,,ii #aafth ,,congress #ast ,session ,s4 #bdch ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #a1 #bjai ,mr4 ,menendez 7for himself and ,mr4 ,young7 introduced the following bill2 which was read twice and referred to the ,committee on ,foreign ,relations ,a ,,bill ,to prevent1 treat1 and cure tuberculosis globally4 #a4 ,short title ,this ,act may be cited as the ,end ,tuberculosis ,now ,act of #bjai4 #b4 ,findings ,congress makes the following findings3 7#a7 ,tuberculosis is a preventable1 treatable1 and curable airborne infection2 however more than #be years after the ,world ,health ,organization declared tuberculosis a public health emergency and called on countries to make scaling up tuberculosis control a priority1 tuberculosis still kills more people worldwide than any other infectious disease1 and is the leading killer of people living with ,,hiv_/,,aids4 7#b7 ,in #bjag1 #aj1jjj1jjj people became ill with tuberculosis1 #aj percent of whom were children1 and #a1fjj1jjj people died from the disease4 ,in order to achieve the goals of the ,world ,health ,organization ,end ,,tb ,strategy by #bjce1 new tools must be developed and made available4 7#c7 ,over one-third of people who become ill with tuberculosis may be undiagnosed1 misdiagnosed1 or treated but not reported1 resulting in unnecessary illness1 communicable infections1 and increased mortality4 7#d7 ,failure to properly treat tuberculosis can cause treatment failure and death1 and exacerbates antimicrobial resistance1 increasing multi-drug-resistant tuberculosis 7,,mdr-,,tb7 and extensively drug-resistant tuberculosis 7,,xdr-,,tb71 which are significantly costlier and more difficult to treat than drug-sensitive tuberculosis and can also be transmitted from person-to-person1 increasing the likelihood that drug-resistant tuberculosis will spread to new geographic areas4 7#e7 ,globally1 only about half of the #ac1jjj1jjj1jjj required annually as outlined in the ,stop ,,tb ,partnership's ,global ,plan to ,end ,,tb for tuberculosis prevention1 diagnosis1 and treatment is currently available4 7#f7 ,there is an annual #a1cjj1jjj1jjj gap in funding needed for the development of vaccines1 additional rapid1 point-of-care diagnostic tests1 and shorter1 less toxic treatments which would facilitate patient adherence to treatment regimens1 reduce program costs1 and mitigate the growing threat of drug-resistant tuberculosis4 ,the ,united ,states ,government continues to be a lead funder of global tuberculosis research and development1 contributing #dj percent of the total #ggb1jjj1jjj in global funding in #bjag1 and can catalyze more investments from other countries4 7#g7 ,the rate of new cases of tuberculosis in countries that receive ,united ,states bilateral assistance for tuberculosis prevention1 treatment1 and control has fallen by one quarter since #bjjj demonstrating the effectiveness of ,united ,states programs and activities4 7#h7 ,in ,september #bjah1 ,united ,nations ,member ,states in the first ,united ,national ,high ,level ,meeting on ,tuberculosis committed to ending the epidemic in all countries1 and pledged to provide leadership and to work together to accelerate our national and global collective actions1 investments1 and innovations urgently to fight this preventable and treatable disease1 as reflected in ,united ,nations ,general ,assembly ,resolution ,a_/,,res_/#gc_/c4 7#i7 ,on ,september #bf1 #bjah1 the ,united ,nations convened the first ,high ,level ,meeting on ,tuberculosis1 where #abj countries signed a ,political ,declaration to accelerate progress against tuberculosis1 including commitments to increase funding for tuberculosis control and research and development programs1 as well as ambitious goals to successfully treat #dj1jjj1jjj people with tuberculosis and prevent at least #cj1jjj1jjj from becoming ill between #bjah and #bjbb4 7#aj7 ,on ,september #bf1 #bjah1 the ,administrator for the ,united ,states ,agency for ,international ,development 7,,usaid7 announced a new business model to support the fight to end tuberculosis 7,,tb74 ,through #cj1jjj1jjj in funding and a new performance-based ,global ,accelerator to ,end ,,tb1 ,,usaid will catalyze investments to meet the target set by the ,united ,nations ,high-,level ,meeting on tuberculosis of treating #dj1jjj1jjj people with the disease by #bjbb4 ,the ,accelerator will increase support to governments and local partners as part of a multisectoral approach to ending tuberculosis4 7#aa7 ,it is essential that