69–006 

110TH CONGRESS REPT. 110–381 " ! HOUSE OF REPRESENTATIVES 1st Session Part 1 

STOP TUBERCULOSIS (TB) NOW ACT OF 2007 

OCTOBER 15, 2007.—Ordered to be printed 

Mr. LANTOS, from the Committee on Foreign Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 1567] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Foreign Affairs, to whom was referred the bill 

(H.R. 1567) to amend the Foreign Assistance Act of 1961 to provide 

increased assistance for the prevention, treatment, and control of 

tuberculosis, and for other purposes, having considered the same, 

reports favorably thereon with an amendment and recommends 

that the bill as amended do pass. 

TABLE OF CONTENTS 

Page 

The Amendment ...................................................................................................... 2 

Summary .................................................................................................................. 5 

Background and Purpose for the Legislation ........................................................ 5 

Hearings ................................................................................................................... 6 

Committee Consideration ........................................................................................ 6 

Votes of the Committee ........................................................................................... 6 

Committee Oversight Findings ............................................................................... 6 

New Budget Authority and Tax Expenditures ...................................................... 7 

Congressional Budget Office Cost Estimate .......................................................... 7 

Intergovernmental and Private Sector Impact ...................................................... 8 

Performance Goals and Objectives ......................................................................... 8 

Constitutional Authority Statement ...................................................................... 8 

New Advisory Committees ...................................................................................... 8 

Congressional Accountability Act ........................................................................... 8 

Earmark Identification ............................................................................................ 8 

Section-by-Section Analysis and Discussion .......................................................... 8 

Changes in Existing Law Made by the Bill, as Reported ..................................... 9 


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AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Stop Tuberculosis (TB) Now Act of 2007’’. 

SEC. 2. FINDINGS. 

Congress finds the following: 

(1) Tuberculosis is one of the greatest infectious causes of death of adults 

worldwide, killing 1.6 million people per year—one person every 20 seconds. 

(2) One-third of the world’s population is infected with the tuberculosis bacterium and an estimated 8.8 million individuals develop active tuberculosis each 

year. 

(3) Tuberculosis is the leading infectious killer among individuals who are 

HIV-positive due to their weakened immune systems, and it is estimated that 

one-third of people with HIV infection have tuberculosis. 

(4) Today, tuberculosis is a leading killer of women of reproductive age. 

(5) There are 22 countries that account for 80 percent of the world’s burden 

of tuberculosis. The People’s Republic of China and India account for 36 percent 

of all estimated new tuberculosis cases each year. 

(6) Driven by the HIV/AIDS pandemic, incidence rates of tuberculosis in Africa have more than doubled on average since 1990. The problem is so pervasive 

that in August 2005, African Health Ministers and the World Health Organization (WHO) declared tuberculosis to be an emergency in Africa. 

(7) The wide extent of drug resistance, including both multi-drug resistant tuberculosis (MDR–TB) and extensively drug resistant tuberculosis (XDR–TB), 

represents both a critical challenge to the global control of tuberculosis and a 

serious worldwide public health threat. XDR–TB, which is characterized as 

being MDR–TB with additional resistance to multiple second-line anti-tuberculosis drugs, is associated with worst treatment outcomes of any form of tuberculosis. XDR–TB is converging with the HIV epidemic, undermining gains in 

HIV prevention and treatment programs and requires urgent interventions. 

Drug resistance surveillance reports have confirmed the serious scale and 

spread of tuberculosis with XDR–TB strains confirmed on six continents. Demonstrating the lethality of XDR–TB, an initial outbreak in Tugela Ferry, South 

Africa, in 2006 killed 52 of 53 patients with hundreds more cases reported since 

that time. Of the world’s regions, sub-Saharan Africa, faces the greatest gap in 

capacity to prevent, find, and treat XDR–TB. 

