Key points
Every five years, CDC updates national performance targets for TB programs in the United States. These targets were developed to track U.S. TB program progress toward TB elimination.
About the Targets
Every five years, CDC updates national performance targets for TB programs in the United States. These targets were developed to track U.S. TB program progress toward TB elimination. TB targets are calculated using national surveillance data from previous years. In previous years, targets were set at a level that 10% of TB programs had already reached in the most recent reporting period with available data.
For 2030, the national TB performance targets for each national TB program objective were calculated using TB surveillance data reported to CDC from years 2015 to 2023. A quantile regression model was used to estimate the 80th percentile for each year. The fitted model was extrapolated to predict the estimated 80th percentile, which serves as the target for 2030. The 80th percentile values reflect the projected performance of the top 20% of TB programs in the United States. In other words, targets are set at a level1 that 20% of TB programs have already reached in 2023.2
Objectives For Reducing TB Incidence and Targets 2030
Mission
| Objectives for Reducing Annual TB Incidence1,2,3,4 | Targets | ||
|---|---|---|---|
| TB Incidence | Reduce the incidence of TB disease. | 1.48 cases per 100,000 | |
| US-Born Persons | Decrease the incidence of TB disease among US-born persons. | 0.37 cases per 100,000 | |
| Non-US–Born Persons | Decrease the incidence of TB disease among non-US–born persons. | 11.33 cases per 100,000 | |
| US-Born Non-Hispanic Black or African American Persons | Decrease the incidence of TB disease among US-born non-Hispanic Black or African American persons. | 0.95 cases per 100,000 | |
| Children Younger than 5 Years of Age | Decrease the incidence of TB disease among children younger than 5 years of age. | 0.36 cases per 100,000 | |
| Objectives on Case Management and Treatment1,2,3 | Targets | ||
| Known HIV Status | Increase the proportion of TB patients with a positive or negative HIV test result reported. | 98% | |
| Treatment Initiation | For TB patients with positive acid-fast bacillus (AFB) sputum-smear results, increase the proportion who initiated treatment within 7 days of specimen collection. | 91% | |
| Recommended Initial Therapy | For patients whose diagnosis is likely to be TB disease, increase the proportion who start on any recommended initial 4-drug regimen. | 96% | |
| Sputum Culture Result Reported | For TB patients aged 12 years or older with a pleural or respiratory site of disease, increase the proportion who have a sputum culture result reported. | 98% | |
| Sputum Culture Conversion | For TB patients with positive sputum culture results, increase the proportion with a documented conversion to negative results within 60 days of treatment initiation. | 80% | |
| Completion of Treatment | For patients with newly diagnosed TB disease for whom 12 months or less of treatment is indicated, increase the proportion who complete treatment within 12 months. | 92% | |
| Objectives on Laboratory Reporting1,2,3 | Targets | ||
| Turnaround Time — Culture | For TB patients with cultures of respiratory specimens identified with M. tuberculosis complex (MTBC), increase the proportion reported by the laboratory within 25 days from the date the specimen was collected. NOTE: 25 days includes 21 days for culture to grow and 4 days for specimen collection and delivery to lab. |
69% | |
| Turnaround Time — Nucleic Acid Amplification Test (NAAT) | For TB patients with respiratory specimens positive for MTBC by nucleic acid amplification test (NAAT), increase the proportion reported by the laboratory within 6 days from the date the specimen was collected. NOTE: 6 days includes 2 days for detection and 4 days for specimen collection and delivery to lab. |
95% | |
| Drug-Susceptibility Result5 | For TB patients with positive culture results, increase the proportion who have initial drug-susceptibility results reported. | 100% | |
| Universal Genotyping | For TB patients with a positive culture result, increase the proportion who have a MTBC genotyping result reported. | 100% | |
| Objectives on Contact Investigations1,3,6 | Targets | ||
| Contact Elicitation | For TB patients with positive AFB sputum-smear results, increase the proportion who have contacts elicited. | 100% | |
| Examination | For contacts to sputum AFB smear-positive TB cases, increase the proportion who are examined for infection and disease. | 90% | |
| Treatment Initiation | For contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection, increase the proportion who start treatment. | 92% | |
| Treatment Completion | For contacts to sputum AFB smear-positive TB cases who have started treatment for latent TB infection, increase the proportion who complete treatment. | 93% | |
| Objectives on Examination of Immigrants and Refugees1,3,7 | Targets | ||
| Examination Initiation | For immigrants and refugees with abnormal chest radiographs (X-rays) read overseas as consistent with TB, increase the proportion who initiate a medical examination within 30 days of notification. | 60% | |
| Examination Completion | For immigrants and refugees with abnormal chest X-rays read overseas as consistent with TB, increase the proportion who complete a medical examination within 120 days of notification. | 68% | |
| Treatment Initiation | For immigrants and refugees with abnormal chest X-rays read overseas as consistent with TB who are diagnosed with latent TB infection or have radiographic findings consistent with prior pulmonary TB (ATS/CDC Class 4) on the basis of examination in the United States, for whom treatment was recommended, increase the proportion who start treatment. | 80% | |
