TB is an airborne disease and globally, a leading cause of death.

One fourth of the world’s population is infected with TB.

In 2017, 1 0. 0 million people around the world became sick with TB disease.

There were 1. 3 million TB-related deaths world-wide, and

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TB is the leading killer of people who are HIV infected.

A total of 9,105 TB cases (a rate of 2. 8 cases per 100,000 persons) were reported in the United States in 201 7.

This is a 1. 6% decrease in the number of cases reported in 2016 and the lowest case count on record in the United States.

While the United States continues to make slow progress, current strategies will not, alone, lead to TB elimination in this century.

Meeting the U.

S.

TB elimination goal will require an added focus on testing and treating high-risk persons with latent TB infection (LTBI) to prevent them from developing active TB disease.

CDC estimates that up to 1 3. 0 million people in the United States have LTBI and over 80% of U.

S.

TB cases result from longstanding, untreated LTBI.

This NOFO supports the continued focus on identifying and curing persons with TB disease, but also includes the addition of a targeted testing and treatment strategy for LTBI.

TB disproportionately affects certain populations, including those who are non-U.S.-born, with HIV infection or diabetes, experiencing homelessness, who are incarcerated, and who use illicit substances.

The TB incidence rate among non-U.S.-born persons in 2017 was approximately 15 times greater compared to U.S.-born persons, and the percentage of TB cases occurring in non-U.S.-born persons continues to increase, reaching 7 0. 1% in 201 7.

Achieving TB elimination in the United States will require focusing on persons in these high-risk groups – an approach that is reinforced by this NOFO.

CDC is continuing a 30-year strategy of funding TB programs through cooperative agreements (CoAgs).

The primary responsibility for developing and implementing TB P&C and laboratory activities rests with state and local health departments, and this funding is intended to complement those efforts.

The intent of this funding is not to supplant or reduce state and local investment in TB control activities and responsibilities (e.g., provision of medications, in-patient care, and health department facilities).