(8) With more than 50 percent of tuberculosis cases in the United States attributable to foreign-born individuals and with the increase in international 

travel, commerce, and migration, elimination of tuberculosis in the United 

States depends on efforts to control the disease in developing countries. Recent 

research has shown that to invest in tuberculosis control abroad, where treatment and program costs are significantly cheaper than in the United States, 

would be a cost-effective strategy to reduce tuberculosis-related morbidity and 

mortality domestically. 

(9) The threat that tuberculosis poses for Americans derives from the global 

spread of tuberculosis and the emergence and spread of strains of multi-drug 

resistant tuberculosis and extensively drug resistant tuberculosis, which are far 

more deadly, and more difficult and costly to treat. 

(10) DOTS (Directly Observed Treatment Short-course) is one of the most 

cost-effective health interventions available today and is a core component of 

the new Stop TB Strategy. 

(11) The Stop TB Strategy, developed by the World Health Organization, 

builds on the success of DOTS and ongoing challenges so as to serve all those 

in need and reach targets for prevalence, mortality, and incidence reduction. 

The Stop TB Strategy includes six components: 

(A) Pursuing high-quality expansion and enhancement of DOTS coverage. 

(B) Implementing tuberculosis and HIV collaborative activities, preventing and controlling multi-drug resistant tuberculosis, and addressing 

other special challenges. 

(C) Contributing to the strengthening of health systems. 

(D) Engaging all health care providers, including promotion of the International Standards for Tuberculosis Care. 

(E) Empowering individuals with tuberculosis and communities. 

(F) Enabling and promoting research to develop new diagnostics, drugs, 

vaccines, and program-based operational research relating to tuberculosis. 


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(12) The Global Plan to Stop TB 2006–2015: Actions for Life is a comprehensive plan developed by the Stop TB Partnership that sets out the actions necessary to achieve the millennium development goal of cutting tuberculosis 

deaths and disease burden in half by 2015 and thus eliminate tuberculosis as 

a global health problem by 2050. 

(13) While innovations such as the Global Tuberculosis Drug Facility have enabled low-income countries to treat a standard case of tuberculosis with drugs 

that cost as little as $16 for a full course of treatment, there are still millions 

of individuals with no access to effective treatment. 

(14) As the global resource investment in fighting tuberculosis increases, partner nations and international institutions must commit to a corresponding increase in the technical and program assistance necessary to ensure that the 

most effective and efficient tuberculosis treatments are provided. 

(15) The Global Fund to Fight AIDS, Tuberculosis and Malaria is an important global partnership established to combat these three infectious diseases 

that together kill millions of people a year. Expansion of effective tuberculosis 

treatment programs constitutes a major component of Global Fund investment, 

along with integrated efforts to address HIV and tuberculosis in areas of high 

prevalence. 

(16) The United States Agency for International Development and the Centers for Disease Control and Prevention are actively involved with global tuberculosis control efforts. Because the global tuberculosis epidemic directly impacts 

tuberculosis in the United States, Congress has urged the Centers for Disease 

Control and Prevention each year to increase its involvement with international 

tuberculosis control efforts. 

(17) The United States Agency for International Development is the lead 

United States Government agency for international tuberculosis efforts, working 

in close partnership with the Centers for Disease Control and Prevention and 

with the President’s Emergency Plan for HIV/AIDS Relief. The goal of the 

United States Agency for International Development is to contribute to the global reduction of morbidity and mortality associated with tuberculosis by building 

country capacity to prevent and cure tuberculosis and achieve global targets of 

70 percent case detection and 85 percent treatment success rates. The United 

States Agency for International Development provides support for tuberculosis 

programs in countries that have a high burden of tuberculosis, a high prevalence of tuberculosis and HIV, and a high risk of MDR–TB. 

SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 

(a) POLICY.—Subsection (b) of section 104B of the Foreign Assistance Act of 1961 

(22 U.S.C. 2151b–3) is amended to read as follows: 

‘‘(b) POLICY.—It is a major objective of the foreign assistance program of the 

United States to control tuberculosis. In all countries in which the Government of 

the United States has established development programs, particularly in countries 

with the highest burden of tuberculosis and other countries with high rates of tuberculosis, the United States Government should prioritize the achievement of the following goals by not later than December 31, 2015: 

‘‘(1) Reduce by half the tuberculosis death and disease burden from the 1990 

baseline. 

‘‘(2) Sustain or exceed the detection of at least 70 percent of sputum smearpositive cases of tuberculosis and the cure of at least 85 percent of those cases 

detected.’’. 

(b) AUTHORIZATION.—Subsection (c) of such section is amended—

(1) in the heading, by striking ‘‘AUTHORIZATION’’ and inserting ‘‘ASSISTANCE

REQUIRED’’; and 

(2) by striking ‘‘is authorized to’’ and inserting ‘‘shall’’. 

(c) PRIORITY TO STOP TB STRATEGY.—Subsection (e) of such section is amended—

(1) in the heading, to read as follows: ‘‘PRIORITY TO STOP TB STRATEGY.—’’; 

(2) in the first sentence, by striking ‘‘In furnishing’’ and all that follows 

through ‘‘, including funding’’ and inserting the following: 

‘‘(1) PRIORITY.—In furnishing assistance under subsection (c), the President 

shall give priority to—

‘‘(A) activities described in the Stop TB Strategy, including expansion and 

enhancement of DOTS coverage, treatment for individuals infected with 

both tuberculosis and HIV and treatment for individuals with multi-drug 

resistant tuberculosis (MDR–TB), strengthening of health systems, use of 

the International Standards for Tuberculosis Care by all providers, empowering individuals with tuberculosis, and enabling and promoting research to 

develop new diagnostics, drugs, and vaccines, and program-based operational research relating to tuberculosis; and 


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‘‘(B) funding’’; and 

(3) in the second sentence—

(A) by striking ‘‘In order to’’ and all that follows through ‘‘not less than’’

and inserting the following: 

‘‘(2) AVAILABILITY OF AMOUNTS.—In order to meet the requirements of paragraph (1), the President—

‘‘(A) shall ensure that not less than’’; 

(B) by striking ‘‘for Directly Observed Treatment Short-course (DOTS) 

coverage and treatment of multi-drug resistant tuberculosis using DOTS–

Plus,’’ and inserting ‘‘to implement the Stop TB Strategy; and’’; and 

(C) by striking ‘‘including’’ and all that follows and inserting the following: 

‘‘(B) should ensure that not less than $15,000,000 of the amount made 

available to carry out this section for a fiscal year is used to make a contribution to the Global Tuberculosis Drug Facility.’’. 

(d) ASSISTANCE FOR WHO AND THE STOP TUBERCULOSIS PARTNERSHIP.—Such section is further amended—

(1) by redesignating subsection (f) as subsection (g); and 

(2) by inserting after subsection (e) the following new subsection: 

‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBERCULOSIS PARTNERSHIP.—In carrying out this section, the President, acting through the Administrator of the United 

States Agency for International Development, is authorized to provide increased resources to the World Health Organization (WHO) and the Stop Tuberculosis Partnership to improve the capacity of countries with high rates of tuberculosis and 

other affected countries to implement the Stop TB Strategy and specific strategies 

related to addressing extensively drug resistant tuberculosis (XDR–TB).’’. 

(e) DEFINITIONS.—Subsection (g) of such section, as redesignated by subsection 

(d)(1), is amended—

(1) in paragraph (1), by adding at the end before the period the following: ‘‘, 

including low cost and effective diagnosis and evaluation of treatment regimes, 

vaccines, and monitoring of tuberculosis, as well as a reliable drug supply, and 

a management strategy for public health systems, with health system strengthening, promotion of the use of the International Standards for Tuberculosis 

Care by all care providers, bacteriology under an external quality assessment 

framework, short-course chemotherapy, and sound reporting and recording systems’’; and 

(2) by adding after paragraph (5) the following new paragraph: 

‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB Strategy’ means the six-point 

strategy to reduce tuberculosis developed by the World Health Organization. 

