Summary: Costly and preventable tuberculosis (TB) cases are occurring across the country. Hardest hit have been poor and urban minorities. In the five cities GAO visited--Atlanta, Chicago, El Paso, Los Angeles, and Newark--TB rates are higher than the national average, and TB cases are growing most rapidly among these vulnerable populations, who often lack access to health care. The upsurge in recent TB cases is attributed to more frequent transmission in settings with poor infection control procedures, the effects of the HIV virus, and the spread of TB by persons from countries with high TB rates. Another serious problem is that TB patients who fail to complete a full course of treatment can transmit drug-resistant strains of the bacterium. Also, the cities GAO visited had difficulty identifying persons who had had contact with TB patients. Although the federal government has increased its assistance to states and localities, state and local budgets for TB control have not increased at the same rate as the federal contribution. In addition to funding problems, a weakened TB control infrastructure in health departments has undercut the ability of local TB programs to find infected persons and successfully treat those with active TB so that they do not spread the disease. GAO estimates that unless control efforts are improved, the total national resources spent treating TB annually could more than double to $1.5 billion by the year 2000.
