	Introduction

The United States has increasingly recognized tuberculosis (TB) as a critical global health issue. In FY2008, Congress significantly increased its funding for global TB, providing $163.1 million to USAID for its TB programs and directing the Office of the Global AIDS Coordinator (OGAC) at the State Department to spend at least $150 million on joint HIV/TB programs. This report provides information on key components of the global TB epidemic and U.S. global TB efforts as the 112 th Congress considers how the United States should continue to respond to the challenge of TB around the world. Individuals infected with TB can have latent TB infection or active TB disease. It is estimated that each year an average of 9 million people are infected with active TB disease. Global TB mortality has fallen by more than one-third since 1990 levels. MDR-TB significantly challenges TB control efforts, as it is more difficult to cure and may lead to high TB-related death rates. Tuberculosis Prevention and Treatment

Treatment: TB is curable through short-term chemotherapy. 106-264 ). The act recommended that the United States Agency for International Development (USAID), the primary U.S. agency responsible for global TB programs, coordinate with WHO, the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH) toward the goal of controlling TB, and put forth the following targets for countries with USAID TB programs, to be met by December 31, 2010: detect at least 70% of infectious TB cases, and cure at least 85% of detected cases. 108-25 ). The act also prohibited U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund, see " Key Partners in the Response to Global Tuberculosis ") ( Table 2 ) from exceeding 33% of the total amount of funds contributed from all sources. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act, P.L. 110-293 ). Office of the Global AIDS Coordinator (OGAC), Department of State: As the coordinator of the President's Emergency Plan for AIDS Relief (PEPFAR), OGAC is the lead for the U.S. response to HIV/TB co-infection. Funding for global TB efforts increased slowly from FY2004 through FY2007. Appropriation levels for global TB rose significantly in FY2008, partly in response to a global public health scare in May 2007 when a man known to be carrying a drug-resistant form of the disease was able to cross a number of international borders, putting dozens of individuals at risk of infection. Appropriation amounts increased each fiscal year from FY2008 to FY2010 and have fluctuated since ( Table 1 and Figure 3 ). Key Partners in the Response to Global Tuberculosis

The United States works with a range of partners to combat TB, including other national governments, multilateral organizations, non-governmental organizations (NGOs), and the private sector. The Global Fund: The Global Fund was established in 2002 as a public-private partnership to provide significant financial support for global responses to HIV/AIDS, TB, and malaria. Key Issues in Global Tuberculosis

The 112 th Congress will likely be faced with a number of issues regarding the U.S. response to global TB, including how much assistance to provide and how to best apportion global TB funds. TB is the leading cause of death for people with HIV, and TB control is significantly impeded in areas with high HIV prevalence. Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB): Drug resistant forms of TB are threatening progress in TB control. Global health experts have debated how to best address the issue of drug resistant TB, including whether more funds should be used to specifically address MDR-TB, particularly in countries with limited resources. Research and Development: Many of the tools used for TB prevention, diagnosis, and treatment are antiquated and have limited success rates.
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 (XDR-TB), 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. The report will be updated as events warrant.