 

Center
 

3200 Vine Street
 

Cincinnati, OH 45220
 

Tel: (513) 475-6398
 

Fax: (513) 475-6399
 

E-mail: gary.roselle@med.va.gov
 

SACKS, Leonard, MD
 

Medical Team Leader
 

Division of Special Pathogens and
 

Immunological Drug Products
 

Center for Drug Evaluation and Research
 

Food and Drug Administration
 

Department of Health and Human Services
 

9201 Corporate Boulevard, HFD-590
 

Rockville, MD 20850
 

Tel: (301) 827-2336
 

Fax: (301) 827-2475
 

E-mail: sacksl@cder.fda.gov
 

SHIVELY, Roxanne G
 

Medical Technologist
 

Center for Devices and Radiological Health
 

Food and Drug Administration
 

Department of Health and Human Services
 

2098 Gaither Road
 

Rockville, MD 20850
 

Tel: (301) 594-2096 Ext. 113
 

Fax: (301) 594-5941
 

E-mail: rgs@cdrh.fda.gov
 

SIZEMORE, Christine F, PhD
 

Program Officer
 

Tuberculosis, Leprosy and Other
 

Mycobacterial Diseases Program
 

National Institute of Allergy and Infectious
 

Diseases
 

National Institutes of Health
 

Department of Health and Human Services
 

6610 Rockledge Drive
 

Suite 5041, MSC 6603
 

Bethesda, MD 20892-6603
 

Express: use 20817 zip code
 

Tel: (301) 496-5305
 

Fax: (301) 496-8030
 

E-mail: cs390s@nih.gov
 

72
 
AGENCY REPRESENTATIVES (Continued)
 

TOSATTO, Robert J, RPh, MPH, MBA
 

CDR, US Public Health Service
 

Executive Secretary, Biotechnology
 

Engagement Program (BTEP)
 