The strategy is described in the Global Plan to Stop TB 2007–2016: Actions for 

Life, a comprehensive plan developed by the Stop Tuberculosis Partnership that 

sets out the actions necessary to achieve the millennium development goal of 

cutting tuberculosis deaths and disease burden in half by 2016.’’. 

(f) ANNUAL REPORT.—Clause (iii) of section 104A(e)(2)(C) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–2(e)(2)(C)) is amended by adding at the end before the semicolon the following: ‘‘, including the percentage of such United States 

foreign assistance provided for diagnosis and treatment of individuals with tuberculosis in countries with the highest burden of tuberculosis, as determined by the 

World Health Organization (WHO)’’. 

(g) AUTHORIZATION OF APPROPRIATIONS.—

(1) IN GENERAL.—There are authorized to be appropriated to the President 

not more than $400,000,000 for fiscal year 2008 and not more than 

$550,000,000 for fiscal year 2009 to carry out section 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–3), as amended by subsections (a) 

through (e) of this section. 

(2) FUNDING FOR CDC.—Of the amounts appropriated pursuant to the authorization of appropriations under paragraph (1), not more than $70,000,000 for 

fiscal year 2008 and not more than $100,000,000 for fiscal year 2009 shall be 

made available for the purpose of carrying out global tuberculosis activities 

through the Centers for Disease Control and Prevention. 

(3) ADDITIONAL PROVISIONS.—Amounts appropriated pursuant to the authorization of appropriations under paragraph (1) and amounts made available pursuant to paragraph (2)—

(A) are in addition amounts otherwise made available for such purposes; 

and 

(B) are authorized to remain available until expended. 


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SUMMARY

The Stop Tuberculosis (TB) Now Act of 2007 amends the Foreign 

Assistance Act of 1961 to require the President to furnish assistance for tuberculosis (TB) prevention, treatment, and elimination. 

The Act gives priority to activities described in the Stop TB Strategy of the World Health Organization (WHO), and revises related 

fund use provisions. The Act authorizes the President, through the 

United States Agency for International Development (USAID), to 

provide increased resources to the World Health Organization 

(WHO) and the Stop Tuberculosis Partnership to improve the capacity of countries with high TB rates and other affected countries 

to implement the Stop TB Strategy and specific strategies related 

to addressing extensively drug resistant tuberculosis (XDR–TB). It 

also authorizes appropriations for Centers for Disease Control and 

Prevention (CDC) TB activities. 

BACKGROUND AND PURPOSE FOR THE LEGISLATION

The Stop TB Act responds to the global tuberculosis crisis that 

has the potential to kill millions of individuals worldwide and introduce new strains of resistant tuberculosis in the United States. 

Worldwide, tuberculosis has one of the highest death rates for 

adults who contract an infectious disease, killing 1.6 million people 

per year—one person every 15 seconds. One-third of the world’s 

population is infected with the tuberculosis bacterium and an estimated 8.8 million individuals develop active tuberculosis each year. 

The emergence of both multi-drug resistant tuberculosis (MDR– TB) and extensively drug resistant tuberculosis (XDR–TB), represents both a critical challenge to the global control of tuberculosis 

and a serious worldwide public health threat. Demonstrating the 

lethality of XDR–TB, an initial outbreak in Tugela Ferry, South Africa killed 52 of 53 patients, with hundreds more cases reported 

since. Between October 2006 and May 2007, KwaZulu-Natal province in South Africa had at least 1,000 diagnosed XDR–TB patients 

with the death rate of 100 percent. Now, MDR–TB has been reported in all regions of the world and, according to the WHO, over 

400,000 cases are emerging every year due to under investment in 

basic TB control, poor management of anti-TB drugs and to transmission of drug-resistant strains. 

