Changes in Tuberculosis Disparities at a Time of Decreasing Tuberculosis Incidence in the United States, 1994-2016.

OBJECTIVES: To assess national progress in reducing disparities in rates of tuberculosis (TB) disease, which disproportionately affects minorities. METHODS: We used Centers for Disease Control and Prevention (CDC) surveillance data and US Census data to calculate TB rates for 1994 through 2016 by race/ethnicity, national origin, and other TB risk factors. We assessed progress in reducing disparities with rate ratios (RRs) and indexes of disparity, defined as the average of the differences between subpopulation and all-population TB rates divided by the all-population rate. RESULTS: Although TB rates decreased for all subpopulations, RRs increased or stayed the same for all minorities compared with Whites. For racial/ethnic groups, indexes of disparity decreased from 1998 to 2008 (P < .001) but increased thereafter (P = .33). The index of disparity by national origin increased an average of 1.5% per year. CONCLUSIONS: Although TB rates have decreased, disparities have persisted and even increased for some populations. To address the problem, the CDC's Division of TB Elimination has focused on screening and treating latent TB infection, which is concentrated among minorities and is the precursor for more than 85% of TB cases in the United States.

Tuberculosis - United States, 1993-2010.

Tuberculosis (TB) is transmitted via the airborne route by person-to-person contact. Although TB is a leading cause of death on a global scale, most cases can be cured with treatment. From 1993 to 2010, the number of TB cases reported in the United States decreased from 25,103 to 11,182. Despite the decrease, TB continues to affect many communities in the United States disproportionately and unequally, especially racial/ethnic minorities and foreign-born persons. TB remains one of many diseases and health conditions with large disparities and inequalities by income, race/ethnicity, educational attainment, and other sociodemographic characteristics.

Tuberculosis among Africans living in the United States, 2000-2009.

The incidence of tuberculosis (TB) has declined steadily in the United States; however, foreign-born persons are disproportionately affected. The aim of our study was to describe characteristics of TB patients diagnosed in the United States who originated from the African continent. Using data from the U.S. National Tuberculosis Surveillance System, we calculated TB case rates and analyzed differences between foreign-born patients from Africa compared with other foreign-born and U.S.-born patients. The 2009 TB case rate among Africans (48.1/100,000) was 3 times as high as among other foreign-born and 27 times as high as among U.S.-born patients. Africans living in the United States have high rates of TB disease; they are more likely to be HIV-positive and to have extrapulmonary TB. Identification and treatment of latent TB infection, HIV testing and treatment, and a high index of suspicion for extrapulmonary TB are needed to better address TB in this population.

Innovative quality-assurance strategies for tuberculosis surveillance in the United States.

Introduction. The Centers for Disease Control and Prevention (CDC)'s National Tuberculosis Surveillance System (NTSS) is the national repository of tuberculosis (TB) data in the United States. Jurisdictions report to NTSS through the Report of Verified Case of Tuberculosis (RVCT) form that transitioned to a web-based system in 2009. Materials and Methods. To improve RVCT data quality, CDC conducted a quality assurance (QA) needs assessment to develop QA strategies. These include QA components (case detection, data accuracy, completeness, timeliness, data security, and confidentiality); sample tools such as National TB Indicators Project (NTIP) to identify TB case reporting discrepancies; comprehensive training course; resource guide and toolkit. Results and Discussion. During July-September 2011, 73 staff from 34 (57%) of 60 reporting jurisdictions participated in QA training. Participants stated usefulness of sharing jurisdictions' QA methods; 66 (93%) wrote that the QA tools will be effective for their activities. Several jurisdictions reported implementation of QA tools pertinent to their programs. Data showed >8% increase in NTSS and NTIP enrollment through Secure Access Management Services, which monitors system usage, from August 2011-February 2012. Conclusions. Despite challenges imposed by web-based surveillance systems, QA strategies can be developed with innovation and collaboration. These strategies can also be used by other disease programs to ensure high data quality.

The National Tuberculosis Surveillance System training program to ensure accuracy of tuberculosis data.

OBJECTIVES: The Centers for Disease Control and Prevention implemented a national training program for health care workers and surveillance staff to ensure accuracy of data reported to the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System and increase training capacity in tuberculosis surveillance. METHODS: To address the changing epidemiology of tuberculosis and related reporting requirements, a working group of tuberculosis experts revised the Report of Verified Case of Tuberculosis (RVCT), the National Tuberculosis Surveillance System data collection form. The revision prompted a need for training in accurately completing the form. A Centers for Disease Control and Prevention interdisciplinary training team collaborated with key partners in assessing health care worker training needs regarding the RVCT. The team conducted 5 field tests to ensure instructional effectiveness of the training materials. Participants worked through materials, shared experiences, asked questions, and stated concerns about the RVCT. On the basis of these inputs, the team developed an innovative and comprehensive training program. RESULTS: The training materials included instructions for completing each item on the RVCT form, case studies to enable participants to apply the instructions to real-life situations, and visual aids to enhance learning. In both quantitative and qualitative responses, participants indicated that the RVCT training course and self-study materials helped them gain the knowledge needed to accurately complete the RVCT. The team conducted 14 facilitator-led courses and trained 343 health care workers and surveillance staff; 82 of these were training-of-trainers participants. CONCLUSIONS: Collaboration and innovation are essential in implementing an effective national surveillance-training program to ensure the accurate collection and reporting of tuberculosis surveillance data.