Recommendation 3.3 To make further progress toward the elimination of tuberculosis in regions of the country experiencing low rates of disease, the committee recommends that

  • Tuberculosis elimination activities be regionalized through a combination of federal and multistate initiatives to provide better access to and more efficient utilization of clinical, epidemiological, and other technical services.

  • Protocols and action plans be developed jointly by CDC and the states for use by state and local health departments to enable planning for the availability of adequate resources.

  • State and local health departments develop case management plans to ensure a uniform high quality of care for patients with tuberculosis and tuberculosis infection in their jurisdictions.

Recommendation 3.4 To maintain quality in tuberculosis care and control services in an era of increased use of managed care systems and privatization of services, the committee recommends that

  • When it is determined that tuberculosis diagnosis and treatment services can be provided more efficiently outside of the public health department, the delivery of such services be governed by well-designed contracts that specify performance measures and responsibilities.

  • Federal categorical funding for tuberculosis control be retained. Funding at the local level should provide sufficient dedicated resources for tuberculosis control but should be structured to provide maximum flexibility and efficiency.

  • Both public and private health insurance programs be billed for tuberculosis diagnostic and treatment services whenever possible, but tuberculosis services should never be denied due to a patient’s inability to make a co-payment.

Recommendation 3.5 To promote a well-trained medical (in a broad sense) workforce and educated public, the committee recommends that

  • The Strategic Plan for Tuberculosis Training and Education, which contains the blueprint that addresses the training and educational needs for tuberculosis control, be fully funded.

  • Programs for the education of patients with tuberculosis be developed and funded.

  • Funding be provided for government, academic, and nongovernmental agencies to work in collaboration with international partners to develop training and educational materials.

Recommendation 4.1 To limit the spread of tuberculosis from infectious patients to their contacts, the committee recommends that more

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