One of the Committee’s greatest concerns is the coinfection of tuberculosis and HIV/AIDS. Studies worldwide have shown that tuberculosis is the leading infectious killer among individuals who 

are HIV-positive. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), about 42 million people are HIVinfected and almost one-third are also infected with TB. In many 

African countries, more than 50 percent of patients with active TB 

disease are also HIV-positive. Persons infected with both HIV and 

TB are 30 times more likely to progress to active TB disease. Also, 

recent studies have shown that infection with TB enhances replication of HIV and may accelerate the progression of HIV infection to 

AIDS. 

The U.S. Government has invested heavily through the President’s Emergency Plan for AIDS Relief (PEPFAR) in prevention, 

treatment, and care programs to address the HIV/AIDS pandemic. 

In FY2006, Congress provided almost $3.4 billion for the PEPFAR 


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programs targeting the 15 most heavily HIV/AIDS impacted countries in the world, primarily in Africa. While the PEPFAR program 

includes some funding to identify and treat HIV/AIDS patients 

with TB, its resources are not intended for broad tuberculosis testing and treatment. However, if the 1.1 million men, women, and 

children on antiretrovirals through PEPFAR live in households and 

communities that do not have access to tuberculosis services, their 

chances of contracting the disease and dying are greatly increased, 

thereby reversing the substantial efforts of the U.S. Government. 

The threat that the global tuberculosis crisis poses for Americans 

is very real. In May 2007, alarm spread across the United States 

as health investigators looked for an airline passenger who had 

traveled on an international commercial fight with a rare form of 

drug-resistant tuberculosis. With more than 50 percent of tuberculosis cases in the United States attributable to foreign-born individuals and with the increase in international travel, commerce, 

and migration, elimination of tuberculosis in the United States depends heavily on efforts to control the disease abroad. Recent research has shown that to invest in tuberculosis control in developing countries, where treatment and program costs are significantly cheaper than in the United States, would be a cost-effective 

strategy to reduce tuberculosis-related morbidity and mortality domestically. 

Consideration of this legislation followed the adoption of an 

amendment to the Fiscal Year 2008 Foreign Operations bill in the 

House of Representatives which would increase funding for anti-TB 

programs by $50 million. 

HEARINGS

The Committee on Foreign Affairs held a Full Committee Hearing on ‘‘PEPFAR: An Assessment of Progress and Challenges’’ on 

April 24, 2007. Testimony was heard from Mark R. Dybul, U.S. 

Global AIDS Coordinator. 

COMMITTEE CONSIDERATION

The Committee marked up H.R. 1567 on July 31, 2007, and favorably reported the bill to the House, by voice vote, a quorum 

being present. 

VOTES OF THE COMMITTEE

There were no recorded votes held on H.R. 1567. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII of the Rules of the 

House of Representatives, the Committee reports that the findings 

and recommendations of the Committee, based on oversight activities under clause 2(b)(1) of rule X of the Rules of the House of Representatives, are incorporated in the descriptive portions of this report. 


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NEW BUDGET AUTHORITY AND TAX EXPENDITURES

Clause 3(c) (2) of House Rule XIII is inapplicable because this 

legislation does not provide new budgetary authority or increased 

tax expenditures. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, September 7, 2007. 

Hon. TOM LANTOS, Chairman, 

Committee on Foreign Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 1567, the Stop Tuberculosis (TB) Now Act of 2007. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Sunita D’Monte, who can 

be reached at 226–2840. 

Sincerely, 

PETER R. ORSZAG. 

Enclosure 

cc: Honorable Ileana Ros-Lehtinen 

Ranking Member 

H.R. 1567—Stop Tuberculosis (TB) Now Act of 2007 

H.R. 1567 would authorize the appropriation of $400 million in 

2008 and $550 million in 2009 for programs working to control the 

global spread of tuberculosis. CBO estimates that implementing 

the bill would cost $93 million in 2008 and about $900 million over 

the 2008–2012 period, assuming that the authorized amounts are 

appropriated and that outlays will follow historical spending patterns for those programs. Enacting the bill would not affect direct 

spending or revenues. 

