Tuberculosis Elimination and Laboratory Cooperative Agreement - The New York State Department of Health, Bureau of Tuberculosis Control (BTBC) requests funding to conduct prevention and control activities, human resource development, laboratory services, and program evaluation in New York State (NYS), exclusive of New York City (NYC). 2025 will be the 43rd project period of funding from the Centers for Disease Control and Prevention (CDC) to the NYS Department of Health for TB control activities. Remarkable success has been achieved through this collaborative relationship as the number of cases has declined from a high of 717 in 1993 to 210 in 2023 in New York State (exclusive of New York City). This reduction has been achieved by establishing a comprehensive and coordinated program addressing the critical elements of TB control, including early case finding, prompt diagnosis, appropriate treatment, case management with directly observed therapy (DOT), aggressive contact investigations, treatment of latent TB infection, and educational programs. Due to large staffing reductions as a result of retirements and decreased funding, the ability to ensure that this decline in cases continues is in danger. TB cases in NYS, including NYC, have increased over the past two years. In NYS 894 cases of TB were reported in 2023, with 684 in NYC and 210 in the rest of state. Eighty-nine percent statewide were born outside the United States or its overseas territories. Fifteen were diagnosed with multiple drug resistance (MDR), one of which was XDR. Forty-one patients were co-infected with HIV. It is imperative to replace lost staff positions to stem further TB case increases through concerted screening, testing, and treating efforts. Achieving TB elimination in NYS will require increasing efforts toward these and other high-risk groups, not only to identify and treat TB but also to increase targeted testing and treatment for LTBI. The purpose of the NYS Tuberculosis Control program is to minimize morbidity and mortality caused by TB disease and to prevent transmission through training, education, and working intensively with local partners. Preventing progression from LTBI to TB disease requires close collaboration with local health departments (LHDs) and community providers to enhance targeted outreach to communities at highest risk for TB disease and to assure sustainable programs of risk assessment, targeted testing, and treatment of TB infection. By 2029, NYS will reduce morbidity and mortality caused by TB by preventing tuberculosis transmission, preventing disease progression, and strengthening laboratory capacity. NYSDOH will seek to address all outcomes in the CDC Project logic model, with particular focus on the bolded objectives, as discussed further below and in the workplan. BTBC is under the direction of the Bureau Director and Medical Director. The Bureau has four units: 1) the Field Operations Unit manages relationships with LHDs and DOCCS for inmate cases/suspects; 2) the Data Unit maintains the State TB Registry; ARPE database, all reporting associated with those functions; and also handles special research projects; 3) the Administration Unit manages fiscal matters; and 4) the Clinical Consultation Unit provides technical support for TB diagnosis and treatment to healthcare providers and institutions, prepares and disseminates educational materials. BTBC works closely with the 57 counties in the Project Area and the NYC Department of Health and Mental Hygiene.