[House Report 110-381]
[From the U.S. Government Publishing Office]
110th Congress Rept. 110-381
HOUSE OF REPRESENTATIVES
1st Session Part 1
======================================================================
STOP TUBERCULOSIS (TB) NOW ACT OF 2007
_______
October 15, 2007.--Ordered to be printed
_______
Mr. Lantos, from the Committee on Foreign Affairs, submitted the
following
R E P O R T
[To accompany H.R. 1567]
[Including cost estimate of the Congressional Budget Office]
The Committee on Foreign Affairs, to whom was referred the
bill (H.R. 1567) to amend the Foreign Assistance Act of 1961 to
provide increased assistance for the prevention, treatment, and
control of tuberculosis, and for other purposes, having
considered the same, reports favorably thereon with an
amendment and recommends that the bill as amended do pass.
TABLE OF CONTENTS
Page
The Amendment.................................................... 2
Summary.......................................................... 5
Background and Purpose for the Legislation....................... 5
Hearings......................................................... 6
Committee Consideration.......................................... 6
Votes of the Committee........................................... 6
Committee Oversight Findings..................................... 6
New Budget Authority and Tax Expenditures........................ 7
Congressional Budget Office Cost Estimate........................ 7
Intergovernmental and Private Sector Impact...................... 8
Performance Goals and Objectives................................. 8
Constitutional Authority Statement............................... 8
New Advisory Committees.......................................... 8
Congressional Accountability Act................................. 8
Earmark Identification........................................... 8
Section-by-Section Analysis and Discussion....................... 8
Changes in Existing Law Made by the Bill, as Reported............ 9
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Stop Tuberculosis (TB) Now Act of
2007''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Tuberculosis is one of the greatest infectious causes of
death of adults worldwide, killing 1.6 million people per
year--one person every 20 seconds.
(2) One-third of the world's population is infected with the
tuberculosis bacterium and an estimated 8.8 million individuals
develop active tuberculosis each year.
(3) Tuberculosis is the leading infectious killer among
individuals who are HIV-positive due to their weakened immune
systems, and it is estimated that one-third of people with HIV
infection have tuberculosis.
(4) Today, tuberculosis is a leading killer of women of
reproductive age.
(5) There are 22 countries that account for 80 percent of the
world's burden of tuberculosis. The People's Republic of China
and India account for 36 percent of all estimated new
tuberculosis cases each year.
(6) Driven by the HIV/AIDS pandemic, incidence rates of
tuberculosis in Africa have more than doubled on average since
1990. The problem is so pervasive that in August 2005, African
Health Ministers and the World Health Organization (WHO)
declared tuberculosis to be an emergency in Africa.
(7) The wide extent of drug resistance, including both multi-
drug resistant tuberculosis (MDR-TB) and extensively drug
resistant tuberculosis (XDR-TB), represents both a critical
challenge to the global control of tuberculosis and a serious
worldwide public health threat. XDR-TB, which is characterized
as being MDR-TB with additional resistance to multiple second-
line anti-tuberculosis drugs, is associated with worst
treatment outcomes of any form of tuberculosis. XDR-TB is
converging with the HIV epidemic, undermining gains in HIV
prevention and treatment programs and requires urgent
interventions. Drug resistance surveillance reports have
confirmed the serious scale and spread of tuberculosis with
XDR-TB strains confirmed on six continents. Demonstrating the
lethality of XDR-TB, an initial outbreak in Tugela Ferry, South
Africa, in 2006 killed 52 of 53 patients with hundreds more
cases reported since that time. Of the world's regions, sub-
Saharan Africa, faces the greatest gap in capacity to prevent,
find, and treat XDR-TB.
(8) With more than 50 percent of tuberculosis cases in the
United States attributable to foreign-born individuals and with
the increase in international travel, commerce, and migration,
elimination of tuberculosis in the United States depends on
efforts to control the disease in developing countries. Recent
research has shown that to invest in tuberculosis control
abroad, where treatment and program costs are significantly
cheaper than in the United States, would be a cost-effective
strategy to reduce tuberculosis-related morbidity and mortality
domestically.