existing funding for tuberculosis programs be allocated prudently1 and with an emphasis on coordination1 to ensure that efforts among ,united ,states agencies1 partner nations1 international organizations1 nongovernmental organizations1 both faith-based and non-faith-based1 the private sector and other actors are complementary and not duplicative4 ,improved data on tuberculosis1 access to services1 accountability1 and program quality can help ensure funding gets to where it is most needed4 7#ab7 ,if progress does not accelerate1 the global tuberculosis epidemic1 particularly increasing cases of ,,mdr-,,tb and ,,xdr-,,tb1 where many cases are not curable and vastly more costly to treat1 could erase decades of progress in global efforts to end both tuberculosis and ,,hiv_/,,aids1 much of which has been achieved with ,united ,states investment4 #c4 ,united ,states ,government actions to end tuberculosis ,section #ajd;,b of the ,foreign ,assistance ,act of #aifa 7#bb ,u4,s4,c4 #baea;b-#c7;g77 is amended by striking subsections 7a7 through 7h7 and inserting the following new subsections3 7a7 ,findings ,congress makes the following findings3 7#a7 ,congress recognizes the continuing challenge of the international tuberculosis epidemic and the deadly impact of its continued existence4 7#b7 ,the means exist to detect1 treat1 prevent1 and cure tuberculosis to a large extent1 but not enough to ensure ending it1 due to inadequate means of diagnosis1 prevention1 and treatment4 7#c7 ,absent accelerated efforts to address tuberculosis and increased domestic mobilization of resources from high-burden tuberculosis countries1 targets set forth in the ,end ,,tb ,strategy will not be met4 7b7 ,policy ,it is a major objective of the foreign assistance program of the ,united ,states to help end the global tuberculosis epidemic through actions to diagnose and treat all adults and children with all forms of tuberculosis1 including tuberculosis infection1 and to prevent new tuberculosis infections in adults and children4 ,in all countries in which the ,united ,states ,government has established development programs1 particularly in countries with the highest burden of tuberculosis and other countries with high rates of tuberculosis1 it is the policy of the ,united ,states to-- 7#a7 support the objectives of the ,world ,health ,organization ,end ,,tb ,strategy1 including goals to-- 7,a7 reduce by #ie percent tuberculosis deaths by #bjce2 7,b7 reduce by #ij percent the tuberculosis incidence rate by #bjce2 and 7,c7 reduce by #ajj percent the number of families facing catastrophic health costs due to tuberculosis by #bjce2 7#b7 support the ,stop ,,tb ,partnership's ,global ,plan to ,end ,,tb #bjaf-bjbj1 including support for-- 7,a7 development and use of innovative new technologies and therapies to increase active case finding to rapidly diagnose and treat children and adults with all forms of tuberculosis1 alleviate suffering1 and ensure tuberculosis treatment completion2 7,b7 the diagnosis and treatment of latent tuberculosis infection1 in support of the global goal of providing preventive therapy to at least #cj1jjj1jjj people1 including #d1jjj1jjj children under five years of age1 #bj1jjj1jjj household contacts of people affected by tuberculosis1 and #f1jjj1jjj people living with ,,hiv1 by #bjbb2 7,c7 steps to ensure high-quality tuberculosis care by closing gaps in care cascades1 implementing continuous quality improvement at all levels of care1 and providing patient support2 and 7,d7 sustainable procurement of tuberculosis commodities1 to avoid interruptions in supply1 procurement of commodities of unknown quality1 or payment of excessive commodity costs in countries impacted by tuberculosis2 7#c7 ensure ,united ,states funding supports activities that simultaneously emphasize-- 7,a7 the development of comprehensive person-centered programs which include diagnosis1 treatment1 and prevention strategies to ensure that those at high risk for infection are found and treated with preventive therapies in a timely manner2 7,b7 robust tuberculosis infection control practices in all congregate settings1 including hospitals and prisons2 7,c7 the deployment of diagnostic and treatment capacity in areas with the highest tuberculosis burdens1 as well as for highly at-risk and impoverished populations1 including patient support2 7,d7 program monitoring and evaluation based on critical tuberculosis indicators1 including infection control1 the numbers of patients accessing tuberculosis