Purpose
This Aggregate Reports for Tuberculosis Program Evaluation (ARPE) report summarizes contact investigation efforts related to TB cases diagnosed in 2022 and summary data from the period 2018-2022 updated through August 5, 2024. The report includes the U.S.-Affiliated Pacific Islands (USAPI).
About the report
Follow-up examination and treatment of contacts to patients with tuberculosis (TB) is a national TB prevention and elimination strategic priority in the United States.
Each year, TB programs report results of their contact investigation activities to CDC by entering the data into the Aggregate Reports for Tuberculosis Program Evaluation (ARPE) form via the National Tuberculosis Indicators Project performance-monitoring tool.
The data are also used by awardees as a tool to evaluate and coordinate TB prevention activities.
The report includes the U.S.-Affiliated Pacific Islands (USAPI), which consist of the U.S. territories of American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam, along with the freely associated states of the Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall Islands.
Data summary
Elicitation and examination of contacts
During the cohort year 2022, 97.2% (70 of 72) of sputum acid-fast bacillus (AFB) smear-positive TB cases diagnosed had contacts elicited. Of the 1,300 contacts elicited, 77.3% (1,005) were evaluated for TB infection. Neither contact elicitation nor contact examination met the 2025 National Performance Targets of 100% and 94%, respectively.
There were several observations in the investigations of sputum AFB smear-positive TB cases. The percentage of contacts elicited and evaluated in 2022 was relatively stable when compared to 2018-2021.
Diagnosis and treatment
Among contacts evaluated, 2.1% (22) were diagnosed with TB disease, and 20.9% (210) were diagnosed with latent TB infection. Treatment of latent TB infection was initiated among 28.1% (59) of infected contacts, and 44.1% (26) of those completed treatment. Both latent TB infection treatment initiation and completion remain below the 2025 National TB Performance Targets of 92% and 93%, respectively.
Latent TB infection treatment initiation steadily increased between 2018 through 2021 (47.0% in 2018, 53.0% in 2019, 55.6% in 2020, 78.8% in 2021) but dropped markedly in 2022 (28.1%). Similarly, latent TB infection treatment completion among those starting treatment declined sharply in 2022 to 44.1% as compared to 2018-2021 (87.1%, 75.8%, 70.8%, and 81.6%, respectively). The reasons for these sharp declines are unclear. Program evaluation can help USAPI jurisdictions understand why these declines occurred in 2022 and provide insight into strategies for improvement.
Appendix A: Sputum smear-positive TB cases
Appendix A. USAPI Counts and Indices for Investigation of Sputum Acid-fast Bacillus (AFB) Smear-Positive TB Cases, 2018-2022A
| Cases and Contacts | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Cases for investigation | 116 | 120 | 105 | 90 | 72 |
| Cases, no contacts | 3 | 0 | 6 | 1 | 2 |
| Number of contacts | 2,411 | 2,166 | 1,217 | 1,756 | 1,300 |
| Evaluated | 1,688 | 1,559 | 962 | 1,258 | 1,005 |
| TB disease | 68 | 53 | 35 | 40 | 22 |
| Latent TB infection | 477 | 480 | 277 | 269 | 210 |
| • Started treatment | 224 | 256 | 154 | 212 | 59 |
| • Completed treatment | 195 | 194 | 109 | 173 | 26 |
| • Treatment outcome unknown/missing | 0 | 0 | 3 | 0 | 23 |
| Reason | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts stopping treatment (n) | 29 | 63 | 42 | 39 | 10 |
| Active TB developed | 1 | 0 | 0 | 2 | 0 |
| Adverse effect of medicine | 6 | 6 | 0 | 1 | 0 |
| Contact chose to stop | 1 | 6 | 4 | 4 | 9 |
| Contact lost to follow-up | 21 | 47 | 36 | 23 | 1 |
| Contact moved (follow-up unknown) | 0 | 2 | 1 | 5 | 0 |
| Death | 0 | 0 | 0 | 0 | 0 |
| Provider decision | 0 | 2 | 1 | 4 | 0 |
| Evaluation Indices (%) | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contact elicitation (%) | 97.4% | 100.0% | 94.3% | 98.9% | 97.2% |
| Contacts per case (N, Average) | 20.8 | 18.0 | 11.6 | 19.5 | 18.0 |
| Contact evaluation (%) | 70.0% | 72.0% | 79.0% | 71.6% | 77.3% |
| TB disease (%) | 4.0% | 3.4% | 3.6% | 3.2% | 2.1% |
| Latent TB Infection (%) | 28.3% | 30.7% | 28.8% | 21.4% | 20.9% |
| Latent TB infection treatment initiated (%) | 47.0% | 53.0% | 55.6% | 78.8% | 28.1% |
| Latent TB infection treatment completed (%) | 87.1% | 75.8% | 70.8% | 81.6% | 44.1% |
| Evaluation Indices (%) | USAPI | US Domestic |
|---|---|---|
| Contact Elicitation (%) | 97.2% | 89.9% |
| Contacts Per Case (N, Average) | 18.0 | 9.9 |
| Contact Examination (%) | 77.3% | 72.5% |
| TB Disease (%) | 2.1% | 1.6% |
| Latent TB Infection (%) | 20.9% | 19.4% |
| Latent TB infection treatment initiated (%) | 28.1% | 76.2% |
| Latent TB infection treatment completed (%) | 44.1% | 79.7% |
Figure 1: Proportion of TB patients with contacts elicited
| Cohort Period | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Total Sputum AFB Smear-Positive TB Cases for Investigation (N) | 116 | 120 | 105 | 90 | 72 |
| Cases with Contacts Elicited (n) | 113 | 120 | 99 | 89 | 70 |
| Cases with No Contacts (n) | 3 | 0 | 6 | 1 | 2 |
National objective
Increase the proportion of TB patients with positive acid-fast bacillus (AFB) sputum-smear results who have contacts elicited to 100.0% by 2025.