(9) The threat that tuberculosis poses for Americans derives
from the global spread of tuberculosis and the emergence and
spread of strains of multi-drug resistant tuberculosis and
extensively drug resistant tuberculosis, which are far more
deadly, and more difficult and costly to treat.
(10) DOTS (Directly Observed Treatment Short-course) is one
of the most cost-effective health interventions available today
and is a core component of the new Stop TB Strategy.
(11) The Stop TB Strategy, developed by the World Health
Organization, builds on the success of DOTS and ongoing
challenges so as to serve all those in need and reach targets
for prevalence, mortality, and incidence reduction. The Stop TB
Strategy includes six components:
(A) Pursuing high-quality expansion and enhancement
of DOTS coverage.
(B) Implementing tuberculosis and HIV collaborative
activities, preventing and controlling multi-drug
resistant tuberculosis, and addressing other special
challenges.
(C) Contributing to the strengthening of health
systems.
(D) Engaging all health care providers, including
promotion of the International Standards for
Tuberculosis Care.
(E) Empowering individuals with tuberculosis and
communities.
(F) Enabling and promoting research to develop new
diagnostics, drugs, vaccines, and program-based
operational research relating to tuberculosis.
(12) The Global Plan to Stop TB 2006-2015: Actions for Life
is a comprehensive plan developed by the Stop TB Partnership
that sets out the actions necessary to achieve the millennium
development goal of cutting tuberculosis deaths and disease
burden in half by 2015 and thus eliminate tuberculosis as a
global health problem by 2050.
(13) While innovations such as the Global Tuberculosis Drug
Facility have enabled low-income countries to treat a standard
case of tuberculosis with drugs that cost as little as $16 for
a full course of treatment, there are still millions of
individuals with no access to effective treatment.
(14) As the global resource investment in fighting
tuberculosis increases, partner nations and international
institutions must commit to a corresponding increase in the
technical and program assistance necessary to ensure that the
most effective and efficient tuberculosis treatments are
provided.
(15) The Global Fund to Fight AIDS, Tuberculosis and Malaria
is an important global partnership established to combat these
three infectious diseases that together kill millions of people
a year. Expansion of effective tuberculosis treatment programs
constitutes a major component of Global Fund investment, along
with integrated efforts to address HIV and tuberculosis in
areas of high prevalence.
(16) The United States Agency for International Development
and the Centers for Disease Control and Prevention are actively
involved with global tuberculosis control efforts. Because the
global tuberculosis epidemic directly impacts tuberculosis in
the United States, Congress has urged the Centers for Disease
Control and Prevention each year to increase its involvement
with international tuberculosis control efforts.
(17) The United States Agency for International Development
is the lead United States Government agency for international
tuberculosis efforts, working in close partnership with the
Centers for Disease Control and Prevention and with the
President's Emergency Plan for HIV/AIDS Relief. The goal of the
United States Agency for International Development is to
contribute to the global reduction of morbidity and mortality
associated with tuberculosis by building country capacity to
prevent and cure tuberculosis and achieve global targets of 70
percent case detection and 85 percent treatment success rates.
The United States Agency for International Development provides
support for tuberculosis programs in countries that have a high
burden of tuberculosis, a high prevalence of tuberculosis and
HIV, and a high risk of MDR-TB.
SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Policy.--Subsection (b) of section 104B of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b-3) is amended to read as follows:
``(b) Policy.--It is a major objective of the foreign assistance
program of the United States to control tuberculosis. In all countries
in which the Government of the United States has established
development programs, particularly in countries with the highest burden
of tuberculosis and other countries with high rates of tuberculosis,
the United States Government should prioritize the achievement of the
following goals by not later than December 31, 2015:
``(1) Reduce by half the tuberculosis death and disease
burden from the 1990 baseline.
``(2) Sustain or exceed the detection of at least 70 percent
of sputum smear-positive cases of tuberculosis and the cure of
at least 85 percent of those cases detected.''.
(b) Authorization.--Subsection (c) of such section is amended--
(1) in the heading, by striking ``Authorization'' and
inserting ``Assistance Required''; and
(2) by striking ``is authorized to'' and inserting ``shall''.
