Disclaimer: The activities in this document are intended for example purposes only. The actual activities implemented as part of TB program 

evaluation should be determined by state or local TB program officials in collaboration with other stakeholders. The example provided here is 

not intended to be applied directly to any specific TB program.

Example of DTBE Program Evaluation Plan and Annual Report 

Increase Use of Nucleic Acid Amplification Tests (NAAT) at Local Health Jurisdictions to Improve Treatment Initiation 

Performance 

Planned Start Date: October 1, 2020 Planned Completion Date: August 01, 2021

Background and Rationale:

In August 2020, our state TB program completed an evaluation that identified challenges to meeting national performance targets 

for TB case management activities. The program evaluator led a discussion about the evaluation findings between state TB program 

staff and collaborating state and local partners. A main concern by partners for not meeting the national TB program objective for 

treatment initiation performance (initiate treatment within 7 days of specimen collection) was that local health jurisdictions (LHJs) 

were not utilizing nucleic acid amplification tests (NAAT). NAAT can be a rapid and efficient option to guide clinicians’ decisions 

to initiate patient therapy and is recommended in the guidelines for diagnosing TB in adults and children.

1 Thus, TB program staff 

and state and local partners collaborated to develop a strategic plan to increase the use of NAAT by LHJs, with a long-term goal of 

improving treatment initiation performance. This long-term goal is aligned with the 2025 national TB program objective and 

performance target for treatment initiation.

Current Goal: To increase the use of NAAT results within local health jurisdictions (LHJ).

Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) Objectives

By August 01, 2021 (Time bound), increase the use of NAAT by LHJs for three TB case groups: 

1 Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease 

Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017;64(2):111-115. 

doi:10.1093/cid/ciw778
• Increase the proportion of sputum smear-positive TB patients with a NAAT result reported prior to a culture result from 52% 

to 60% (Specific, Measurable, Achievable, and Relevant).

• Increase the proportion of sputum smear-negative TB patients with a NAAT result reported prior to a culture result from 

47% to 55% (Specific, Measurable, Achievable, and Relevant).

• Increase the proportion of HIV-positive TB patients with a NAAT result reported prior to a culture result from 68% to 75%

(Specific, Measurable, Achievable, and Relevant).

State TB Program Objective and Performance Target for 2025: For TB patients with positive acid-fast bacillus (AFB) sputum-smear 

results (Specific and Relevant), increase the proportion who initiated treatment within 7 days of specimen collection from 68% to 

80% (Measurable and Achievable) by August 1, 2021 (Time-bound).

Relevant National TB Program Objective and Performance Target for 2025 (hyperlink to: 

https://www.cdc.gov/tb/programs/evaluation/indicators/default.htm): For TB patients with positive acid-fast bacillus (AFB) sputumsmear results, increase the proportion who initiated treatment within 7 days of specimen collection to 96% by 2025.

Corresponding National Tuberculosis Indicators Project (NTIP) Indicator if Applicable or Relation to CDC Cooperative 

Agreement Scope of Work

Program evaluation efforts should reflect upon the national indicators. Please indicate the core NTIP indicator(s) addressed by this 

evaluation. If the evaluation is not linked to an NTIP indicator, please provide an explanation of how the evaluation relates to your 

scope of work in the CDC Cooperative Agreement.

Relevant National TB Program Indicator and Performance Target for Case Management and Treatment

Indicator: TB Disease Treatment Initiation 

For TB patients with positive acid-fast bacillus (AFB) sputum-smear results, increase the proportion who initiated treatment within 

7 days of specimen collection.

2025 National Performance Target: 96%
Evaluation Plan Questions, Indicators, Analysis and Timeline

Evaluation 

Question

Indicator/

Deliverable

Data Source Data Calculation/ 

Method

Benchmark/Target Timeline

To what extent do 

program activities 

in the strategic plan 

with LHJs increase 

their use of NAAT 

results?

Increase proportion 

of pulmonary TB 

patients with 

NAAT result 

reported prior to a 

culture result for 

smear-positive, 

smear-negative and 

HIV-positive 

patients

Report of Verified 

Case of 

Tuberculosis 

(RVCT)

For each case 

group: Number of

patients with a 

NAAT result 

reported prior to a 

culture result / 

Number of

pulmonary TB 

patients X 100

Target for sputum 

smear-positive:

60% by 08/2021

Target for sputum 

smear-negative: 

55% by 08/2021

HIV-positive:

75% by 08/2021

Work with LHJs to 

begin collecting 

data starting in

October 2020 and 

ending in July 

2021

Analyze and report 

findings by August 

2021

Did increased 

NAAT use by LHJs 

contribute to 

improved treatment 

initiation 

performance?

