The United States has increasingly recognized tuberculosis (TB) as a critical global health issue. In FY2008, Congress significantly increased its funding for global TB, providing $163.1 million to USAID for its TB programs and directing the Office of the Global AIDS Coordinator (OGAC) at the State Department to spend at least $150 million on joint HIV/TB programs. Fighting TB is a key goal of President Barack Obama's Global Health Initiative (GHI) and global TB programs saw funding increases in FY2009, FY2010, and FY2012, with a slight decrease in FY2011, reflecting deficit reduction measures that affected most discretionary spending amounts. This report provides information on key components of the global TB epidemic and U.S. global TB efforts as the 112 th Congress considers how the United States should continue to respond to the challenge of TB around the world. TB is an infectious disease spread through the air. TB most often affects the lungs, but it can also affect the brain, kidneys, or spine. The disease is passed when an infected person coughs, sneezes, talks, or spits and another person inhales the infected air. Individuals infected with TB can have latent TB infection or active TB disease. Those with latent TB infection do not exhibit symptoms and cannot spread the infection to others, whereas those with active TB disease exhibit a range of symptoms and are contagious. Without treatment, individuals with active TB will infect an average of 10-15 people each year and can ultimately die from the disease. TB most often becomes active when one's immune system is weakened, for example by HIV/AIDS. Prevalence: Prevalence measures the number of people living with a disease. The World Health Organization (WHO) estimates that about one-third of all people in the world are currently carriers of TB. An estimated 12 million people were living with active TB in 2010. Incidence: Incidence measures the number of people who contract a disease within a given time period (usually one year). It is estimated that each year an average of 9 million people are infected with active TB disease. In 2010, there were an estimated 8.8 million new cases of TB worldwide, including roughly 1.1 million new TB patients who were also infected with HIV. Global TB incidence rates fell from 1990 to 1997, increased again from 1997 to 2002, due in part to the HIV epidemic, and have slowly declined since. Mortality: In 2010, there were 1.4 million TB-related deaths, including 0.35 million TB-related deaths among HIV-positive individuals. Global TB mortality has fallen by more than one-third since 1990 levels. Multidrug-Resistant TB (MDR-TB) is resistant to the two most powerful first-line TB drugs. MDR-TB significantly challenges TB control efforts, as it is more difficult to cure and may lead to high TB-related death rates. TB drug resistance is due to poor treatment adherence or incorrect drug usage. In 2010, there were an estimated 650,000 cases of MDR-TB among the world's 12 million prevalent cases of TB. Twenty-seven countries, known as high MDR-TB burden countries, account for the vast majority of all MDR-TB cases. Extensively Drug-Resistant TB (XDR-TB) is resistant to any fluoroquinolone—antibiotics commonly used in treating TB—and at least one of the three injectable second-line drugs. XDR-TB is more difficult to diagnosis and treat than either drug-susceptible TB or MDR-TB. In low-resource settings, XDR-TB is often fatal. As of July 2010, 58 countries and territories had reported at least one case of XDR-TB. XDR strains of TB are likely under-diagnosed due to weak laboratory capacity to test for second-line drug resistance. Although TB occurs all over the world, there are a number of regions, as categorized by WHO, that are home to the highest TB prevalence and incidence rates. In 2010, 59% of all TB cases occurred in Asia, 26% in Africa, 7% in the Eastern Mediterranean Region, 5% in Europe, and 3% in the Americas. Figure 1 shows the global distribution of new TB cases in 2010. Twenty-two high-burden countries (HBCs) are home to the highest absolute number of TB cases and account for 81% of all TB around the world. In 2010, the five countries with the largest number of new TB cases were India, China, South Africa, Indonesia, and Pakistan. Estimates suggest that levels of MDR-TB among newly infected TB patients are stable in the Americas, decreasing in the Eastern Mediterranean, South-East Asia, and Western Pacific regions, and increasing in the African and European regions. Treatment: TB is curable through short-term chemotherapy. Active TB is treated with a combination of drugs, taken over the course of 6-12 months. In 