(c) Priority To Stop TB Strategy.--Subsection (e) of such section is
amended--
(1) in the heading, to read as follows: ``Priority To Stop TB
Strategy.--'';
(2) in the first sentence, by striking ``In furnishing'' and
all that follows through ``, including funding'' and inserting
the following:
``(1) Priority.--In furnishing assistance under subsection
(c), the President shall give priority to--
``(A) activities described in the Stop TB Strategy,
including expansion and enhancement of DOTS coverage,
treatment for individuals infected with both
tuberculosis and HIV and treatment for individuals with
multi-drug resistant tuberculosis (MDR-TB),
strengthening of health systems, use of the
International Standards for Tuberculosis Care by all
providers, empowering individuals with tuberculosis,
and enabling and promoting research to develop new
diagnostics, drugs, and vaccines, and program-based
operational research relating to tuberculosis; and
``(B) funding''; and
(3) in the second sentence--
(A) by striking ``In order to'' and all that follows
through ``not less than'' and inserting the following:
``(2) Availability of amounts.--In order to meet the
requirements of paragraph (1), the President--
``(A) shall ensure that not less than'';
(B) by striking ``for Directly Observed Treatment
Short-course (DOTS) coverage and treatment of multi-
drug resistant tuberculosis using DOTS-Plus,'' and
inserting ``to implement the Stop TB Strategy; and'';
and
(C) by striking ``including'' and all that follows
and inserting the following:
``(B) should ensure that not less than $15,000,000 of
the amount made available to carry out this section for
a fiscal year is used to make a contribution to the
Global Tuberculosis Drug Facility.''.
(d) Assistance for WHO and the Stop Tuberculosis Partnership.--Such
section is further amended--
(1) by redesignating subsection (f) as subsection (g); and
(2) by inserting after subsection (e) the following new
subsection:
``(f) Assistance for WHO and the Stop Tuberculosis Partnership.--In
carrying out this section, the President, acting through the
Administrator of the United States Agency for International
Development, is authorized to provide increased resources to the World
Health Organization (WHO) and the Stop Tuberculosis Partnership to
improve the capacity of countries with high rates of tuberculosis and
other affected countries to implement the Stop TB Strategy and specific
strategies related to addressing extensively drug resistant
tuberculosis (XDR-TB).''.
(e) Definitions.--Subsection (g) of such section, as redesignated by
subsection (d)(1), is amended--
(1) in paragraph (1), by adding at the end before the period
the following: ``, including low cost and effective diagnosis
and evaluation of treatment regimes, vaccines, and monitoring
of tuberculosis, as well as a reliable drug supply, and a
management strategy for public health systems, with health
system strengthening, promotion of the use of the International
Standards for Tuberculosis Care by all care providers,
bacteriology under an external quality assessment framework,
short-course chemotherapy, and sound reporting and recording
systems''; and
(2) by adding after paragraph (5) the following new
paragraph:
``(6) Stop tb strategy.--The term `Stop TB Strategy' means
the six-point strategy to reduce tuberculosis developed by the
World Health Organization. The strategy is described in the
Global Plan to Stop TB 2007-2016: Actions for Life, a
comprehensive plan developed by the Stop Tuberculosis
Partnership that sets out the actions necessary to achieve the
millennium development goal of cutting tuberculosis deaths and
disease burden in half by 2016.''.
(f) Annual Report.--Clause (iii) of section 104A(e)(2)(C) of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)(2)(C)) is amended
by adding at the end before the semicolon the following: ``, including
the percentage of such United States foreign assistance provided for
diagnosis and treatment of individuals with tuberculosis in countries
with the highest burden of tuberculosis, as determined by the World
Health Organization (WHO)''.
(g) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated to
the President not more than $400,000,000 for fiscal year 2008
and not more than $550,000,000 for fiscal year 2009 to carry
out section 104B of the Foreign Assistance Act of 1961 (22
U.S.C. 2151b-3), as amended by subsections (a) through (e) of
this section.
(2) Funding for cdc.--Of the amounts appropriated pursuant to
the authorization of appropriations under paragraph (1), not
more than $70,000,000 for fiscal year 2008 and not more than
$100,000,000 for fiscal year 2009 shall be made available for
the purpose of carrying out global tuberculosis activities
through the Centers for Disease Control and Prevention.
