Tuberculosis

Costly and preventable tuberculosis (TB) cases are occurring across the country. Hardest hit have been poor and urban minorities. In the five cities GAO visited--Atlanta, Chicago, El Paso, Los Angeles, and Newark--TB rates are higher than the national average, and TB cases are growing most rapidly among these vulnerable populations, who often lack access to health care. The upsurge in recent TB cases is attributed to more frequent transmission in settings with poor infection control procedures, the effects of the HIV virus, and the spread of TB by persons from countries with high TB rates. Another serious problem is that TB patients who fail to complete a full course of treatment can transmit drug-resistant strains of the bacterium. Also, the cities GAO visited had difficulty identifying persons who had had contact with TB patients. Although the federal government has increased its assistance to states and localities, state and local budgets for TB control have not increased at the same rate as the federal contribution. In addition to funding problems, a weakened TB control infrastructure in health departments has undercut the ability of local TB programs to find infected persons and successfully treat those with active TB so that they do not spread the disease. GAO estimates that unless control efforts are improved, the total national resources spent treating TB annually could more than double to $1.5 billion by the year 2000.

GAO found that: (1) costly and preventable TB cases are occurring nationwide and are predominantly impacting poor, urban, racial, and ethnic minorities; (2) according to the Centers for Disease Control and Prevention (CDC), the highest priority of a TB control program is to detect persons with active TB and treat them with antibiotic drugs; (3) four of the cities reviewed reported that staffing shortages caused by hiring freezes, attrition, and resource limitations have affected their ability to provide TB services; (4) in many instances, local TB control programs could not ensure that TB patients would complete appropriate treatment; (5) although the federal government has increased its assistance to states and localities, state and local budgets for TB control activities have not kept pace with the need for treatment and preventive services; and (6) recent increases in cooperative agreements have increased TB funding, helped improve the number of patients who completed the full TB treatment, and increased the speed and accuracy of TB diagnoses.