Cooperative Agreement for Tuberculosis Elimination and Laboratory in the state of California - The State of California reports more tuberculosis (TB) cases than any other reporting area in the nation; 2,113 new TB cases in 2023. California’s 2023 annual TB incidence of 5.4 cases per 100,000 persons is nearly double the national incidence rate of 2.9. Since 2020, TB cases in California have been increasing each year for a total increase of 24% over the last four years, returning to case numbers not seen since before the COVID-19 pandemic. Among California’s TB cases, the vast majority (85%) were attributed to progression of LTBI to active TB. The California Department of Public Health Tuberculosis Control Branch collaborates with California’s 61 local health jurisdictions (LHJs), including LHJs previously directly funded under this cooperative agreement (i.e., Los Angeles, San Francisco, and San Diego), to assess and improve the State’s ability to find and treat active TB cases and their contacts, halt TB transmission, prevent deaths due to TB, stop the development and spread of drug-resistant TB and prevent residents infected with TB from developing active disease. The TB Control Branch’s five major areas of activity are: surveillance; technical support; coordination among TB control partner organizations; direct financial assistance; and leadership. While TB cases have declined 62% since 1992, the epidemiology of TB in sub-populations in California highlights areas where TB continues to pose an ongoing threat to the public’s health. The purpose of this application will be to use Cooperative Agreement funds to augment essential public health TB control, prevention, program evaluation and measurement, human resource development and laboratory activities. A majority of the award will be combined with $7 million in state funds (fiscal year 2024-25) to augment local health department front-line TB control and prevention efforts. The CA TB Control Branch’s strategies and activities will be conducted to address the framework outlined in the CDC TB Elimination and Laboratory Strengthening Cooperative Agreement. The primary outcome is to reduce the overall TB case rate in the state, particularly among populations at greater risk of TB disease. A detailed list of California TB Control Branch outcomes, objectives, and performance targets for project period 2025-2029, by Cooperative Agreement Strategy Area can be found at https://www.cdph.ca.gov/Programs/CID/DCDC/ Pages/TBCB-CA-Objectives-Targets-2025-2029.aspx.