1993, WHO developed an internationally recommended strategy for detection and treatment of TB called "Directly Observed Treatment, Short-course" (DOTS). DOTS is widely recognized as the standard treatment protocol by national governments and external donors. DOTS recommends that once patients are diagnosed with TB using microscopy, health workers and volunteers observe and record patients each time they take medication throughout their anti-TB regimen. DOTS has five key components: sustained political and financial commitment; diagnosis by quality-ensured sputum-smear microscopy; standardized short-course anti-TB treatment given under direct and supportive observation; a regular, uninterrupted supply of high-quality anti-TB drugs; and standardized recording and reporting. In areas with moderate to high levels of MDR-TB, WHO recommends implementation of DOTS-Plus, a strategy that includes guidance on the appropriate use of second-line TB drugs. In 2000, WHO and its partners released its "Global Plan to Stop TB," which included global targets for TB control from 2001 to 2005. WHO released updated plans in 2006 and 2010. Underpinning the most recent Global Plan to Stop TB is WHO's 2006 "Stop TB Strategy: 2006-2015," which outlines actions that national TB control programs and their partners should take to reach the global TB control targets. The central component of the Stop TB Strategy is the use of DOTS to diagnose and treat TB. The Stop TB Strategy has six focus areas: pursue high-quality DOTS expansion and enhancement; address TB/HIV, MDR-TB, and the needs of poor and vulnerable populations; contribute to health system strengthening based on primary health care; engage all care providers; empower people with TB, and communities through partnerships; and enable and promote research. WHO's strategy has been widely adopted by national TB control programs and their partners. By 2007, 99% of all cases of TB reported to WHO were being treated in DOTS programs. In 2009, DOTS had a treatment success rate of 87%. Prevention: Preventative therapy is available for individuals at high risk of developing TB—such as HIV-positive patients—and those diagnosed with latent TB. There is a TB vaccine called Bacille Calmette Guerin (BCG), but it has been found to have inconsistent success in protecting individuals from infection. When successful, protection is thought to last around 15 years. The vaccine has also been shown to cause potentially fatal infection when given to HIV-positive adults or to children with weak immune systems. On August 19, 2000, President Bill Clinton signed into law the Global AIDS and Tuberculosis Relief Act of 2000 ( P.L. 106-264 ). The act authorized $60 million to be spent on global TB programs in FY2001 and FY2002. The act recommended that the United States Agency for International Development (USAID), the primary U.S. agency responsible for global TB programs, coordinate with WHO, the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) toward the goal of controlling TB, and put forth the following targets for countries with USAID TB programs, to be met by December 31, 2010: detect at least 70% of infectious TB cases, and cure at least 85% of detected cases. On May 27, 2003, President George W. Bush signed into law the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act, P.L. 108-25 ). The act authorized $15 billion to be spent on global HIV/AIDS, TB, and malaria programs over five years, though it did not authorize a specific funding amount for bilateral TB programs. The act outlined congressional priorities for tackling TB from FY2004 through FY2008 and put forth the following goals: detect at least 70% of infectious TB cases in high-burden countries (HBCs) by December 31, 2005, and in all countries with USAID TB programs by December 31, 2010; and cure at least 85% of detected cases in HBCs by December 31, 2005, and in all countries with USAID TB programs by December 31, 2010. The act mandated that U.S. global TB assistance prioritize DOTS coverage and spend at least 75% of global TB funding on TB medicines, supplies, direct patient services, and training in diagnosis and treatment for DOTS coverage and treatment of MDR-TB using DOTS-Plus, including funding for the Global Tuberculosis Drug Facility (see " Key Partners in the Response to Global Tuberculosis "). The act also prohibited U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund, see " Key Partners in the Response to Global Tuberculosis ") ( Table 2 ) from exceeding 33% of the total amount of funds contributed from all sources. On July 24, 2008, President Bush signed into law the Tom Lantos and Henry J. Hyde U.S.