Sputum AFB smear-positive TB Cases with contacts elicited = Number of sputum AFB smear-positive TB cases for investigation - Number of sputum AFB smear-positive TB cases with no contacts.
Indicator
Percent of sputum AFB smear-positive TB cases with contacts elicited
Cohort
Sputum AFB smear-positive TB cases are counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data sources
ARPEs (Contacts) fields, a1 (Sputum smear+ Cases for Investigation), b1 (Sputum smear + Cases with No Contacts)
Calculation
[(Number of sputum AFB smear-positive TB cases with contacts elicited) / Cohort] x 100.
Figure 2: Evaluation of contacts
| Cohort Period | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Total Contacts to Sputum AFB Smear-Positive TB Cases (N) | 2,411 | 2,166 | 1,217 | 1,756 | 1,300 |
| Contacts Examined (n) | 1,688 | 1,559 | 962 | 1,258 | 1,005 |
| Contacts Not Examined (n) | 723 | 607 | 255 | 498 | 295 |
National objective
Increase the proportion of contacts to sputum AFB smear-positive TB cases who are examined for infection and disease to 94.0% by 2025.
Contacts are counted as evaluated if they have been tested and examined to the point where a final determination of diagnosis is either latent TB infection or TB disease.
Indicator
Percent of contacts to sputum AFB smear-positive TB cases examined for infection and disease
Cohort
Contacts to sputum AFB smear-positive TB cases counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data sources
ARPEs (Contacts) fields, c1 (Number of Contacts to Sputum smear+ Cases), d1 (Contacts to Sputum smear + Cases Evaluated)
Calculation
[Number of contacts to sputum AFB smear-positive TB cases evaluated / Cohort] x 100.
Figure 3: Latent TB infection treatment initiation
| Cohort Period | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts to Sputum AFB Smear-Positive TB Cases Diagnosed with Latent TB Infection (N) | 477 | 480 | 277 | 269 | 210 |
| Contacts Who Started Treatment (n) | 224 | 256 | 154 | 212 | 59 |
| Contacts Who Did Not Start Treatment (n) | 253 | 224 | 123 | 57 | 151 |
National objective
Increase the proportion of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who start treatment to 92.0% by 2025.
Indicator
Percent of contacts to sputum AFB smear-positive TB cases diagnosed with latent TB infection who started treatment. Contacts are counted as having started treatment after taking the first dose of a treatment course.
Cohort
Contacts to sputum AFB smear-positive TB cases who have newly diagnosed latent TB infection, counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data Sources
ARPEs (Contacts) fields, f1 (Contacts to Sputum smear+ Cases with Latent TB Infection), g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment)
Calculation
[Number of contacts diagnosed with latent TB infection who started treatment/ Cohort] x 100.
Figure 4: Latent TB infection treatment completion
| Cohort Period | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Total Contacts to Sputum AFB Smear-Positive TB Cases Who Have Started Treatment for Latent TB Infection (N) | 224 | 256 | 154 | 212 | 59 |
| Contacts Who Completed Treatment (n) | 195 | 194 | 109 | 173 | 26 |
| Contacts Who Did Not Complete Treatment (n) | 29 | 62 | 45 | 39 | 33 |
National objective
For contacts to sputum AFB smear-positive TB cases who have started treatment for latent TB infection, increase the proportion who complete treatment to 93.0% by 2025.
Indicator
Percent of contacts to sputum AFB smear-positive TB cases who complete treatment.
Cohort
Contacts to sputum AFB smear-positive TB cases with newly diagnosed latent TB infection and have started treatment are counted in the cohort period of interest. Records with a variable(s) for which exclusion criteria cannot be assessed are included in the analytic cohort.
