,,ii #aagth ,,congress #ast ,session ,s4 #cchf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ad1 #bjba,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 #bjba4 #b4 ,findings ,congress makes the following findings3 7#a7 ,more than #be years after the ,world ,health ,organization declared ,tuberculosis 7referred to in this ,act as ,,tb7 a public health emergency and called on countries to make scaling up tuberculosis control a priority1 ,,tb remains a deadly health threat despite the fact that ,,tb is a preventable1 treatable1 and curable disease4 7#b7 ,in #bjai alone1 an estimated #aj1jjj1jjj people became ill with ,,tb1 #aj percent of whom were children1 and #a1djj1jjj of whom died4 ,in order to achieve by #bjce the goals of the ,political ,declaration of the ,high-,level ,meeting of the ,general ,assembly on the ,fight ,against ,tuberculosis1 adopted by the ,united ,nations ,general ,assembly ,october #aj1 #bjah1 and of the ,world ,health ,organization ,end ,,tb ,strategy1 adopted by the ,world ,health ,assembly in #bjad1 new tools must be developed and made available4 7#c7 ,over #a_/c of people who become ill with ,,tb may be undiagnosed or misdiagnosed1 resulting in unnecessary illness1 communicable infections1 and increased mortality4 7#d7 ,since ,march #bjbj1 the ,,covid-#ai pandemic has severely disrupted ,,tb responses in low- and middle-income countries1 stalling and reversing years of progress made against ,,tb1 with detection dropping by #ej percent and an estimated #a1jjj1jjj fewer people will be diagnosed and enrolled on ,,tb treatment4 7#e7 ,in ,may #bjbj1 a modeling study conducted by the ,stop ,tuberculosis ,partnership 7referred to in this ,act as the ,stop ,,tb ,partnership7 in collaboration with the ,united ,states ,agency for ,international ,development 7referred to in this ,act as ,,usaid7 and partners estimated that a #c-month global lockdown followed by a protracted #aj-month restoration could lead to an additional #f1cjj1jjj cases of ,,tb between #bjbj and #bjbe and an additional #a1djj1jjj ,,tb deaths during this period1 causing a setback of at least #e to #h years in the fight against ,,tb4 7#f7 ,findings released by the ,stop ,,tb ,partnership on ,march #ah1 #bjba1 found that ,,tb diagnosis and enrolment on treatment in #bjbj declined by an estimated total of #a1jjj1jjj cases in #i countries that collectively represent #fj percent of the global ,,tb caseload1 pushing the ,,tb response back to #bjjh levels in terms of people diagnosed and treated4 7#g7 ,failure to properly diagnose and treat ,,tb can lead to death and can exacerbate antimicrobial resistance1 a key contributor to rising cases of multi-drug-resistant tuberculosis1 and extensively drug-resistant tuberculosis1 and increasing the probability of the introduction of resistant ,,tb into new geographic areas4 7#h7 ,,tb programs have played a central role in responding to ,,covid-#ai1 including through leveraging the expertise of medical staff with expertise in ,,tb and lung diseases1 the repurposing of ,,tb hospitals1 and the use of the ,,tb rapid molecular testing platforms and ,x-,ray equipment for multiple purposes1 including ,,covid-#ai4 7#i7 ,with sufficient resourcing1 ,,tb program expertise1 infection control1 laboratory capacity1 active case finding and contact investigation1 can serve as a platform for respiratory pandemic response against existing and new infectious respiratory disease without such a response necessitating the disruption of ongoing ,,tb programs and activities4 7#aj7 ,globally1 only about #a_/b of the #ac1jjj1jjj1jjj required annually outlined in the ,stop ,,tb ,partnership's ,global ,plan to ,end ,,tb for tuberculosis prevention1 diagnosis1 and treatment is currently available4 7#aa7 ,an estimated additional #c1ejj1jjj1jjj will be needed during #bjba for ,,tb programs in countries eligible for ,global ,fund for ,,aids1 ,tuberculosis1 and ,malaria programming to recover from the negative impacts of ,,covid-#ai1 with a total annual gap of at least #h1jjj1jjj1jjj for ,,tb diagnosis1 prevention1 and treatment in such countries4 7#ab7 ,on ,september #bf1 #bjah1 the ,united ,nations convened the first ,high-,level ,meeting of the ,general ,assembly on the ,fight ,against ,tuberculosis1 at which #abj countries-- 7,a7 signed a ,political ,declaration to accelerate progress against ,,tb1 including commitments to increase funding for ,,tb control and research and development programs1 and ambitious