Using the tuberculosis cohort review to evaluate and improve the U.S. Army's tuberculosis control program

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Military Medicine

Background:

• Tuberculosis (TB) control in the U.S. military is complicated by factors like deployments and congregate living.
• The U.S. Military Health System requires specific strategies for managing TB in a dispersed and mobile population.

Purpose of the Study:

• To evaluate the quality and effectiveness of the U.S. Army's TB control program.
• To assess TB control indicators using a cohort review process within the U.S. Army.

Main Methods:

• A TB cohort review process was implemented.
• Analysis of 10 TB disease cases occurring at U.S. Army installations in 2011.

Main Results:

• Two active component U.S. Army cases (0.4/100,000); none linked to deployment.
• Eight cases (80%) were foreign-born; 70% were smear-positive; 10% had multi-drug resistant TB.
• Median time to diagnosis was 98 days; 100% of eligible cases completed therapy.

Conclusions:

• The TB cohort review methodology was successfully applied to a military population for the first time.
• Most TB control performance indicators in the U.S. Army met or neared national standards.
• Despite challenges, the U.S. Army's TB control program demonstrates effectiveness, though diagnostic delays require attention.