Data sources
ARPEs (Contacts) fields, g1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Started Treatment), h1 (Contacts to Sputum smear+ Cases Diagnosed with Latent TB Infection Who Completed Treatment)
Calculation
[Number of contacts diagnosed with latent TB infection who completed treatment / Cohort] x 100
Figure 5: Number of contacts to AFB-smear positive TB cases
Number of contacts to AFB-smear positive TB cases by examination and treatment disposition
Appendix B: Sputum smear-negative, culture positive TB cases
Appendix B. USAPI Counts and Indices for Investigation of Sputum AFB Smear-Negative, Culture-Positive TB Cases, 2018-2022B
| Cases and Contacts | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Cases for investigation | 53 | 26 | 25 | 20 | 18 |
| Cases, no contacts | 2 | 5 | 5 | 1 | 0 |
| Number of contacts | 425 | 167 | 164 | 142 | 233 |
| Evaluated | 114 | 130 | 125 | 125 | 159 |
| TB disease | 2 | 0 | 0 | 6 | 0 |
| Latent TB Infection | 25 | 53 | 54 | 29 | 54 |
| • Started treatment | 14 | 27 | 43 | 17 | 23 |
| • Completed treatment | 9 | 21 | 27 | 16 | 13 |
| • Treatment outcome unknown/missing | 4 | 0 | 2 | 0 | 6 |
| Reason | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts stopping treatment (n) | 1 | 6 | 14 | 1 | 4 |
| Active TB developed | 0 | 0 | 0 | 0 | 0 |
| Adverse effect of medicine | 1 | 0 | 0 | 0 | 0 |
| Contact chose to stop | 0 | 0 | 0 | 1 | 4 |
| Contact lost to follow-up | 0 | 6 | 13 | 0 | 0 |
| Contact moved (follow-up unknown) | 0 | 0 | 0 | 0 | 0 |
| Death | 0 | 0 | 1 | 0 | 0 |
| Provider decision | 0 | 0 | 0 | 0 | 0 |
| Evaluation Indices (%) | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contact elicitation (%) | 96.2% | 80.8% | 80.0% | 95.0% | 100% |
| Contacts per case (N, Average) | 8.01 | 6.4 | 6.6 | 7.1 | 12.9% |
| Contact evaluation (%) | 26.8% | 77.8% | 76.2% | 88.0% | 68.2% |
| TB disease (%) | 1.7% | 0% | 0% | 4.8% | 0% |
| Latent TB Infection (%) | 21.9% | 40.8% | 43.2% | 23.2% | 34.0% |
| Latent TB infection treatment initiated (%) | 56.0% | 50.9% | 79.6% | 58.6% | 42.6% |
| Latent TB infection treatment completed (%) | 64.3% | 77.7% | 62.8% | 94.1% | 56.5% |
Appendix C: Other*
Appendix C. USAPI Counts and Indices for Investigation of Other* Cases, 2018-2022C
Other = Contact investigations not captured in investigating sputum acid-fast bacillus (AFB) smear-positive or sputum AFB smear-negative, culture-positive. For example: Associate-contact or source-case investigations done because of a child with TB.
| Contacts | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Number of contacts | 0 | 46 | 11 | 11 | 81 |
| Evaluated | 0 | 21 | 7 | 11 | 19 |
| TB disease | 0 | 1 | 0 | 0 | 0 |
| Latent TB Infection | 0 | 9 | 5 | 11 | 12 |
| • Started treatment | 0 | 5 | 3 | 8 | 3 |
| • Completed treatment | 0 | 2 | 3 | 6 | 0 |
| • Treatment outcome unknown/missing | 0 | 0 | 3 | 0 | 3 |
| Reason | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contacts stopping treatment (n) | 0 | 3 | 0 | 2 | 0 |
| Active TB developed | 0 | 0 | 0 | 0 | 0 |
| Adverse effect of medicine | 0 | 0 | 0 | 0 | 0 |
| Contact chose to stop | 0 | 0 | 0 | 0 | 0 |
| Contact lost to follow-up | 0 | 3 | 0 | 2 | 0 |
| Contact moved (follow-up unknown) | 0 | 0 | 0 | 0 | 0 |
| Death | 0 | 0 | 0 | 0 | 0 |
| Provider decision | 0 | 0 | 0 | 0 | 0 |
| Evaluation Indices (%) | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|
| Contact evaluation (%) | -- | 45.7% | 63.6% | 100.0% | 76.5% |
| TB disease (%) | -- | 4.8% | 0% | 0% | 0% |
| Latent TB Infection (%) | -- | 42.9% | 71.4% | 100.0% | 63.2% |
| Latent TB infection treatment initiated (%) | -- | 55.6% | 60.0% | 72.7% | 25% |
| Latent TB infection treatment completed (%) | -- | 40.0% | 100.0% | 75.0% | 0% |
- Reporting jurisdictions: All jurisdictions reported data for 2018-2021: American Samoa, the Federated States of Micronesia, Guam, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, and the Republic of the Marshall Islands. The Federated States of Micronesia did not report in 2022. All other jurisdictions reported. Data shown in tables and figures are up to date as of August 5, 2024.
- Reporting jurisdictions: the Federated States of Micronesia and Samoa did not report 2018 data. The Federated States did not report 2019 data. American Samoa did not report 2020 or 2021 data. The Federated States of Micronesia and American Samoa did not report 2022 data. Data shown in tables and figures are up to date as of August 5, 2024.
- Reporting jurisdictions: No data was reported in 2018. Guam, Palau, and Northern Marian Islands reported 2019 data. Guam and the Republic of Palau reported 2020 -2022 data. Data shown in tables and figures are up to date as of August 5, 2024.