(3) Additional provisions.--Amounts appropriated pursuant to
the authorization of appropriations under paragraph (1) and
amounts made available pursuant to paragraph (2)--
(A) are in addition amounts otherwise made available
for such purposes; and
(B) are authorized to remain available until
expended.
Summary
The Stop Tuberculosis (TB) Now Act of 2007 amends the
Foreign Assistance Act of 1961 to require the President to
furnish assistance for tuberculosis (TB) prevention, treatment,
and elimination. The Act gives priority to activities described
in the Stop TB Strategy of the World Health Organization (WHO),
and revises related fund use provisions. The Act authorizes the
President, through the United States Agency for International
Development (USAID), to provide increased resources to the
World Health Organization (WHO) and the Stop Tuberculosis
Partnership to improve the capacity of countries with high TB
rates and other affected countries to implement the Stop TB
Strategy and specific strategies related to addressing
extensively drug resistant tuberculosis (XDR-TB). It also
authorizes appropriations for Centers for Disease Control and
Prevention (CDC) TB activities.
Background and Purpose for the Legislation
The Stop TB Act responds to the global tuberculosis crisis
that has the potential to kill millions of individuals
worldwide and introduce new strains of resistant tuberculosis
in the United States. Worldwide, tuberculosis has one of the
highest death rates for adults who contract an infectious
disease, killing 1.6 million people per year--one person every
15 seconds. One-third of the world's population is infected
with the tuberculosis bacterium and an estimated 8.8 million
individuals develop active tuberculosis each year.
The emergence of both multi-drug resistant tuberculosis
(MDR-TB) and extensively drug resistant tuberculosis (XDR-TB),
represents both a critical challenge to the global control of
tuberculosis and a serious worldwide public health threat.
Demonstrating the lethality of XDR-TB, an initial outbreak in
Tugela Ferry, South Africa killed 52 of 53 patients, with
hundreds more cases reported since. Between October 2006 and
May 2007, KwaZulu-Natal province in South Africa had at least
1,000 diagnosed XDR-TB patients with the death rate of 100
percent. Now, MDR-TB has been reported in all regions of the
world and, according to the WHO, over 400,000 cases are
emerging every year due to under investment in basic TB
control, poor management of anti-TB drugs and to transmission
of drug-resistant strains.
One of the Committee's greatest concerns is the coinfection
of tuberculosis and HIV/AIDS. Studies worldwide have shown that
tuberculosis is the leading infectious killer among individuals
who are HIV-positive. According to the Joint United Nations
Programme on HIV/AIDS (UNAIDS), about 42 million people are
HIV-infected and almost one-third are also infected with TB. In
many African countries, more than 50 percent of patients with
active TB disease are also HIV-positive. Persons infected with
both HIV and TB are 30 times more likely to progress to active
TB disease. Also, recent studies have shown that infection with
TB enhances replication of HIV and may accelerate the
progression of HIV infection to AIDS.
The U.S. Government has invested heavily through the
President's Emergency Plan for AIDS Relief (PEPFAR) in
prevention, treatment, and care programs to address the HIV/
AIDS pandemic. In FY2006, Congress provided almost $3.4 billion
for the PEPFAR programs targeting the 15 most heavily HIV/AIDS
impacted countries in the world, primarily in Africa. While the
PEPFAR program includes some funding to identify and treat HIV/
AIDS patients with TB, its resources are not intended for broad
tuberculosis testing and treatment. However, if the 1.1 million
men, women, and children on antiretrovirals through PEPFAR live
in households and communities that do not have access to
tuberculosis services, their chances of contracting the disease
and dying are greatly increased, thereby reversing the
substantial efforts of the U.S. Government.
The threat that the global tuberculosis crisis poses for
Americans is very real. In May 2007, alarm spread across the
United States as health investigators looked for an airline
passenger who had traveled on an international commercial fight
with a rare form of drug-resistant tuberculosis. With more than
50 percent of tuberculosis cases in the United States
attributable to foreign-born individuals and with the increase
in international travel, commerce, and migration, elimination
of tuberculosis in the United States depends heavily on efforts
to control the disease abroad. Recent research has shown that
to invest in tuberculosis control in developing countries,
where treatment and program costs are significantly cheaper
than in the United States, would be a cost-effective strategy
to reduce tuberculosis-related morbidity and mortality
domestically.