| Treatment Completion | For immigrants and refugees with abnormal chest X-rays read overseas as consistent with TB who are diagnosed with latent TB infection or have radiographic findings consistent with prior pulmonary TB (ATS/CDC Class 4) on the basis of examination in the United States, and who have started on treatment, increase the proportion who complete treatment. | 92% | |
| Objectives on Data Reporting | Targets | ||
| RVCT8 | Ensure the completeness of each core Report of Verified Case of Tuberculosis (RVCT) data item reported to CDC. | 100% | |
| ARPE9 | Ensure the completeness of each core Aggregate Reports for Tuberculosis Program Evaluation (ARPE) data items reported to CDC. | 100% | |
| EDN10 | Ensure the completeness of each core TB Follow-Up Worksheet data item reported to CDC via the Electronic Disease Notification (EDN) system. | 86% | |
| Objectives on Program Evaluation | Targets | ||
| Evaluation Activities | Ensure submission of a program-specific performance-monitoring plan and an annual program evaluation plan to improve program performance. | 100% | |
| Evaluation Focal Point | Ensure designation of a TB evaluation focal point. | 100% | |
| Objectives on Human Resource Development | Targets | ||
| Development Plan | Ensure submission of a program-specific human resource development plan (HRD) and a yearly update of progress. | 100% | |
| Training Focal Point | Ensure designation of a TB training focal point. | 100% | |
Notes
- Indicator calculations for measuring progress are established by the National TB Indicators Project (NTIP).
- Targets for incidence rates and objectives on case management and laboratory reporting are established based on performance reported in NTIP using 2015 – 2023 data from the National TB surveillance system. For Sputum Culture Conversion and Completion of Treatment, the latest year with data available is 2021.
- Targets are based on a statistical model that uses data to find trends from 2015 through 2023 (or the latest year with data available). TB programs with fewer than 150 cases in total from 2021–2023 were excluded. For each objective, we used a quantile regression model to estimate the 80th percentile for each year and extrapolated the fitted model to predict the estimated 80th percentile in the year 2030, which served as the target for 2030. The "80th percentile" values reflect the projected performance of the top 20% of TB programs in the United States in 2030. The quantile regression serves to establish a smooth trend over time, which is useful since the actual percentiles in any given year (e.g. the final year of available data) may not be representative of the overall trend.
- Population data are derived from the American Community Survey. Jurisdictions with a non-US–born population or US-born non-Hispanic Black or African American population less than an average of 100,000 persons per year in 2021–2023 are also excluded in the statistical model for TB incidence rates for non-US–born persons and US-born non-Hispanic Blacks or African Americans persons.
- Drug-susceptibility results from molecular tests will be counted as having met the objective in the indicator calculation starting in 2020.
- Targets for objectives on contact investigation are established based on performance reported in NTIP using 2010–2016 data from the Aggregate Reports for Tuberculosis Program Evaluation (ARPE) for contacts.
- Targets for objectives on the examination of immigrants and refugees are established based on performance reported in NTIP using 2015–2023 data from the Electronic Disease Notification (EDN) system. For Treatment Initiation and Treatment Completion, the latest year with data available is 2022.
- Report of Verified Case of Tuberculosis (RVCT) is the standard surveillance data collection form for reporting tuberculosis cases.
- Aggregate Reports for Tuberculosis Program Evaluation (ARPE) is the standard form for reporting contact investigation activities.
- Electronic Disease Notification (EDN) system is a web-based system used to notify health departments of the immigrants and refugees' entry into the United States. The system also includes a module for the TB Follow-Up Worksheet, a data collection form for reporting the outcomes of TB follow-up examinations in the United States.
How to Use National TB Performance Targets
National TB Performance targets are measurable and aspirational and are intended to be used by TB programs to assess their level of performance in achieving national program objectives. In short, they are longer-term goals to work toward.
Targets are set using historical data and do not consider program resources or local TB epidemiology. Programs should aim for steady progress to achieve targets. While TB programs should make efforts to reach targets, the targets are not annual TB program requirements.
Regular performance monitoring and program evaluation can help TB programs document their progress. Programs can use the National TB Indicators Project (NTIP) as a tool to conduct routine program monitoring. NTIP provides information that is used to show how a program is performing over time and how a program is performing to reach a target.
Monitoring and evaluation can help identify areas for improvement to assist TB programs in achieving the performance targets. Once a TB program identifies why it is performing well or where improvement is needed, changes can be made over time to move closer to the target. Additionally, program performance can be used to brief local leadership who may be able to provide additional input and needed resources.