The estimated budgetary impact of H.R. 1567 is shown in the following table. The costs of this legislation fall within budget functions 150 (international affairs) and 550 (health). 

By Fiscal Year, in Millions of Dollars 

2008 2009 2010 2011 2012 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

International Assistance 

Authorization Level 330 450 0 0 0 

Estimated Outlays 66 239 264 113 52 

Centers for Disease Control and Prevention 

Authorization Level 70 100 0 0 0 

Estimated Outlays 27 68 52 16 5 

Total Changes 

Authorization Level 400 550 0 0 0 

Estimated Outlays 93 307 316 129 57 

H.R. 1567 would authorize the appropriation of $400 million in 

2008 and $550 million in 2009 for foreign assistance to improve the 


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detection of tuberculosis, to reduce the number of tuberculosis-related deaths in other countries, and to provide funds for those purposes to international organizations. Of those amounts, $70 million 

in 2008 and $100 million in 2009 would be earmarked for global 

antituberculosis programs of the Centers for Disease Control and 

Prevention. 

H.R. 1567 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would 

not affect the budgets of state, local, or tribal governments. 

The CBO staff contact for this estimate is Sunita D’Monte, who 

can be reached at 226–2840. This estimate was approved by Peter 

H. Fontaine, Assistant Director for Budget Analysis. 

INTERGOVERNMENTAL AND PRIVATE SECTOR IMPACT

H.R. 1567 contains no intergovernmental or private-sector mandates as defined in UMRA and would not affect the budgets of 

state, local, or tribal governments 

PERFORMANCE GOALS AND OBJECTIVES

Pursuant to clause (3)(c) of House rule XIII, upon enactment of 

this legislation, assistance will be increased for the prevention, 

treatment and control of TB. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d) (1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds the authority for this legislation in article I, section 8 of the Constitution. 

NEW ADVISORY COMMITTEES

H.R. 567 does not establish or authorize any new advisory committees. 

CONGRESSIONAL ACCOUNTABILITY ACT

H.R. 1567 does not apply to the Legislative Branch. 

EARMARK IDENTIFICATION

H.R. 1567 does not contain any congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined in clause 9(d), 9(e), 

or 9(f) of rule XXI. 

SECTION-BY-SECTION ANALYSIS AND DISCUSSION

Section 1. Short Title. 

This section states that this Act may be cited as the ‘‘Stop Tuberculosis (TB) Now Act of 2007.’’

Section 2. Findings. 

This section presents a number of findings that stress the urgency of new initiatives to combat the global spread of tuberculosis. 

The findings note that tuberculosis represents one of the greatest 

causes of deaths among adults worldwide and is a leading killer of 

women of reproductive age. The findings also note the virulent new 

form of XDR–TB that came to our attention when the disease 


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began to surge throughout South Africa. The Committee is concerned that this strain of TB could undo all of the achievements 

gained to date in lives saved through treatment and care programs 

funded by the PEPFAR. 

This section also highlights the DOTS (Directly Observed Treatment Short-Course) program that has been determined to be one 

of the most cost-effective and patient-friendly ways to treat TB in 

poor countries. DOTS is part of the new Stop TB Strategy developed by the WHO. 

Section 3. Assistance to Combat Tuberculosis. 

This section establishes as a U.S. policy objective the control of 

tuberculosis, particularly in countries where the United States has 

established development programs, and should achieve the following, no later than December 31, 2015—

• reduce by half the tuberculosis death and disease burden 

from the 1990 baseline; and 

• sustain or exceed the detection of at last 70 percent of sputum smear-positive cases of tuberculosis and the cure of at 

least 85 percent of those cases detected. 

