Programs aimed at eliminating tuberculosis have improved throughout the United States, with most indicating reductions in disease incidence and higher rates of treatment completion.
Programs aimed at eliminating tuberculosis (TB) in the United States have made improvements in identifying individuals infected with TB and latent TB and ensuring they complete treatment. These findings were published in Morbidity and Mortality Weekly Report.
The US Centers for Disease Control and Prevention (CDC) and internal and external partners defined a set of national TB objectives and indicators aimed at eliminating TB. These objectives are assessed via the National TB Indicators Project (NTIP), a web-based performance monitoring tool that compiles national TB surveillance data to help prioritize activities and improvement efforts in TB elimination programs.
In this study, researchers aimed to assess the overall TB incidence among individuals born inside and outside of the US, the rate of patients with available drug susceptibility test results, and the rate of treatment completion for patients with TB and latent TB. Data were sourced from the NTIP, the National TB Surveillance System (NTSS), and the Aggregate Reports for Program Evaluation. A total of 52 jurisdictions with TB programs, including 1 for each state as well as Washington DC and New York City, were stratified into terciles based on the mean number of TB diagnoses reported to the NTSS over a 5-year period.
Between 2018 and 2022, the incidence of TB decreased in 71.2% of jurisdictions, with a national 5-year mean TB case number of 2.5 per 100,000 persons. More than a quarter of jurisdictions (28.9%) were below the national performance target of 1.3 TB diagnoses per 100,000 persons and more than half (53.9%) were below the mean national 5-year incidence rate.
The incidence of TB among individuals born outside the US decreased in approximately half (51.0%) of all jurisdictions. In addition, 15.7% of jurisdictions met the 5-year national performance target of 8.8 TB diagnoses per 100,000 persons born outside the US.
Further analysis of data captured between 2018 and 2022 showed that the rate of patients with available drug susceptibility test results increased in 23.1% of jurisdictions. The researchers noted that the 5-year mean rate of patients having initial drug susceptibility test results available was 97%. Overall, 53.9% of jurisdictions met or exceeded this target, and a total of 6 jurisdictions met the 2025 national performance target of 100%.
Between 2017 and 2021, the percentage of patients with a new diagnosis of latent TB who completed treatment increased in 55.8% of jurisdictions. The overall mean rate of treatment completion for patients with latent TB was 81.2%, and 55.8% of jurisdictions met or exceeded this rate. Of note, 2 jurisdictions met the 2025 national target of 93%.
The national rate of TB treatment completion within 12 months was 89.7% from 2016 to 2020. During this period, most jurisdictions (61.5%) exceeded this rate. Moreover, jurisdictions with a higher number of diagnoses generally exhibited greater improvement in treatment completion compared with those with a lower number of diagnoses. One jurisdiction (Wyoming) met the 2025 performance target of 99%, though only a single TB diagnosis was reported.
Study limitations include the lack of data on programmatic and contextual factors such as population demographics and the complexity of TB diagnoses, variations between TB programs with respect to size and available resources, and potentially misleading data for jurisdictions in which a relatively small number of TB diagnoses were reported.
According to the researchers, “To sustain progress toward TB elimination, maintaining strong evaluation and performance monitoring systems is important.”
References:
Woodruff R, Pratt R, Kolasa M. Progress toward tuberculosis elimination and tuberculosis program performance — national tuberculosis indicators project, 2016–2022. MMWR Surveill Summ. 2024;73(4):1-18. doi:10.15585/mmwr.ss7304a1
Source: Infectious Disease Advisor