Tuberculosis
- Topics
- Basic TB Facts
- Treatment
- Testing & Diagnosis
- TB & HIV Coinfection
- Infection Control & Prevention
- Drug-Resistant TB
- TB in Specific Populations
- African-American Community
- Correctional Facilities
- Table of Contents
- Introduction
- Strengthen TB Information Systems and Program Assessment
- Strengthen TB Environmental Controls and Isolation Practices
- Provide More Comprehensive and Timely Screening and Diagnostic Evaluations
- Develop and Strengthen Contact Investigation Protocols
- Increase HIV Counseling and Testing
- Increase Staff Training
- Strengthen Collaboration Between Health Departments and Jails
- International Travelers
- Pregnancy
- Disaster Responders
- Children
- Vaccines & Immunizations
- Laboratory Information
- Drug Susceptibility Testing
- The Uses of Nucleic Acid Amplification Tests for the Diagnosis of TB
- Rapid Molecular Testing to Detect Drug-Resistant TB in the US
- Executive Summary
- Introduction
- Background on Tests for Molecular Detection of DR
- General Considerations and Principles for a Molecular DR Testing Service�
- Possible Scenarios and Scope of Testing for a Molecular DR Testing Service
- Research Needs
- General Recommendations of the Expert Panel
- Communication Plan for the Report
- Recommendations
- References
- Panel Members and CDC Participants
- Appendix 1
- Appendix 2
- Appendix 3
- Interim Laboratory Biosafety Guidance for XDR Mycobacterium tuberculosis strains
- Molecular Detection of Drug Resistance (MDDR)
- Research
- TB Epidemiologic Studies Consortium
- Background
- Infrastructure
- Research Projects
- Publications
- Meetings
- Directory
- TBESC Committee Members
- Translating Research into Practice (TRIP)
- Contact TBESC
- Prospective Evaluation of Immunogenetic and Immunologic Markers for Susceptibility to Tuberculosis Infection and Progression from M. Tuberculosisinfection to active TB
- Zero Tolerance for Pediatric TB
- Models for Incorporating HIV Counseling, Testing, and Referral into Tuberculosis Contact Investigations
- Prevalence of Latent TB Infection Among High Risk Populations in the United States
- Regional Capacity-Building in Low-Incidence Areas
- Use of Network Analysis Methods to Characterize M. tuberculosis Transmission Patterns Among Women and Other High-Risk Populations
- An Analysis of Molecular Epidemiology of Multi-Drug Resistant M. tuberculosisin the United States
- Missed Opportunities for TB Prevention in Foreign-Born Population in the United States and Canada
- New Model for Assessing TB Surveillance and Action Performance and Cost
- Addressing TB Among African Americans in the Southeast: Identifying and Overcoming Barriers to Treatment Adherence for Latent TB Infection and TB Disease
- Assessing the TB Knowledge, Attitudes, Beliefs, and Practices Among Private Providers Serving Foreign-born Populations at Risk for TB
- Factors Associated with Acceptance of, Adherence to and Toxicity From Treatment for Latent TB Infection and Pilot Study of Treatment for Latent TB Infection Effectiveness
- Culturally Appropriate TB Educational Materials for Leaders and Staff of Hispanic Service Organizations
- Enhancing TB Programs� Capacity for Self-Evaluation: Testing New Tools and Developing an Evaluation Toolkit
- African Refugee Women�s Health Improvement Project
- Evaluation of the TK Medium: A New Rapid Solid Culture System for Tuberculosis
- Evaluation of New Interferon-y Release Assays in the Diagnosis of Latent TB Infection in Health Care Workers
- Request for Proposal
- TB Trials Consortium
- Behavioral & Social Science Research
- TB Epidemiologic Studies Consortium
- Data & Statistics
- Education & Training
- Resources for TB Programs
- Publications & Products
- Fact Sheets
- General
- Fact sheets - Spanish
- TB - General Information
- The Difference Between Latent TB Infection and Active TB Disease