This section also requires assistance to adhere to the Stop TB 

Strategy, including expansion of DOTS. 

In addition, this section authorizes not less than $15,000,000 to 

the Global Tuberculosis Drug Facility. It further authorizes 

through USAID up to $330,000,000 for Fiscal Year 2008 and up to 

$450,000,000 for fiscal year 2009 to support the WHO and the Stop 

Tuberculosis Partnership to improve the capacity of countries with 

high rates of tuberculosis to implement the Stop TB Strategy. This 

section also authorizes an appropriation of up to $70,000,000 for 

fiscal year 2008 and up to $100,000,000 for fiscal year 2009 to 

carry out global TB activities through the CDC. The appropriations 

shall remain available until expended. 

The Committee expects USAID and the CDC to ensure fully that 

all such TB funding increases authorized under this section or endorsed by the House in an amendment to the FY 2008 Foreign Operations bill in June 2007 are expended in a transparent and efficient manner. All U.S. funded anti-TB programs should be resultsdriven and should expand upon or complement, but not duplicate, 

other international and indigenous efforts. The Committee further 

asserts that the Stop Tuberculosis Partnership, a multilateral effort which is to receive increased funding pursuant to this section, 

also must be held to the highest standard of transparency in terms 

of planning, procurement and implementation. The Committee intends to conduct rigorous oversight of these programs as they expand and develop over the next two years. This Section also requires an annual report that includes the percentage of U.S. foreign assistance provided for diagnosis and treatment of individuals 

with tuberculosis in countries with the highest burden of tuberculosis, as determined by WHO. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitVerDate Aug 31 2005 23:59 Oct 15, 2007 Jkt 069006 PO 00000 Frm 00009 Fmt 6659 Sfmt 6601 E:\HR\OC\HR381P1.XXX HR381P1

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ted is enclosed in black brackets, new matter is printed in italics, 

existing law in which no change is proposed is shown in roman): 

FOREIGN ASSISTANCE ACT OF 1961 

* * * * * * * 

PART I 

CHAPTER 1—POLICY; DEVELOPMENT ASSISTANCE AUTHORIZATIONS

* * * * * * * 

SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS. 

(a) * * * 

* * * * * * * 

(e) ANNUAL REPORT.—

(1) * * * 

(2) REPORT ELEMENTS.—Each report shall include—

(A) * * * 

* * * * * * * 

(C) a detailed assessment of the impact of programs established pursuant to such sections, including—

(i) * * * 

* * * * * * * 

(iii) with respect to tuberculosis, the increase in the 

number of people treated and the increase in number 

of tuberculosis patients cured through each program, 

project, or activity receiving United States foreign assistance for tuberculosis control purposes, including 

the percentage of such United States foreign assistance 

provided for diagnosis and treatment of individuals 

with tuberculosis in countries with the highest burden 

of tuberculosis, as determined by the World Health Organization (WHO); and 

* * * * * * * 

SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 

(a) * * * 

ø(b) POLICY.—It is a major objective of the foreign assistance program of the United States to control tuberculosis, including the detection of at least 70 percent of the cases of infectious tuberculosis, 

and the cure of at least 85 percent of the cases detected, not later 

than December 31, 2005, in those countries classified by the World 

Health Organization as among the highest tuberculosis burden, 

and not later than December 31, 2010, in all countries in which the 

United States Agency for International Development has established development programs.¿ 

(b) POLICY.—It is a major objective of the foreign assistance program of the United States to control tuberculosis. In all countries 

in which the Government of the United States has established development programs, particularly in countries with the highest burden 

of tuberculosis and other countries with high rates of tuberculosis, 

the United States Government should prioritize the achievement of 

the following goals by not later than December 31, 2015: 


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(1) Reduce by half the tuberculosis death and disease burden 

from the 1990 baseline. 

(2) Sustain or exceed the detection of at least 70 percent of 

sputum smear-positive cases of tuberculosis and the cure of at 

least 85 percent of those cases detected. 