treatment1 along with patient support1 and preventative therapy for those at risk1 including all close contacts1 as well as treatment completion for all forms of tuberculosis2 7,e7 training health care workers on the use of new diagnostic tools and therapies as they become available2 7,f7 coordination with domestic agencies on an aggressive research agenda to develop vaccines as well as new tools to diagnose1 treat1 and prevent tuberculosis globally2 7,g7 linkages with the private sector on improved diagnosis and treatment of tuberculosis1 training for healthcare professionals on use of the most effective diagnostic and therapeutic tools1 and research in the areas of vaccine development as well as the development of therapeutics and diagnostic tools2 7,h7 efforts to address barriers to patients seeking care including stigma and costs related to diagnosis and treatment2 7,i7 efforts to address human rights-related barriers to tuberculosis services1 including-- 7i7 training health workers2 7ii7 sensitizing policy makers2 7iii7 legal literacy and patient empowerment campaigns2 7iv7 strengthening legal services2 and 7v7 monitoring laws and policies2 and 7,j7 the establishment of independent accountability mechanisms and inclusive country level systems to measure progress and ensure that commitments made by governments and relevant stakeholders are met4 7c7 ,authorization ,to carry out this section and consistent with section #ajd7;c71 the ,president is authorized to furnish assistance1 on such terms and conditions as the ,president may determine1 for the prevention1 treatment1 control1 and elimination of tuberculosis4 7d7 ,goals ,in consultation with the appropriate congressional committees1 the ,president shall establish new goals for ,united ,states efforts1 based on the policy and indicators described in subsection 7b71 to reach1 cure1 and prevent all forms of tuberculosis globally over the #e-year period following the date of the enactment of this subsection by updating the ,united ,states ,government ,tuberculosis ,strategy 7#bjae-bjai7 and the ,national ,action ,plan for ,combatting ,multidrug-,resistant ,tuberculosis4 7e7 ,coordination 7#a7 ,in general ,in carrying out this section1 the ,president shall coordinate with the ,world ,health ,organization1 the ,stop ,,tb ,partnership1 the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria1 and other organizations with respect to the development and implementation of a comprehensive tuberculosis response program4 7#b7 ,bilateral assistance ,in providing bilateral assistance under this section1 the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 shall-- 7,a7 coordinate and catalyze intensified international tuberculosis research and development1 prevention1 diagnosis1 treatment1 and control efforts1 particularly to reduce the incidence of1 and mortality from1 all forms of drug resistant tuberculosis2 and 7,b7 ensure coordination among relevant ,united ,states ,government agencies and programs1 including the ,centers for ,disease ,control and ,prevention1 the ,national ,institutes of ,health1 the ,biomedical ,advanced ,research and ,development ,authority1 the ,food and ,drug ,administration1 the ,national ,science ,foundation1 the ,department of ,defense ,congressionally ,directed ,medical ,research ,program1 and the ,president's ,emergency ,plan for ,,aids ,relief 7,,pepfar71 that engage in international tuberculosis activities to ensure accountability and transparency1 reduce duplication of efforts1 ensure equitable shares in domestic expenditure and advancement on research and development1 and ensure appropriate integration and coordination of tuberculosis services into other ,united ,states-supported health programs4 7f7 ,priority to ,end ,,tb ,strategy ,in furnishing assistance under subsection 7b71 the ,president shall give priority to-- 7#a7 direct1 high-quality services for all forms of tuberculosis described in international policies and guidelines1 with a preference for programs that implement a coordinated package of active case finding1 treatment of all forms of tuberculosis disease and infection1 patient support and tuberculosis prevention2 7#b7 individuals infected with both tuberculosis and ,,hiv1 and other co-morbidities1 treatment for individuals with ,,mdr-,,tb1 ,,xdr-,,tb1 strengthening of health systems1 use of the latest ,international ,standards for ,tuberculosis ,care by all providers1 and empowering individuals with tuberculosis2 7#c7 enabling and promoting