- Diferencia entre la infección de tuberculosis latente y enfermedad de tuberculosis activa
- A Global Perspective on TB
- Tuberculosis Information for Employers in Non-Healthcare Settings
- Bovine Tuberculosis in Humans
- Tuberculosis Information for International Travelers
- TB Can Be Treated
- Exposure to TB
- TB and HIV/AIDS
- You Can Prevent TB
- Testing for TB
- Tuberculosis: informaci�n general
- Diferencia entre la infecci�n de tuberculosis latente y enfermedad de tuberculosis activa
- Informaci�n sobre la tuberculosis para los viajeros internacionales
- Exposición a la tuberculosis
- Usted puede prevenir la tuberculosis
- La tuberculosis puede ser tratada
- Tuberculosis y VIH/SIDA
- Usted puede prevenir la tuberculosis
- Pruebas para detectar la tuberculosis
- Data & Statistics
- A Global Perspective on TB
- Trends in Tuberculosis – United States
- The Revised Report of Verified Case of Tuberculosis
- The National Tuberculosis Indicators Project (NTIP)
- National Tuberculosis Indicators Project (NTIP): Frequently Asked Questions
- TB Genotyping
- TB Genotyping Information Management System (TB GIMS)
- Drug-Resistant TB
- Multidrug-Resistant Tuberculosis (MDR TB)
- Extensively Drug-Resistant Tuberculosis (XDR TB)
- CDC’s Role in Preventing Extensively Drug-Resistant Tuberculosis (XDR TB)
- Tuberculosis multirresistente (MDR)
- Tuberculosis extremadamente resistente (XDR)
- El papel de los CDC en la prevenci�n de la tuberculosis extremadamente resistente (XDR)
- Infection Control & Prevention
- TB in Specific Populations
- Tuberculosis Information for Employers in Non-Healthcare Settings
- Tuberculosis in Minorities
- Tuberculosis Information for International Travelers
- TB and HIV/AIDS
- Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis (TB) Clinics
- Treatment of Drug-Susceptible Tuberculosis Disease in HIV-Infected Persons
- Tuberculosis in Blacks
- Tuberculosis and Pregnancy
- Tuberculosis y embarazo
- Treatment
- TB Can Be Treated
- Treatment of Latent TB Infection
- Treatment of Latent Tuberculosis Infection: Maximizing Adherence
- Treatment Options for Latent Tuberculosis Infection
- Treatment of Drug-Resistant Tuberculosis
- Treatment of Drug-Susceptible Tuberculosis Disease in Persons Not Infected with HIV
- Treatment of Drug-Susceptible Tuberculosis Disease in HIV-Infected Persons
- Tratamiento de la infecci�n de tuberculosis latente
- Testing & Diagnosis
- TB Can Be Treated
- Testing for TB
- Recommendations for Human Immunodeficiency Virus (HIV) Screening in Tuberculosis (TB) Clinics
- Interferon-Gamma Release Assays (IGRAs)
- Tuberculin Skin Testing
- Diagnosis of Tuberculosis Disease
- Targeted Tuberculin Testing and Interpreting Tuberculin Skin Test Results
- Prueba cutánea de la tuberculina
- Diagnóstico de la tuberculosis activa
- Vaccines & Immunizations
- General
- Guidelines
- Guides & Toolkits
- Core Curriculum
- Self-Study Modules
- Report of Verified Case of Tuberculosis (RVCT)
- Forging Partnerships to Eliminate TB
- Understanding the TB Cohort Review Process
- Latent Tuberculosis Infection: A Guide for Primary Health Care Providers
- Effective TB Interviewing for Contact Investigation
- Mantoux Tuberculin Skin Testing Products
- Ethnographic Guides
- Newsletters
- Pamphlets, Brochures, Booklets
- Posters
- Mantoux Tuberculin Skin Test Wall Chart
- World TB Day
- Afiches
- 2011 Poster (English)
- 2011 Poster (Spanish)
- 2010 Poster (English)
- 2010 Poster (Spanish)
- 2008 Poster (English)
- 2008 Poster (Spanish)
- 2006 Poster (English)
- 2004 Poster (English)
- 2004 Poster (Spanish)
- 2003 Poster (English)
- 2003 Poster (Spanish)
- 2003 Now is the Time Poster (English)
- 2003 Now is the Time Poster (Spanish)
- Think TB
- Stop TB
- Reports & Articles
- Morbidity and Mortality Weekly Reports (MMWRs)
- Contact Investigations