(c) øAUTHORIZATION¿ ASSISTANCE REQUIRED.—To carry out this 

section and consistent with section 104(c), the President øis authorized to¿ shall furnish assistance, on such terms and conditions as 

the President may determine, for the prevention, treatment, control, and elimination of tuberculosis. 

* * * * * * * 

(e) øPRIORITY TO DOTS COVERAGE.—In furnishing assistance 

under subsection (c), the President shall give priority to activities 

that increase Directly Observed Treatment Short-course (DOTS) 

coverage and treatment of multi-drug resistant tuberculosis where 

needed using DOTS-Plus, including funding¿ PRIORITY TO STOP TB 

STRATEGY.— (1) PRIORITY.—In furnishing assistance under subsection (c), 

the President shall give priority to— (A) activities described in the Stop TB Strategy, including expansion and enhancement of DOTS coverage, treatment for individuals infected with both tuberculosis and 

HIV and treatment for individuals with multi-drug resistant tuberculosis (MDR–TB), strengthening of health systems, use of the International Standards for Tuberculosis 

Care by all providers, empowering individuals with tuberculosis, and enabling and promoting research to develop 

new diagnostics, drugs, and vaccines, and program-based 

operational research relating to tuberculosis; and 

(B) funding for the Global Tuberculosis Drug Facility, 

the Stop Tuberculosis Partnership, and the Global Alliance 

for TB Drug Development. øIn order to meet the requirement of the preceding sentence, the President should ensure that not less than¿ 

(2) AVAILABILITY OF AMOUNTS.—In order to meet the requirements of paragraph (1), the President— (A) shall ensure that not less than 75 percent of the 

amount made available to carry out this section for a fiscal 

year should be expended for antituberculosis drugs, supplies, direct patient services, and training in diagnosis and 

treatment øfor Directly Observed Treatment Short-course 

(DOTS) coverage and treatment of multi-drug resistant tuberculosis using DOTS–Plus, including substantially increased funding for the Global Tuberculosis Drug Facility.¿ to implement the Stop TB Strategy; and (B) should ensure that not less than $15,000,000 of the 

amount made available to carry out this section for a fiscal 

year is used to make a contribution to the Global Tuberculosis Drug Facility. 

(f) ASSISTANCE FOR WHO AND THE STOP TUBERCULOSIS PART- NERSHIP.—In carrying out this section, the President, acting 

through the Administrator of the United States Agency for International Development, is authorized to provide increased resources 

to the World Health Organization (WHO) and the Stop Tuberculosis 

Partnership to improve the capacity of countries with high rates of 


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tuberculosis and other affected countries to implement the Stop TB 

Strategy and specific strategies related to addressing extensively 

drug resistant tuberculosis (XDR–TB). 

ø(f)¿ (g) DEFINITIONS.—In this section: 

(1) DOTS.—The term ‘‘DOTS’’ or ‘‘Directly Observed Treatment Short-course’’ means the World Health Organization-recommended strategy for treating tuberculosis, including low 

cost and effective diagnosis and evaluation of treatment regimes, vaccines, and monitoring of tuberculosis, as well as a reliable drug supply, and a management strategy for public 

health systems, with health system strengthening, promotion of 

the use of the International Standards for Tuberculosis Care by 

all care providers, bacteriology under an external quality assessment framework, short-course chemotherapy, and sound reporting and recording systems. 

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(6) STOP TB STRATEGY.—The term ‘‘Stop TB Strategy’’ means 

the six-point strategy to reduce tuberculosis developed by the 

World Health Organization. The strategy is described in the 

Global Plan to Stop TB 2007–2016: Actions for Life, a comprehensive plan developed by the Stop Tuberculosis Partnership 

that sets out the actions necessary to achieve the millennium development goal of cutting tuberculosis deaths and disease burden in half by 2016. 

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bajohnson on PROD1PC69 with REPORTS