Sec. 781. Elimination of all forms of tuberculosis
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This subtitle be cited as the End Tuberculosis Act . The Congress makes the following findings: In the United States, 9,272 people were diagnosed with tuberculosis (referred to in this section as TB ) in 2016. Disparities in TB exist and significantly impact minority communities in the United States. The Centers for Disease Control and Prevention (referred to in this section as CDC ) finds that 87 percent of people diagnosed with TB in 2016 self-identified as racial and ethnic minorities.
African Americans comprised 21 percent of people diagnosed with TB during 2016. The population-adjusted rate of TB among African Americans is 1.7 times higher than the national total, and 8.2 times higher than among Whites. Asian Americans, Native Hawaiians, and other Pacific Islanders comprised 35 percent of people diagnosed with TB during 2016. The population-adjusted rate of TB among Asian Americans is 6.2 times higher than the national total, and 30 times higher than among Whites.
The population-adjusted rate of TB among Native Hawaiians and other Pacific Islanders is 4.8 times higher than the national total, and 23.2 times higher than among Whites. Hispanics and Latinos comprised 28 percent of people diagnosed with TB during 2016. The population-adjusted rate of TB among Hispanics and Latinos is 1.6 times higher than the national total, and 7.5 times higher than among Whites. TB is both preventable and curable, but the current rate of decline of TB in the United States remains too slow to achieve TB elimination in this century.
TB is transmitted through the air when a person who has TB disease in their lungs coughs or sneezes. People who are in close proximity to the person with TB can breathe in the TB bacteria, and the bacteria will initially settle in their lungs. Without proper and timely diagnosis and access to treatment, the TB bacteria may grow and spread to other parts of their body. As many as 13,000,000 people in the United States may have Latent TB Infection (referred to in this section as LTBI ).
People with LTBI have TB bacteria in their bodies, but their immune system is containing the bacteria, and they are not sick, nor do they have any current risk of spreading TB to others. LTBI can activate into infectious, life-threatening TB if not treated. Modeling has shown that eliminating TB is not possible without addressing LTBI. Comorbidities associated with TB include cancer, diabetes mellitus, and HIV. People with these medical conditions and compromised immune systems are more likely to develop active TB disease and to have worse outcomes from TB.
Forms of active TB that do not show drug resistance are classified as Drug-susceptible TB (referred to in this section as DS–TB ). Drug-resistant TB (referred to in this section as DR–TB ) is a rising threat to the public health of the United States. DR–TB that exhibits resistance to two or more first-line drugs is referred to as multi-drug resistant TB (referred to in this section as MDR–TB ). MDR–TB that also is resistant to at least one injectable second-line medication and at least one fluoroquinolone is classified as extensively drug-resistant TB (referred to in this section as XDR–TB ).
Approximately 78 people in the United States were diagnosed with MDR–TB in 2016. One person was diagnosed with XDR–TB in the same year. In the United States, direct treatment costs average $17,000 to treat a patient with DS–TB, $150,000 to treat a patient with MDR–TB, and $482,000 to treat a patient with XDR–TB. When factoring in productivity losses during treatment, DS–TB averages $46,000, MDR–TB averages $294,000 and XDR–TB averages $694,000. Treatment is often difficult, with daily complex multi-pill regimens and injections, with side-effects ranging from hearing and vision loss to mental health issues.
Recognizing the public health, economic and societal costs to the threat of MDR–TB, the National Action Plan to Combat MDR–TB
(NAP)was developed by the White House to provide the United States with a comprehensive three-pronged strategy to address MDR–TB by strengthening domestic capacity to combat MDR–TB; improve international capacity and cooperation to combat MDR–TB; accelerate basic and applied research and development for new therapies, diagnostics and prevention strategies to combat MDR–TB. Additional Federal support is necessary to expand TB control efforts in case finding and treatment to address LTBI in a national prevention initiative. Key policy and research breakthroughs increase the success of a TB prevention initiative: the U.S. Preventative Services Task Force recommendation’s B rating, screening for LTBI among high-risk adults as a covered service increases the likelihood that impacted racial and ethnic minority groups can get tested for TB; a new, shorter course treatment regimen
(3HP)reduces the length of treatment for LTBI from every day for 6 to 9 months to one dose per week for 12 weeks, increasing likelihood of treatment completion; and the use of blood-based diagnostic tests, Interferon-gamma release assays or IGRAs, increases ability to detect LTBI among patients in affected communities.