- Control and Elimination
- Data & Statistics
- Drug-Resistant Tuberculosis
- Infection Control & Prevention
- Laboratory
- TB in Specific Populations
- Foreign-Born
- High-Risk Settings
- Homeless
- International
- Occupational Groups
- Travel
- TB & HIV
- Testing & Diagnosis
- Treatment
- LTBI Updates
- Vaccines & Immunizations
- World TB Day
- DTBE Authored Journal Articles
- Tuberculosis Laboratory Aggregate Reports
- Morbidity and Mortality Weekly Reports (MMWRs)
- Slide Sets
- Core Curriculum
- Self-Study Modules
- Prevention and Control of Tuberculosis in Correctional and Detention Facilities
- Guidelines for Preventing the Transmission of M. TB in Health care Settings
- Investigation of Contacts of Persons with Infectious TB
- Text-Only version
- Introduction
- Decisions to Initiate a Contact Investigation
- Investigating the Index Patient and Sites of Transmission
- Assigning Priorities to Contacts
- Diagnostic and Public Health Evaluation of Contacts
- Medical Treatment for Contacts with LTBI
- When to Expand a Contact Investigation
- Communicating Through the News Media
- Data Management and Evaluation of Contact Investigations
- Confidentiality and Consent in Contact Investigations
- Staff Training for Contact Investigations
- Contact Investigations in Special Circumstances
- Source-Case Investigations
- Cultural Competency and Social Network Analysis
- Resources
- Epidemiology of Pediatric Tuberculosis in the United States
- Text-Only version
- Introduction
- Pediatric TB Cases by Age and Race
- Pediatric TB Cases by Origin of Birth
- Pediatric Cases, Percentages and Rates by States
- Pediatric TB Cases by Case Verification Criterion and Site of Disease
- Pediatric TB Cases in Specific Groups
- Pediatric TB Cases Case Completion
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- Slide 30
- Slide 31
- Treatment of TB
- Targeted Tuberculosis Testing and Treatment of Latent Tuberculosis Infection
- CD Roms
- Electronic Tools & Resources
- Web-Based Courses & Webinars
- Fact Sheets
- Global TB
- Events
- Links
- About Us
- Mission Statement and Activities
- Organization Chart
- Advisory Groups
- Federal TB Task Force
- Table of Contents
- Executive Summary
- Introduction
- Chronology in the Development of This Report
- Strategies for Maintaining Control of TB
- Strategies for Accelerating the Decline of TB
- Activities for Developing New Tools
- Global U.S. Actions
- Assessing the Impact of Actions Taken
- Federal TB Task Force Members and Others Involved in the Development of This Report
- Glossary
- References
- Federal TB Task Force Roster
- Table of Contents
- Executive Summary
- Introduction
- How to Eliminate TB? – The IOM Report
- Why Eliminate TB? – Rationale for Elimination
- Who Will Lead? – CDC's Response
- Goal I: Maintain control of TB
- Goal II: Accelerate the decline
- Goal III: Create new tools
- Goal IV: Reduce the global burden of TB
- Goal V: Summon and sustain support
- Goal VI: Track progress
- References
- Federal TB Task Force
- Funding
National TB Indicators Project: Initial Indicators and Performance Targets
Methodology Employed
Selecting potential objectives: The Workgroup collected a wide range of potential objectives from a variety of sources, including current GPRA and HP2010 goals, California’s Tuberculosis Indicators Project objectives, Aggregate Reports for Tuberculosis Program Evaluation (ARPE) indices, and DTBE Cooperative Agreement goals. The Workgroup decided to focus on only those objectives for which there were reliable data already collected. We recognized that there were many other important program objectives that would be valuable in guiding performance evaluation, but without reliable data available, such objectives would not allow us to measure current performance or future improvement. In total, we considered 28 objectives.