goals to successfully treat #dj1jjj1jjj people with tuberculosis and prevent at least #cj1jjj1jjj from becoming ill with ,,tb between #bjah and #bjbb2 and 7,b7 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 investments and innovations urgently to fight this preventable and treatable disease1 as reflected in ,united ,nations ,general ,assembly ,resolution ,a_/,,res_/#gc_/c4 7#ac7 ,the ,united ,states ,government continues to be a lead funder of global ,,tb research and development1 contributing #dd percent of the total #ija1jjj1jjj in global funding in #bjai1 and can catalyze more investments from other countries4 7#ad7 ,working with governments and partners around the world1 the ,,tb efforts by ,,usaid have saved #fj1jjj1jjj lives1 demonstrating the effectiveness of ,united ,states programs and activities4 7#ae7 ,on ,september #bf1 #bjah1 the ,,usaid ,administrator announced a new performance-based ,global ,accelerator to ,end ,,tb1 aimed at catalyzing investments to meet the target set by the ,united ,nations ,high-,level ,meeting on tuberculosis of treating #dj1jjj1jjj people with the disease by #bjbb1 further demonstrating the critical role that ,united ,states leadership and assistance plays in the fight to eliminate ,,tb4 7#af7 ,it is essential to ensure that efforts among ,united ,states ,government agencies1 partner nations1 international organizations1 nongovernmental organizations1 the private sector1 and other actors are complementary and not duplicative in order to achieve the goal of ending the ,,tb epidemic in all countries4 #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 is amended to read as follows3 #ajd;,b4 ,assistance to combat tuberculosis 7a7 ,findings ,congress makes the following findings3 7#a7 ,congress recognizes the continuing challenge of the international spread of tuberculosis1 and the deadly impact of the continued existence of ,,tb4 7#b7 ,additional tools and resources are required to effectively diagnose1 prevent1 and treat tuberculosis4 7#c7 ,effectively resourced tuberculosis programs can serve as a critical platform for respiratory pandemic response against existing and new infectious respiratory disease4 7b7 ,policy ,it is a major objective of the foreign assistance program of the ,united ,states to help end the global tuberculosis pandemic through actions to support the diagnosis and treatment of all adults and children with all forms of tuberculosis1 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-- 7#a7 to support the objectives of the ,world ,health ,organization ,end ,,tb ,strategy1 including goals-- 7,a7 to reduce by #ie percent tuberculosis deaths by #bjce2 7,b7 to reduce by #ij percent the tuberculosis incidence rate by #bjce2 and 7,c7 to reduce by #ajj percent the number of families facing catastrophic health costs due to tuberculosis by #bjce2 7#b7 to support the ,stop ,,tb ,partnership's ,global ,plan to ,end ,,tb #bjah-bjbb1 and any follow up plan1 including support for-- 7,a7 developing and using 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 providing diagnosis and treatment with the goal of successfully treating #dj1jjj1jjj people with tuberculosis by #bjbb1 including #c1ejj1jjj children1 and #a1ejj1jjj people with drug-resistant tuberculosis in support of the target set by the ,political ,declaration of the ,high-,level ,meeting of the ,general ,assembly on the ,fight ,against ,tuberculosis2 7,c7 diagnosing and treating latent tuberculosis infection1 in support of the global goal of providing preventive therapy to at least #cj1jjj1jjj people1 including #d1jjj1jjj children under #e years of age1 #bj1jjj1jjj household contacts of people affected by tuberculosis1 and #f1jjj1jjj people living with ,,hiv1 by #bjbb2 7,d7 ensuring 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,e7 sustainably procuring tuberculosis commodities to avoid interruptions in supply1 the procurement of commodities of unknown quality1 or payment of excessive commodity costs in countries impacted by tuberculosis2 and 7#c7 to ensure that ,united ,states funding supports activities that simultaneously emphasize-- 7,a7 the development of comprehensive person-centered programs1 including diagnosis1 treatment1 and prevention strategies to ensure that-- 7i7 all people sick with tuberculosis receive quality diagnosis and treatment through active case finding2 and 7ii7 people at high risk for tuberculosis infection are found and treated with preventive therapies in