Consideration of this legislation followed the adoption of
an amendment to the Fiscal Year 2008 Foreign Operations bill in
the House of Representatives which would increase funding for
anti-TB programs by $50 million.
Hearings
The Committee on Foreign Affairs held a Full Committee
Hearing on ``PEPFAR: An Assessment of Progress and Challenges''
on April 24, 2007. Testimony was heard from Mark R. Dybul, U.S.
Global AIDS Coordinator.
Committee Consideration
The Committee marked up H.R. 1567 on July 31, 2007, and
favorably reported the bill to the House, by voice vote, a
quorum being present.
Votes of the Committee
There were no recorded votes held on H.R. 1567.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the Committee reports that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated in the
descriptive portions of this report.
New Budget Authority and Tax Expenditures
Clause 3(c) (2) of House Rule XIII is inapplicable because
this legislation does not provide new budgetary authority or
increased tax expenditures.
Congressional Budget Office Cost Estimate
U.S. Congress,
Congressional Budget Office,
Washington, DC, September 7, 2007.
Hon. Tom Lantos, Chairman,
Committee on Foreign Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1567, the Stop
Tuberculosis (TB) Now Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte, who can be reached at 226-2840.
Sincerely,
Peter R. Orszag.
Enclosure
cc:
Honorable Ileana Ros-Lehtinen
Ranking Member
H.R. 1567--Stop Tuberculosis (TB) Now Act of 2007
H.R. 1567 would authorize the appropriation of $400 million
in 2008 and $550 million in 2009 for programs working to
control the global spread of tuberculosis. CBO estimates that
implementing the bill would cost $93 million in 2008 and about
$900 million over the 2008-2012 period, assuming that the
authorized amounts are appropriated and that outlays will
follow historical spending patterns for those programs.
Enacting the bill would not affect direct spending or revenues.
The estimated budgetary impact of H.R. 1567 is shown in the
following table. The costs of this legislation fall within
budget functions 150 (international affairs) and 550 (health).
By Fiscal Year, in Millions of Dollars
----------------------------------------------------------------------------------------------------------------
2008 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
International Assistance 330 450 0 0 0
Authorization Level
Estimated Outlays 66 239 264 113 52
Centers for Disease Control and Prevention 70 100 0 0 0
Authorization Level
Estimated Outlays 27 68 52 16 5
Total Changes 400 550 0 0 0
Authorization Level
Estimated Outlays 93 307 316 129 57
----------------------------------------------------------------------------------------------------------------
H.R. 1567 would authorize the appropriation of $400 million
in 2008 and $550 million in 2009 for foreign assistance to
improve the detection of tuberculosis, to reduce the number of
tuberculosis-related deaths in other countries, and to provide
funds for those purposes to international organizations. Of
those amounts, $70 million in 2008 and $100 million in 2009
would be earmarked for global antituberculosis programs of the
Centers for Disease Control and Prevention.
H.R. 1567 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Sunita D'Monte,
who can be reached at 226-2840. This estimate was approved by
Peter H. Fontaine, Assistant Director for Budget Analysis.
Intergovernmental and Private Sector Impact
H.R. 1567 contains no intergovernmental or private-sector
mandates as defined in UMRA and would not affect the budgets of
state, local, or tribal governments
Performance Goals and Objectives
Pursuant to clause (3)(c) of House rule XIII, upon
enactment of this legislation, assistance will be increased for
the prevention, treatment and control of TB.
Constitutional Authority Statement
Pursuant to clause 3(d) (1) of rule XIII of the Rules of
the House of Representatives, the Committee finds the authority
for this legislation in article I, section 8 of the
Constitution.
New Advisory Committees
H.R. 567 does not establish or authorize any new advisory
committees.
Congressional Accountability Act
H.R. 1567 does not apply to the Legislative Branch.
Earmark Identification
H.R. 1567 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) of rule XXI.
