Oral

Tuberculosis (TB) has historically been associated with marginalized populations in the United States and globally, and this disparity is rapidly increasing. In 2008 of the 12,904 TB cases in the United States, 83% were reported in racial and ethnic minorities, including foreign-born persons. The plan to eliminate TB in the United States, first proposed in 1989 and reaffirmed by the Institute of Medicine (IOM) in 2000 (Ending Neglect: The Elimination of Tuberculosis in the United States), failed to meet the original goal of reducing the number of TB cases to one per million person-years by 2010. Based on TB cases reported during 2003-2008, this life-threatening and disabling disease is projected to persist until the year 2107. The social mobilization in the 1990’s that was sufficient to reverse the resurgence of TB in 1985-1992 associated with outbreaks of multidrug resistant (MDR)-TB and HIV infection has not been sustained, and TB is projected to be a disease exclusively of minorities in less than 50 years. Budget cuts and flat-funding for nearly two decades have reduced federal TB funding by 40%, and resources have dwindled in many local and state health departments, raising concerns about the potential for another resurgence of TB and leaving local health departments ill-prepared for dealing with the new strains of extensively drug resistant (XDR)-TB. The new technologies that were identified in 1989 as critical to the elimination effort in the United States have been slow in coming due to decreased funding, despite the four-fold increase recommended by the IOM. Achieving TB elimination in the United States by the year 2035 instead of 2107 would lead to savings of 253,000 fewer TB cases, 15,200 fewer TB-related deaths and $1.3 billion less in treatment costs. Worldwide there are approximately 9 million new cases of TB each year, of whom 1.7 million die; many of the deaths among persons with AIDS are due to TB. In resource-limited settings, TB is associated with poverty and its environmental conditions, overcrowding, poor ventilation, and malnutrition; inadequate access; stigma and discrimination; and lack of voice and representation in persons with or at-risk for TB. The devastating spread of MDR- and XDR-TB in developing countries and the ongoing importation of this disease into the United States will not be stopped by the use of current poorly-tolerated and prolonged treatment regimens; new tools are required. The potential benefits resulting from health system strengthening and implementing better tools are far greater in developing countries, where many residents lack access to even the outdated diagnostics, treatments, and vaccines that are currently available in industrialized nations. Global funding for TB research and development totaled $510 million in 2008, with 52% coming from the public sector, 14% from the private sector and 34% from philanthropies, but this falls far short of the $2 billion per year needed to meet the ambitious goals in the Global Plan to Stop TB. Social justice demands that we create the political will needed for accelerating the development and implementation of new tools for the diagnosis, treatment and prevention of TB. This session will describe inequities and disparities in health care and access associated with TB in resource-rich and resource-poor settings, identify barriers to TB elimination, explain gaps in funding, and discuss new tools and technologies that address the problem.

Session Objectives: 1. Identify three barriers to TB elimination in the United States. 2. Describe the effects of health disparities and marginalized populations on the TB epidemic in developing countries. 3. Name two new or promising investigational drugs for the treatment of TB.