Prioritizing objectives: The Workgroup members cast individual votes for the objectives they felt were most helpful as indicators of good program performance. Each member ranked their top 10 objectives in priority order, with their top pick being given a score of 10 and their 10th pick being given a score of 1. All votes were summed, and the 28 objectives were listed in priority order, from highest to lowest. Based on this prioritization, the Workgroup decided on 16 broad indicators and 24 objectives. Of these, the Workgroup focused on the four highest priority indicators and their 13 corresponding objectives for initial target setting.
Setting performance targets: To set performance targets, we first collected baseline data for each of the 13 highest priority objectives. We collected baseline information for the previous 5 years, when it was available. In most cases, this baseline information represented annual data from 2000, 2001, 2002, 2003 and 2004. In the case of objective 1, (“increase timely completion of treatment”), surveillance data lags 2 years behind case reporting, and the 5 years from 1998 to 2002 were used. For objectives based on the Aggregate Reports for Tuberculosis Program Evaluation (ARPE), data is available only for the 4 years from 2000 to 2003. For the objective related to culture identification, data was available only for 2003 and 2004.
Once baseline data were collected, we applied an exponential line fitting equation to forecast future values based on the baseline data and the assumption that all TB control program performance would remain constant (i.e., programs would not get better or more efficient nor would they get worse or less efficient). We used the Excel function Growth(), which applies the formula y=m^x to determine future values (“y”), based on the slope (“m”) of the baseline data points and the future year (“x”). We called this forecast of future national performance the “U.S. forecast.”
We considered two general approaches to setting performance targets. The first approach was to set future performance targets based on a percentage improvement over our U.S. forecast. Say, for arguments sake, that we decided to set our performance target as 20% better than our forecast. If our forecast indicated that the nation was improving at rate of 2% per year on completion of therapy, our new target would be to improve at a rate of 2.4% per year. This approach has the advantage of being simple to understand and to calculate, and we could decide how ambitious to make these targets by simply varying the percentage improvement we decided on. The biggest disadvantage to this first approach, and the ultimate reason this approach was rejected, is that whatever percentage improvement we decided on would be arbitrary, and we had no way to know a priori if a particular percentage improvement was realistic.
The second approach we considered, and finally adopted, was to base our future performance target on the actual performance of a good-performing state. Say, for arguments sake, that we decide that we will select as our good-performing state the one that represents the 90th percentile. In other words, if we ordered all 51 reporting sites (the 50 states plus the District of Columbia) from the best to the worst by their completion of therapy results, then counted down 5 reporting sites, we would see which site was the 90th percentile performer. In fact, this process would reveal that the 90th percentile site reported completing therapy within 12 months in 93% of their patients in 2002 (the latest year for which completion of therapy data are available). According to this approach, we would set 93% as the national performance target for some future year – we selected the year 2015 as a reasonable target date. This approach has to be modified slightly to accommodate objectives that are based on declines in the rates of TB. In the case of rates, we had to calculate the yearly decline in rates for each reporting site, then select the 90th percentile performer. The yearly decline of the 90th percentile state for the current year then became performance target for the nation. To be more technically accurate, the exponential slope of the baseline values reported by the 90th percentile state was used to calculate the expected performance target for the year 2015. Although more difficult to calculate, this approach had the advantage of basing our expectations of future improvement on the actual performance of a specific state. The Workgroup decided to apply this second approach and decided to select the state whose performance represented the 90th percentile of all the states reporting data.
On a technical note, for certain objectives, it was difficult to determine the rate of improvement of states with low occurrences of the event under observation. In order to be certain that our performance targets were not skewed by low-occurrence states, we did a detailed sensitivity analyses, which basically asked the question, what is the impact of dropping data from reporting sites that reported <10 cases, <20 cases, .... up to <100 cases? In many instances, we were able to show that we could keep in all data without affecting the results. In the case of US-born blacks, we chose to drop states reporting <50 cases in 2004, since this is what the Cooperative Agreements stipulate for the measurement of this objective. For the others, we used the highest number of states possible that gave a stable target (i.e., the 90th percentile target did not change when we dropped reporting sites with 10 fewer cases). We made another exception in the case of rates in children <5 years of age. In this case, many states reported no cases in 2004 and many others reported fewer than 5 cases, so for the determination of the 90th percentile target, we excluded those states that reported fewer than 5 cases in 2004.
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