Improved program activities are associated with decreasing tuberculosis incidence in the United States.
OBJECTIVE
This study was conducted to determine whether improvements in tuberculosis (TB) program activities correlate with incident TB cases.


METHODS
National TB surveillance data and program data from patients with pulmonary and laryngeal TB and their contacts were collected. These data were analyzed using regression models to assess the association between changes in incident TB cases and indicators of program performance (a time series of percent changes in program indices).


RESULTS
A total of 1,361,113 contacts exposed to 150,668 TB patients were identified through contact investigations. From 1987 to 1992 (the period of TB resurgence and antedating increased funding), there was a decline in several measures used by TB programs for outcomes of contact investigations. From 1993 to 1998 (the period after increases in TB funds), there was an observable improvement in the program indices. Four program indices for contacts and two for TB cases (directly observed therapy and completion of therapy) were statistically associated (p < or = .01) with the decline in TB incident cases.


CONCLUSIONS
These analyses suggest that expanded TB program activities resulted in the reduction in national TB cases and underscore the importance of treatment completion for TB disease and latent TB infection. Based on these results, we propose that further improvements in these activities will accelerate the decline of TB in the United States.
Lobato
Mark N
MN
Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-10, Atlanta, GA 30333, USA. mn10@cdc.gov
Wang
Yong-Cheng
YC
Becerra
Jose E
JE
Simone
Patricia M
PM
Castro
Kenneth G
KG
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016358:Contact Tracing; D023801:Directly Observed Therapy; D006801:Humans; D015994:Incidence; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D011635:Public Health Administration; D014374:Tuberculin Test; D014387:Tuberculosis, Laryngeal / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
D000995:Antitubercular Agents