Section-by-Section Analysis and Discussion
Section 1. Short Title.
This section states that this Act may be cited as the
``Stop Tuberculosis (TB) Now Act of 2007.''
Section 2. Findings.
This section presents a number of findings that stress the
urgency of new initiatives to combat the global spread of
tuberculosis. The findings note that tuberculosis represents
one of the greatest causes of deaths among adults worldwide and
is a leading killer of women of reproductive age. The findings
also note the virulent new form of XDR-TB that came to our
attention when the disease began to surge throughout South
Africa. The Committee is concerned that this strain of TB could
undo all of the achievements gained to date in lives saved
through treatment and care programs funded by the PEPFAR.
This section also highlights the DOTS (Directly Observed
Treatment Short-Course) program that has been determined to be
one of the most cost-effective and patient-friendly ways to
treat TB in poor countries. DOTS is part of the new Stop TB
Strategy developed by the WHO.
Section 3. Assistance to Combat Tuberculosis.
This section establishes as a U.S. policy objective the
control of tuberculosis, particularly in countries where the
United States has established development programs, and should
achieve the following, no later than December 31, 2015--
Lreduce by half the tuberculosis death and
disease burden from the 1990 baseline; and
Lsustain or exceed the detection of at last 70
percent of sputum smear-positive cases of tuberculosis
and the cure of at least 85 percent of those cases
detected.
This section also requires assistance to adhere to the Stop
TB Strategy, including expansion of DOTS.
In addition, this section authorizes not less than
$15,000,000 to the Global Tuberculosis Drug Facility. It
further authorizes through USAID up to $330,000,000 for Fiscal
Year 2008 and up to $450,000,000 for fiscal year 2009 to
support the WHO and the Stop Tuberculosis Partnership to
improve the capacity of countries with high rates of
tuberculosis to implement the Stop TB Strategy. This section
also authorizes an appropriation of up to $70,000,000 for
fiscal year 2008 and up to $100,000,000 for fiscal year 2009 to
carry out global TB activities through the CDC. The
appropriations shall remain available until expended.
The Committee expects USAID and the CDC to ensure fully
that all such TB funding increases authorized under this
section or endorsed by the House in an amendment to the FY 2008
Foreign Operations bill in June 2007 are expended in a
transparent and efficient manner. All U.S. funded anti-TB
programs should be results-driven and should expand upon or
complement, but not duplicate, other international and
indigenous efforts. The Committee further asserts that the Stop
Tuberculosis Partnership, a multilateral effort which is to
receive increased funding pursuant to this section, also must
be held to the highest standard of transparency in terms of
planning, procurement and implementation. The Committee intends
to conduct rigorous oversight of these programs as they expand
and develop over the next two years. This Section also requires
an annual report that includes the percentage of U.S. foreign
assistance provided for diagnosis and treatment of individuals
with tuberculosis in countries with the highest burden of
tuberculosis, as determined by WHO.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
FOREIGN ASSISTANCE ACT OF 1961
* * * * * * *
PART I
Chapter 1--Policy; Development Assistance Authorizations
* * * * * * *
SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
(a) * * *
* * * * * * *
(e) Annual Report.--
(1) * * *
(2) Report elements.--Each report shall include--
(A) * * *
* * * * * * *
(C) a detailed assessment of the impact of
programs established pursuant to such sections,
including--
(i) * * *
* * * * * * *
(iii) with respect to tuberculosis,
the increase in the number of people
treated and the increase in number of
tuberculosis patients cured through
each program, project, or activity
receiving United States foreign
assistance for tuberculosis control
purposes, including the percentage of
such United States foreign assistance
provided for diagnosis and treatment of
individuals with tuberculosis in
countries with the highest burden of
tuberculosis, as determined by the
World Health Organization (WHO); and
* * * * * * *
SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) * * *
[(b) Policy.--It is a major objective of the foreign
assistance program of the United States to control
tuberculosis, including the detection of at least 70 percent of
the cases of infectious tuberculosis, and the cure of at least
85 percent of the cases detected, not later than December 31,
2005, in those countries classified by the World Health
Organization as among the highest tuberculosis burden, and not
later than December 31, 2010, in all countries in which the
United States Agency for International Development has
established development programs.]