tuberculosis research to develop innovative new diagnostics1 drug therapies1 and vaccines1 and program-based operational research2 and 7#d7 funding for the ,stop ,tuberculosis ,partnership's ,global ,drug ,facility the ,stop ,tuberculosis ,partnership1 and the ,global ,alliance for ,tuberculosis ,drug ,development4 7g7 ,assistance for the ,world ,health ,organization and the ,stop ,tuberculosis ,partnership ,in carrying out this section1 the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 is authorized to provide increased resources to the ,world ,health ,organization and the ,stop ,tuberculosis ,partnership to improve the capacity of countries with high rates of tuberculosis and other affected countries to implement the ,stop ,tuberculosis ,strategy and specific strategies related to addressing ,,mdr-,,tb and ,,xdr-,,tb4 7h7 ,annual report on tuberculosis activities ,the ,president shall submit an annual report to ,congress that describes the impact of ,united ,states foreign assistance on efforts to control tuberculosis1 including-- 7#a7 the number of people with active tuberculosis and the number with tuberculosis infection diagnosed and treated1 including the rate of treatment completion and the number receiving patient support1 in countries receiving ,united ,states bilateral foreign assistance for tuberculosis control purposes2 7#b7 the number of persons who have been diagnosed and started treatment for ,,mdr-,,tb and ,,xdr-,,tb in countries receiving ,united ,states bilateral foreign assistance for tuberculosis control programs2 7#c7 a description of the collaboration and coordination of ,united ,states anti-tuberculosis efforts with the ,world ,health ,organization1 the ,global ,fund1 and other major public and private entities2 7#d7 a description of the collaboration and coordination among the ,united ,states ,agency for ,international ,development and other ,united ,states agencies1 including the ,centers for ,disease ,control and the ,office of the ,global ,,aids ,coordinator1 for the purposes of combatting tuberculosis2 7#e7 the constraints on implementation of programs posed by health workforce shortages1 heath system limitations1 and other capacities2 7#f7 the numbers of people trained by the ,united ,states ,government in tuberculosis surveillance and control2 7#g7 a breakdown of expenditures for direct patient tuberculosis services1 drugs and other commodities1 drug management1 training in diagnosis and treatment1 health systems strengthening1 research1 and support costs2 and 7#h7 for each country receiving bilateral ,united ,states assistance for the purpose of tuberculosis prevention1 treatment1 and control-- 7,a7 a description of progress to adopt and implement the most recent ,world ,health ,organization guidelines to improve diagnosis1 treatment1 and prevention of tuberculosis for adults and children1 disaggregated by sex1 including the proportion of health facilities which have adopted the latest ,,who guidelines on strengthening surveillance systems and preventative1 diagnostic1 and therapeutic methods1 including the use of rapid diagnostic tests and orally administered ,,tb treatment regimens2 7,b7 the rate of tuberculosis incidence for adults and children1 disaggregated by sex1 and a description of progress in implementing measures to reduce incidence1 including the number of adults and children receiving tuberculosis preventive therapy1 including people with ,,hiv and all close contacts1 disaggregated by sex1 and the establishment of effective tuberculosis infection control in all congregant settings1 including hospitals1 clinics1 and prisons2 7,c7 a description of progress to expand diagnosis1 prevention1 and treatment for all forms of tuberculosis1 including in pregnant women1 children1 and other high-risk groups who are vulnerable or in vulnerable situations1 such as migrants1 prisoners1 miners1 and others exposed to silica1 and people living with ,,hiv_/,,aids1 disaggregated by sex2 7,d7 the rate of successful completion of tuberculosis treatment for adults and children1 disaggregated by sex1 and the number of patients receiving support for treatment completion2 7,e7 the number of people1 disaggregated by sex1 receiving treatment for ,,mdr-,,tb1 the proportion of those treated with the latest regimens endorsed by the ,world ,health ,organization1 any factors impeding scale up of such treatment1 and a description of progress to expand community-based ,,mdr-,,tb care2 7,f7 a description of tuberculosis