Office of Europe and Northern Eurasia
 

Office of Global Health Affairs
 

Department of Health and Human Services
 

5600 Fishers Lane
 

Parklawn Building, Room 18-90
 

Rockville, MD 20857
 

Tel: (301) 443-2379
 

Fax: (301) 443-0742
 

E-mail: Rtosatto@osophs.dhhs.gov
 

WATKINS-BRYANT, Theresa, MD, FAAP
 

Chief Medical Officer
 

Division of Health Center Management
 

Bureau of Primary Health Care
 

Health Resources and Services
 

Administration
 

Department of Health and Human Services
 

4350 East West Highway
 

7th Floor, Room 77D3
 

Bethesda, MD 20814
 

Tel: (301) 594-4423
 

Fax: (301) 594-2470
 

E-mail: twatkins-bryant@hrsa.gov
 

DINGER, Maria, RN, MS
 

Captain, US Public Health Service
 

Chief, US Public Health Service Officer
 

United States Marshals Service
 

Department of Justice
 

Washington, DC 20530-1000
 

Tel: (202) 307-9263
 

Fax: (202) 307-5029
 

E-mail: maria.dinger2.@usdoj.gov
 

ZELINGER, Gerald, MD
 

Medical Advisor
 

Health Care Financing Administration
 

Department of Health and Human Services
 

7500 Security Boulevard
 

Room C-4, S2-01-16
 

Baltimore, MD 21244-1850
 

Tel: (410) 786-5929
 

Fax: (410) 786-3252
 

E-mail: gzelinger@hcfa.gov
 

73
 
OUTSIDE CONSULTANTS
 

CALLAN, William J, PhD
 

Laboratory Director
 

Association of State and Territorial Public
 

Health Laboratory Directors
 

Alabama State Public Health Laboratories
 

8140 AUM Drive
 

Montgomery, AL 36117
 

Tel: (334) 260-3400
 

Fax: (334) 244-5083
 

E-mail: jcallan@adph.state.al.us
 

HADLER, James, MD, MPH
 

State Epidemiologist
 

Infectious Disease Division
 

State of Connecticut
 

Department of Public Health
 

410 Capitol Avenue, MS#11FDS
 

P.O. Box 340308
 

Hartford, CT 06134-0308
 

Tel: (860) 509-7995
 

Fax: (860) 509-7910
 

E-mail: james.hadler@po.state.ct.us
 

KRAHENBUHL, James, MD
 

Chief
 

Laboratory Research Branch
 

National Hansen’s Disease Program
 

School of Veterinary Medicine
 

Louisiana State University
 

South Stadium Drive
 

Baton Rouge, LA 70803
 

Tel: (225) 346-9845
 

Fax: (225) 346-5786
 

E-mail: jkrahe1@lsu.edu
 

REICHMAN, Lee, MD, MPH, FACP, FCCP
 

Professor of Medicine
 

Professor of Preventive Medicine and
 

Community Health
 

Executive Director
 

New Jersey Medical School National
 

Tuberculosis Center
 

225 Warren Street, 2nd Floor, East Wing
 

P.O. Box 1709
 

Newark, NJ 07101-1709
 

Tel: (973) 972-3270
 

Fax: (973) 972-3268
 

E-mail: reichmlb@umdnj.edu
 

ROYCE, Sarah, MD, MPH
 

Chief
 

Tuberculosis Control Branch
 

National TB Controllers Association
 

California Department of Health Services
 

2151 Berkeley Way
 

Room 608
 

Berkeley, CA 94705
 

Tel: (510) 540-2973
 

Fax: (510) 849-5269
 

E-mail: sroyce@dhs.ca.gov
 

WALLACE, Charles, PhD, MPH
 

Director
 

Tuberculosis Elimination Division
 

Texas Department of Health
 

1100 West 49th Street
 

Austin, TX 78756
 

Tel: (512) 458-7447
 

Fax: (512) 458-7787
 

E-mail: charles.wallace@tdh.state.tx.us
 

74
 
CDC PARTICIPANTS 

Centers for Disease Control and Prevention 

1600 Clifton Road, NE 

Atlanta, Georgia 30333
 

Chair 

CASTRO, Kenneth G, MD
 

Director
 

Division of Tuberculosis Elimination
 

National Center for HIV, STD, and TB
 

Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-10
 

Atlanta, GA 30333
 

Tel: (404) 639-8120
 

Fax: (404) 639-8604
 

E-mail: Kcastro@cdc.gov
 

Coordinator 

THRASH, Tonya
 

Program Operations Assistant
 

Division of Tuberculosis Elimination
 

National Center for HIV, STD, and TB
 

Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-10
 

Atlanta, GA 30333
 

Tel: (404) 639-8492 or 8120
 

Fax: (404) 639-8604
 

E-mail: Tthrash@cdc.gov
 

IADEMARCO, Michael F, MD, MPH
 

Associate Director for Science
 

Division of Tuberculosis Elimination
 

National Center for HIV, STD, and TB
 

Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-10
 

Atlanta, GA 30333
 

Tel: (404) 639-8120
 

Fax: (404) 639-8604
 

E-mail: Miademarco@cdc.gov
 

KAPLAN, Jonathan, MD
 

Director
 

Division of AIDS, STD, and TB Laboratory
 

Research
 

National Center for Infectious Diseases
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop A-12
 

Atlanta, GA 30333
 

Tel: (404) 639-4581
 

Fax: (404) 639-4664
 

E-mail: Jkaplan@cdc.gov
 

MALONEY, Susan, MD, MHSc
 

Medical Epidemiologist
 

Division of Global Migration and Quarantine
 

National Center for Infectious Diseases
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-03
 

Atlanta, GA 30333
 

Tel: (404) 498-1631
 

Fax (404) 498-1633
 

E-mail: Smaloney@cdc.gov
 

O’BRIEN, Rick, MD
 

Chief, Clinical and Health Systems Research
 

Branch
 

Division of Tuberculosis Elimination
 

National Center for HIV, STD, and TB
 

Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-10
 

Atlanta, GA 30333
 

Tel: (404) 639-8123
 

Fax: (404) 639-8961
 

E-mail: ROBrien@cdc.gov
 

75
 
CDC PARTICIPANTS (Continued)
 

POPPE, Paul
 

Deputy Director
 

Division of Tuberculosis Elimination
 

National Center for HIV, STD, and TB
 

Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-10
 

Atlanta, GA 30333
 

Tel: (404) 639-8120
 

Fax: (404) 639-8604
 

E-mail: Ppoppe@cdc.gov
 

RIDDERHOF, John, DrPH
 

Chief, Office of Laboratory Systems
 

Development
 

Division of Laboratory Systems
 

Public Health Practice Program Office
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop G-25
 

Atlanta, GA 30333
 

Tel: (770) 488-8076
 

Fax: (770) 488-8282
 

E-mail: Jridderhof@cdc.gov
 

SHINNICK, Tom, PhD
 

Chief, TB Mycobacteriology Branch
 

Division of AIDS, STD, and TB Laboratory
 

Research
 

National Center for Infectious Diseases
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop G-35
 

Atlanta, GA 30333
 

Tel: (404) 639-1474
 

Fax: (404) 639-1287
 

E-mail: Tshinnick@cdc.gov
 

VALDISERRI, Ronald O, MD, MPH
 

Deputy Director
 

Office of the Director
 

National Center for HIV, STD, and TB
 

Prevention
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1600 Clifton Road, NE, Mail Stop E-07
 

Atlanta, GA 30333
 

Tel: (404) 639-8002
 

Fax: (404) 639-8600
 

E-mail: Rvaldiserri@cdc.gov
 

WAGNER, Gregory, MD
 

Director
 

Division of Respiratory Disease Studies
 

National Institute for Occupational Safety and
 

Health
 

Centers for Disease Control and Prevention
 

Department of Health and Human Services
 

1095 Willowdale Road
 

Morgantown, WV 26501
 

Tel: (304) 285-5750
 

Fax: (304) 285-5861
 

E-mail: Gwagner@cdc.gov
 

76