State and local health departments have primary responsibility for preventing and controlling TB. To meet this challenge successfully, CDC has recommended six core components for TB prevention and control. This section of the NPIN Website outlines these core components, explains the challenges facing areas with a low TB incidence rate, and provides links to more information about TB prevention and control.
The Six Components of TB Prevention and Control Programs
Challenges Facing Low-Incidence Areas
Featured TB Program Management Information
The Six Components of TB Prevention and Control Programs
Every state health department needs the basic framework for a TB control program that includes all six components, and a designated program director. Sufficient capability in each of the following components is necessary for progress toward TB elimination:
- Planning and developing policy
- Finding and managing suspected and confirmed tuberculosis cases
- Finding and managing latent tuberculosis infection
- Providing laboratory and diagnostic services
- Collecting and analyzing data
- Providing consultation, training, and education
TB programs may perform these activities directly, or programs may coordinate with other providers to ensure the implementation of these activities. Failure to meet these core standards can decrease a TB program's effectiveness in controlling this public health risk.
Challenges Facing Low-Incidence Areas 1
The decrease in TB incidence to historic low levels creates challenges for public health officials who are working to sustain programs and systems, especially when low incidence fails to indicate the full efforts required for comprehensive TB control. These challenges include:
- Loss of healthcare providers or specialists with TB expertise
- Scarcity of special facilities for prolonged health care
- Laboratory costs and decreased proficiency
- Travel in rural areas
- Loss of funds and personnel dedicated to TB control
These challenges, particularly sustainability, are shared by TB programs in all states but are amplified by circumstances in low-incidence states. The Advisory Council for the Elimination of Tuberculosis (ACET) recommends that TB control programs in states or regions that have achieved low TB incidence status seek innovative approaches to meet these special challenges. ACET recognizes that the best solutions will be unique to each state and locality.
Featured TB Program Management Information
Tuberculosis Infection Control: A Practical Manual for Preventing TB
From the Francis J. Curry National Tuberculosis Center
http://www.nationaltbcenter.edu/TB_IC/
Model Tuberculosis Outbreak Response Plan for Low-Incidence Areas
From Francis J. Curry National Tuberculosis Center
http://www.nationaltbcenter.edu/resources/tb_orp_lia.cfm
Identifying Missed Opportunities for Preventing TB: A Resource for TB Programs
From New Jersey Medical School Global Tuberculosis Institute
http://www.umdnj.edu/globaltb/downloads/products/Missed%20Opportunities.pdf
Performance Improvement Resources
From the New Jersey Medical School Global Tuberculosis Institute
http://www.umdnj.edu/ntbcweb/performanceimprovement.htm
Effective TB Interviewing for Contact Investigation
From the Division of Tuberculosis Elimination (DTBE)
http://www.cdc.gov/NCHHSTP/tb/pubs/Interviewing/default.htm
Understanding the TB Cohort Review Process: Instruction Guide 2006
From DTBE
http://www.cdc.gov/NCHHSTP/tb/pubs/cohort/default.htm
Self-Study Modules on Tuberculosis
From DTBE
http://www.cdc.gov/NCHHSTP/tb/pubs/ssmodules/default.htm
Interactive Core Curriculum on Tuberculosis: What the Clinician Should Know – 2004
From DTBE
http://www.cdc.gov/NCHHSTP/tb/pubs/corecurr/index.htm
Forging Partnerships to Eliminate Tuberculosis
From DTBE
http://www.cdc.gov/NCHHSTP/tb/pubs/forge/default.htm
Risk-Based Targeted Tuberculosis Screening in Virginia
Policy summary, including core components and outcome information, on a TB screening policy implemented by the Virginia Department of TB Control from the Best Practice Initiative of the US Department of Health and Human Services
http://www.osophs.dhhs.gov/ophs/BestPractice/VA_tuberculosis.htm
Essential Components of a Tuberculosis Prevention and Control Program Recommendations of the Advisory Council for the Elimination of Tuberculosis
From CDC’s MMWR Reports and Recommendations: September 8, 1995 / Vol. 44 / No. RR-11
http://www.cdc.gov/mmwr/preview/mmwrhtml/00038823.htm
Progressing Toward Tuberculosis Elimination in Low-Incidence Areas of the United States Recommendations of the Advisory Council for the Elimination of Tuberculosis
From CDC’s MMWR Reports and Recommendations: May 3, 2002 / Vol. 51 / No. RR-05
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5105a1.htm
1From Progressing Toward Tuberculosis Elimination in Low-Incidence Areas of the United States Recommendations of the Advisory Council for the Elimination of Tuberculosis:TB incidence rates less than or equal to the Advisory Council for the Elimination of Tuberculosis (ACET) year 2000 interim objective of 3.5 cases/100,000 population, is defined as low incidence. In 2000, 22 (44%) states reported incidence rates <3.5/100,000, which was the year 2000 interim objective set by ACET in the 1989 strategic plan. These states are regarded as areas with a low TB incidence rate, on target in the drive toward elimination. Furthermore, the fraction of US counties reporting no TB cases has increased steadily during the past several decades. In 2000, 1,606 (51%) counties reported no cases. Yet 712 (44%) of these counties had reported one or more cases in the preceding 5 years, which underscores another public health challenge in these settings, i.e., how to maintain sufficient resources to stay prepared for sporadic cases when TB becomes rare.