(b) Policy.--It is a major objective of the foreign
assistance program of the United States to control
tuberculosis. In all countries in which the Government of the
United States has established development programs,
particularly in countries with the highest burden of
tuberculosis and other countries with high rates of
tuberculosis, the United States Government should prioritize
the achievement of the following goals by not later than
December 31, 2015:
(1) Reduce by half the tuberculosis death and disease
burden from the 1990 baseline.
(2) Sustain or exceed the detection of at least 70
percent of sputum smear-positive cases of tuberculosis
and the cure of at least 85 percent of those cases
detected.
(c) [Authorization] Assistance Required.--To carry out this
section and consistent with section 104(c), the President [is
authorized to] shall furnish assistance, on such terms and
conditions as the President may determine, for the prevention,
treatment, control, and elimination of tuberculosis.
* * * * * * *
(e) [Priority to DOTS Coverage.--In furnishing assistance
under subsection (c), the President shall give priority to
activities that increase Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant
tuberculosis where needed using DOTS-Plus, including funding]
Priority To Stop TB Strategy.--
(1) Priority.--In furnishing assistance under
subsection (c), the President shall give priority to--
(A) activities described in the Stop TB
Strategy, including expansion and enhancement
of DOTS coverage, treatment for individuals
infected with both tuberculosis and HIV and
treatment for individuals with multi-drug
resistant tuberculosis (MDR-TB), strengthening
of health systems, use of the International
Standards for Tuberculosis Care by all
providers, empowering individuals with
tuberculosis, and enabling and promoting
research to develop new diagnostics, drugs, and
vaccines, and program-based operational
research relating to tuberculosis; and
(B) funding for the Global Tuberculosis Drug
Facility, the Stop Tuberculosis Partnership,
and the Global Alliance for TB Drug
Development. [In order to meet the requirement
of the preceding sentence, the President should
ensure that not less than]
(2) Availability of amounts.--In order to meet the
requirements of paragraph (1), the President--
(A) shall ensure that not less than 75
percent of the amount made available to carry
out this section for a fiscal year should be
expended for antituberculosis drugs, supplies,
direct patient services, and training in
diagnosis and treatment [for Directly Observed
Treatment Short-course (DOTS) coverage and
treatment of multi-drug resistant tuberculosis
using DOTS-Plus, including substantially
increased funding for the Global Tuberculosis
Drug Facility.] to implement the Stop TB
Strategy; and
(B) should ensure that not less than
$15,000,000 of the amount made available to
carry out this section for a fiscal year is
used to make a contribution to the Global
Tuberculosis Drug Facility.
(f) Assistance for WHO and the Stop Tuberculosis
Partnership.--In carrying out this section, the President,
acting through the Administrator of the United States Agency
for International Development, is authorized to provide
increased resources to the World Health Organization (WHO) and
the Stop Tuberculosis Partnership to improve the capacity of
countries with high rates of tuberculosis and other affected
countries to implement the Stop TB Strategy and specific
strategies related to addressing extensively drug resistant
tuberculosis (XDR-TB).
[(f)] (g) Definitions.--In this section:
(1) DOTS.--The term ``DOTS'' or ``Directly Observed
Treatment Short-course'' means the World Health
Organization-recommended strategy for treating
tuberculosis, including low cost and effective
diagnosis and evaluation of treatment regimes,
vaccines, and monitoring of tuberculosis, as well as a
reliable drug supply, and a management strategy for
public health systems, with health system
strengthening, promotion of the use of the
International Standards for Tuberculosis Care by all
care providers, bacteriology under an external quality
assessment framework, short-course chemotherapy, and
sound reporting and recording systems.
* * * * * * *
(6) Stop tb strategy.--The term ``Stop TB Strategy''
means the six-point strategy to reduce tuberculosis
developed by the World Health Organization. The
strategy is described in the Global Plan to Stop TB
2007-2016: Actions for Life, a comprehensive plan
developed by the Stop Tuberculosis Partnership that
sets out the actions necessary to achieve the
millennium development goal of cutting tuberculosis
deaths and disease burden in half by 2016.
* * * * * * *