North Carolina Tuberculosis Elimination and Laboratory Cooperative Agreement - North Carolina (NC) is considered a high-incidence TB jurisdiction; in 2023, incidence of TB infection was 2 per 100,000 people, up 31% from 2022. In recent years, the percentage of cases in NC among non-US born individuals increased from 51% in 2018 to 67% in 2023, reflecting demographic shifts in groups at highest risk for TB, from rural, US-born individuals to non-US born individuals residing in urban centers. Despite significant successes in TB prevention and control to date, making continued progress toward the U.S. TB elimination goal will require significant ongoing investments in TB control. The NC TB program (NC TB) aims to bolster current programming by implementing a comprehensive strategy to quickly diagnose and treat tuberculosis disease; promptly investigate contacts of individuals with infectious TB; and efficiently streamline testing and treatment for LTBI. A commitment to these aims will reduce TB transmission and minimize the progression of LTBI to active TB disease, while decreasing inequitable access to LTBI/TB testing, treatment, and support resources, and addressing disparities in TB health outcomes. These goals will be achieved through strategic performance improvement cycles incorporating best practices, guided by set NTIP indicators and reviewed quarterly, combined with focused support for local health departments and jurisdictions, which provide direct care for patients with TB and are the cornerstone of TB control. In addition to programmatic goals, the NC State Laboratory of Public Health (NCSLPH) will continue to advance testing capabilities in the state and increase efficiency in communications, including implementing routine electronic laboratory reporting; using data informed genotyping and universal susceptibility testing to identify multidrug resistant strains; establishing quick turnaround times for processing specimens; and collaborating with partners to ensure optimal use of laboratory services and a timely flow of information.