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Friday, June 22, 2012

U.S. Response to the Global Threat of Tuberculosis: Basic Facts

Alexandra E. Kendall
Analyst in Global Health

Tuberculosis (TB) is one of the most widespread infectious diseases in the world, infecting an average of 9 million people annually. Although TB is curable, more than 1 million TB-related deaths occur each year. Due in part to a growing global response to TB, progress has been made in combating the disease. Globally, new TB infection rates have begun to slowly decline and TB mortality rates have decreased significantly since 1990. At the same time, absolute numbers of people infected with TB, particularly in Asia and Africa, continue to rise. Congress has recognized TB as an important humanitarian issue and increasingly as a potential threat to global security. In its second session, the 112th Congress will likely debate the appropriate funding levels and optimum strategy for addressing the continued challenge of global TB.

Congress has enacted several key pieces of legislation related to the prevention, treatment, and care of people with TB around the world. These include the Global AIDS and Tuberculosis Relief Act of 2000 (P.L. 106-264); the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25); and the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110- 293). These acts have authorized funds to be used in the fight against global TB and have recommended priority areas for the use of these funds.

From FY2004 to FY2007, U.S. spending for global TB remained at around $90 million per fiscal year. TB received new attention as a critical issue in May 2007, when a man known to be carrying a drug-resistant form of the disease was able to cross several international borders, putting dozens of others at risk of infection. In response to this event and to growing recognition of the global threat posed by TB, congressional funding for global TB began to increase significantly in FY2008, when Congress provided $163.1 million to USAID for its TB programs and directed the State Department to spend at least $150 million of funds for the President’s Emergency Plan for AIDS Relief (PEPFAR) on joint HIV/TB programs. Funding for global TB saw steady increases from FY2008 to FY2010 and has seen small fluctuations since.

The United States Agency for International Development (USAID) is the lead U.S. agency in global TB control and oversees bilateral programs in over 40 countries. The United States works closely with a range of multilateral partners in responding to global TB, including the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund), the largest external donor for TB. National governments play a critical role in responding to TB, and domestic government expenditures account for the majority of global TB funding.

Several key issues threaten global control of TB. First, HIV/TB co-infection, particularly in Africa, is a growing challenge. TB is the leading cause of death for people with HIV, and TB control is significantly impeded in areas with high HIV prevalence. Second, drug-resistant forms of TB, including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDRTB), are more difficult and expensive to treat, leading to greater TB-related mortality. Finally, the methods currently used for both TB diagnosis and treatment are antiquated and have varying degrees of success, particularly in the face of HIV/TB co-infection and drug-resistant TB. This report outlines basic facts related to global TB, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to the global response to TB.

Date of Report: June 15, 2012
Number of Pages: 15
Order Number: R41643
Price: $29.95

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