commodity procurement challenges1 including shortages1 stockouts1 or failed tenders for tuberculosis drugs or other commodities2 7,g7 the proportion of health facilities with specimen referral linkages to ,gene,xpert testing sites1 and to reference labs for second line drug resistance testing1 and a description of the turnaround time for test results2 7,h7 the number of people trained by the ,united ,states ,government to deliver high-quality tuberculosis surveillance1 laboratory services1 prevention1 treatment1 and care2 7,i7 a description of activities that serve to coordinate and leverage countries' domestic resources1 including development of plans1 procedures1 and disease estimates that support effective use of resources from the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria2 and 7,j7 the full text of any ,statement of ,partnership agreed to by the ministry of health and the ,united ,states ,agency for ,international ,development to establish a shared framework combatting tuberculosis4 7i7 ,annual report on tuberculosis research and development ,the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 shall submit to ,congress an annual report1 to be prepared in coordination with the ,national ,institutes of ,health1 the ,centers for ,disease ,control and ,prevention1 the ,biomedical ,advanced ,research and ,development ,authority 7,,barda71 the ,food and ,drug ,administration1 the ,national ,science ,foundation1 the ,department of ,defense ,congressionally ,directed ,medical ,research ,program1 and the ,president's ,emergency ,plan for ,,aids ,relief 7,,pepfar7-- 7#a7 describing current progress and challenges to the development of new tools for the purpose of tuberculosis prevention1 treatment1 and control2 7#b7 identifying critical gaps and emerging priorities for research and development1 including for rapid and point-of-care diagnostics1 shortened treatments and prevention methods1 and vaccines2 and 7#c7 describing research investments by type1 funded entities1 and level of investment4 7j7 ,evaluation report 7#a7 ,in general ,not later than one year after the date of the enactment of this subsection1 and every #e years thereafter1 the ,comptroller ,general of the ,united ,states shall submit to the ,administrator of the ,united ,states ,agency for ,international ,development and the appropriate congressional committees a report that evaluates the performance and impact on tuberculosis prevention1 diagnosis1 treatment1 and care efforts that are supported by ,united ,states bilateral assistance funding1 including recommendations for improving such programs4 7#b7 ,form ,the report required under paragraph 7#a7 shall be submitted in unclassified form1 but may contain a classified annex if necessary4 7#c7 ,public availability ,the ,comptroller ,general shall publish the unclassified portion of the report required under paragraph 7#a7 on a publicly available website of the ,government ,accountability ,office4 7k7 ,definitions ,in this section3 7#a7 ,appropriate congressional committees ,the term appropriate congressional committees means the ,committee on ,foreign ,relations of the ,senate and the ,committee on ,foreign ,affairs of the ,house of ,representatives4 7#b7 ,global ,alliance for ,tuberculosis ,drug ,development ,the term ,global ,alliance for ,tuberculosis ,drug ,development means the public-private partnership that bring together leaders in health1 science1 philanthropy1 and private industry to devise new approaches to tuberculosis4 7#c7 ,global ,tuberculosis ,drug ,facility ,the term ,global ,tuberculosis ,drug ,facility 7,,gdf7 means the initiative of the ,stop ,tuberculosis ,partnership to increase access to the most advanced1 affordable1 quality-assured tuberculosis drugs and diagnostics4 7#d7 ,end ,,tb ,strategy ,the term ,end ,,tb ,strategy means the strategy to eliminate tuberculosis approved by the ,world ,health ,assembly in ,may #bjad1 which is described in ,the ,end ,,tb ,strategy3 ,global ,strategy and ,targets for ,tuberculosis ,prevention1 ,care and ,control after #bjae4 7#e7 ,stop ,tuberculosis ,partnership ,the term ,stop ,tuberculosis ,partnership means the partnership of the ,united ,nations ,office for ,project ,services1 donors including the ,united ,states1 high-burden tuberculosis countries1 multilateral agencies1 and nongovernmental and technical agencies committed to short- and long-term measures required to control and eventually eliminate tuberculosis as a public health problem in the world4 4