NTIP Treatment 

Initiation

Number of days 

between specimen 

collection and 

treatment initiation 

by LHJs

NTIP NTIP Treatment 

Initiation 

Compare the 

median number of 

days from specimen 

collection to

treatment initiation 

for TB patients with 

Target Treatment 

Initiation:

80% by 08/2021

Fewer median days 

to treatment 

initiation for TB 

patients with NAAT 

result

Work with LHJs to 

begin collecting 

data starting in 

October 2020 and 

ending in July 

2021

Analyze and report 

findings by August 

2021
and without NAAT 

result 

Evaluations Findings and Conclusions

Is this a final report of a completed evaluation or an interim report of an ongoing evaluation? Final or Interim

Final

Evaluation Question and Related Findings Benchmark

Met or Not Met?

To what extent does the implemented program activities in the strategic plan with LHJs increase their use of 

NAAT results?

• The state TB program education and training team identified 15 LHJs to implement targeted outreach 

activities; 13 LHJs agreed to participate in the study and integrate greater use of NAAT as a diagnostic

tool for TB.

• Across all participating LHJs, the proportion of pulmonary TB patients with NAAT results reported 

prior to a culture result increased:

o from a baseline of 52% to 60% at follow-up for sputum smear-positive,

o from a baseline of 47% to 57% at follow-up for sputum smear-negative,

o from a baseline of 68% to 76% for HIV-positive patients.

Met the 60% 

target for sputum 

smear-positive 

Met the 55% for 

sputum smearnegative

Met the 75% for 

sputum HIVpositive

Did increased NAAT use by LHJs contribute to improved treatment initiation performance? Not Met with 

71.5% of treatment 

initiation
• The state performance on TB Treatment Initiation did not reach the target of 80% by August 01, 2021. 

The current state performance for TB Treatment Initiation is 71.5%. However, this is an improvement 

from 2020 when the performance was 68%.

• Overall, TB patients with a NAAT result initiated treatment in a shorter median amount of time than 

those without a NAAT result.

o Sputum smear-positive TB patients who had a NAAT result were more likely to start treatment 

in a shorter amount of time (median of 5 days) compared to sputum smear-positive patients 

without a NAAT result (median of 16 days).

o Sputum smear-negative TB patients who had a NAAT results were more likely to start 

treatment in a shorter amount of time (median of 7 days) compared to sputum smear-negative 

patients without a NAAT result (median of 24 days).

o TB patients who are HIV-positive with a NAAT results were more likely to start treatment in a 

shorter amount of time (median of 11 days) compared to TB patients who are HIV-positive 

without a NAAT result (median of 18 days).

Met with a lower 

median number of 

days from 

specimen 

collection to 

treatment initiation 

for TB patients 

with a NAAT 

result compared to 

those without a 

NAAT result

Program Facilitators

Having a timeline and stakeholders involved in the process of developing strategies, prioritizing objectives, and establishing 

deadlines and activities were helpful in creating a feasible strategy and gaining buy-in from LHJs. 

Using existing data and protocols already in place for data reporting to CDC was beneficial in developing a manageable timeline to 

complete evaluation activities and in obtaining useful findings that are relevant to national TB program objectives. 

Program Challenges

Major challenges in the evaluation for not reaching targets
While targeted LHJs increased their use of NAAT and improved their performance of TB treatment initiation, this contribution was 

not enough for the state to reach the national performance target. A challenge identified during the outreach process were reports by 

many LHJs that their NAAT ordering protocols varied compared to their partnering laboratory’s protocols, potentially causing 

delays. For example, there were several discrepancies in their testing and reporting schedules for when to offer a test and conduct 

the test, when to send the test to the lab, and when to report results back to LHJs to inform provision of treatment.

Use of Findings

How findings were used: We held a meeting with TB program staff and partnering stakeholders in February 2021 to discuss new 

evaluation findings and challenges. The group has developed a new strategy to facilitate working partnerships between LHJs and 

laboratories to improve TB testing procedures for the long-term goal of further contribution to improved program treatment 

initiation performance. 

1. Gather more information on current TB diagnostic protocols from LHJs. 

2. Gather more information on current TB testing protocols from laboratories. 

3. Finalize a strategy and begin promoting the strategy to improve TB program treatment initiation performance. 

4. Identify solutions to improve the data quality, completeness, and timeliness of NAAT result reporting to local health 

jurisdictions. 

5. Evaluate collaboration efforts and effectiveness of targeted strategies to achieve long-term goals to achieve national TB 

Program objectives for laboratory reporting and case management and treatment. 

List of Deliverables and Products, Dissemination Plan

1. Brief report to share strategies and findings with LHJs, laboratories and other partners. 

2. Comprehensive report to share with state partners, CDC colleagues, and other TB programs who wish to adopt the same 

study or strategies. 

3. Revised outreach materials to share with LHJs.

4. New plan to promote partnerships between LHJs and laboratories for the next targeted evaluation.

5. Success story to share with state partners, CDC colleagues, and LHJs to promote use of NAAT for earlier TB diagnosis.