Arkansas Tuberculosis Elimination and Laboratory Cooperative Agreement, 2025-2029 - Background: Tuberculosis disease (TB) is caused by Mycobacterium tuberculosis, an airborne bacterium that spreads from person to person. An estimated 4.7% (143,000) of the 3.05 million people in Arkansas have latent tuberculosis infection (LTBI), the inactive form of TB. People with LTBI do not spread the bacteria to others. The prevalence of LTBI is much higher in the non-US born population, for example, 25% of the adult population in the Marshallese community have inactive TB. There has been a surge in TB incidence during the COVID-19 pandemic due to uninterrupted disease transmission; 68 TB cases were reported in 2019, compared to 83 in 2023, an increase of 22.1%. In the period January-August 2024, 90 TB cases have already been reported. With funding from this Cooperative Agreement, we aim to address the 2 drivers of TB incidence, namely recent TB transmission from an infectious case to others, and interruption of progression of LTBI to active TB by detecting and treating persons with LTBI early, before development of active TB. Purpose: Arkansas aims to accelerate TB elimination through this Cooperative Agreement by developing and implementing a TB Elimination Plan to champion dissemination of TB health education and communication among providers and the community. The key message in this plan is “Think TB”, for both providers and the community. This message is intended to combat TB missed opportunities, and delayed TB diagnosis. The result will be: (1) enhanced timely TB diagnosis and treatment, (2) increased efficiency of TB contact investigations, (3) detection and treatment of LTBI based on high-risk based screening strategy. High-risk groups include contacts to an infectious TB case; persons with HIV, diabetes mellitus, hepatitis; the non-US from TB endemic countries; persons in the birth cohort before advent of TB drugs (1950). Strategies and Activities: The Plan for TB Elimination is structured under 7 strategies; (1) Diagnosis and Treatment of Persons with TB disease, (2) Conduct contact investigations for infectious TB cases, (3) Test and treat populations at higher risk for TB and LTBI, (4) Program planning, monitoring, evaluation, and improvement, (5) Surveillance, (6) Human resource development and partnerships, (7) Laboratory strengthening. The Arkansas Department of Health (ADH) is a Centralized Agency. All the 75 counties in the state are part of ADH. The 75 counties are organized into 5 public health regions. The management of TB and LTBI is also centralized. In the TB Program at agency headquarters, there is a clinical team that is comprised of 3 physicians and 2 nurse consultants. Of those, there is a pediatric TB physician and nurse consultant. The nurse at the county local health unit manages TB and LTBI with guidance from the clinical team in central office and a TB Case Manager in each of the five regions. TB and LTBI are reportable conditions in Arkansas. Thus, individuals presumed to have TB or LTBI are reported to ADH. Diagnosis and treatment of TB is supported by a well-established State TB Laboratory. Case-isolates are prepared and shipped for genotyping in Michigan and the CDC. The surveillance and epidemiology of TB and LTBI activities are led by a designated epidemiologist. An LTBI Registry will be constructed and LTBI data will be reported to CDC for years 2014-2029, enabling the epidemiology of LTBI in Arkansas to inform TB elimination efforts. Outcomes: 1. Rapid diagnosis of TB 2. Enhanced detection and treatment of LTBI; each year, approximately 1000 LTBI cases will be reported to CDC. 2. Decrease in TB transmission, measured by trends in clustering of genotypes 3. Downward trend in TB incidence toward the Healthy People 2030 goal of 1.8 cases per 100,000 population. The requested budget is $955,985.00.