a timely manner2 7,b7 robust tuberculosis infection control practices are implemented in all congregate settings1 including hospitals and prisons2 7,c7 the deployment of diagnostic and treatment capacity-- 7i7 in areas with the highest tuberculosis burdens2 and 7ii7 for highly at-risk and impoverished populations1 including patient support2 7,d7 program monitoring and evaluation based on critical tuberculosis indicators1 including indicators relating to infection control1 the numbers of patients accessing tuberculosis treatment1 along with patient support services1 and preventative therapy for those at risk1 including all close contacts1 and treatment outcomes for all forms of tuberculosis2 7,e7 training and engagement of health care workers on the use of new diagnostic tools and therapies as they become available1 and increased support for training frontline health care workers to support expanded tuberculosis active case finding1 contact tracing and patient support2 7,f7 coordination with domestic agencies and organizations 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-- 7i7 research and development of a vaccine1 and on new tools for diagnosis and treatment of tuberculosis2 7ii7 improving current tools for diagnosis and treatment of tuberculosis2 and 7iii7 training healthcare professionals on use of the newest and most effective diagnostic and therapeutic tools2 7,h7 the reduction of barriers to care1 including stigma and treatment and diagnosis costs1 through-- 7i7 training for health workers2 7ii7 sensitizing of policy makers2 7iii7 requirements for access and affordability provisions in all grants and funding agreements2 7iv7 education and empowerment campaigns for tuberculosis patients regarding local tuberculosis services2 7v7 monitoring barriers to accessing tuberculosis services2 and 7vi7 increased support for patient-led and community-led tuberculosis outreach efforts2 and 7,i7 support for country-level1 sustainable accountability mechanisms and capacity to measure progress and ensure that commitments made by governments and relevant stakeholders are met4 7c7 ,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 ,end ,,tb strategy ,the term ,end ,,tb ,strategy means the strategy to eliminate tuberculosis that was approved by the ,world ,health ,assembly in ,may #bjad1 and is described in ,the ,end ,,tb ,strategy3 ,global strategy and targets for tuberculosis prevention1 care and control after #bjae4 7#c7 ,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#d7 ,global tuberculosis drug facility ,the term ,global ,tuberculosis ,drug ,facility means the initiative of the ,stop ,tuberculosis ,partnership to increase access to the most advanced1 affordable1 quality-assured tuberculosis drugs and diagnostics4 7#e7 ,,mdr-,,tb ,the term ,,mdr-,,tb means multi-drug-resistant tuberculosis4 7#f7 ,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 tuberculosis burden 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 7#g7 ,,xdr-,,tb ,the term ,,xdr-,,tb means extensively drug-resistant tuberculosis4 7d7 ,authorization ,to carry out this section1 the ,president is authorized1 consistent with section #ajd7;c71 to furnish assistance1 on such terms and conditions as the ,president may determine1 for the prevention1 treatment1 control1 and elimination of tuberculosis4 7e7 ,goals ,in consultation with the appropriate congressional committees1 the ,president shall establish goals1 based on the policy and indicators described in subsection 7b71 for ,united ,states tuberculosis programs to detect1 cure and prevent all forms of tuberculosis globally for the period between #bjbc and #bjcj that is aligned with the ,end ,,tb ,strategy's #bjcj targets1 by updating the ,united ,states ,government ,tuberculosis ,strategy 7#bjae-bjai7 and the ,national ,action ,plan for ,combating ,multidrug-,resistant ,tuberculosis4 7f7 ,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 global 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 catalyze support for research and development of new tools to prevent1 diagnose1 treat1 and control tuberculosis worldwide1 particularly to reduce the incidence of1 and mortality from1 all forms of drug-resistant tuberculosis2 7,b7 ensure ,united ,states programs and activities aimed at reaching those infected with tuberculosis provide quality diagnosis and treatment1 and reach those at high risk with preventive therapy2 and 7,c7 ensure coordination among relevant ,united ,states ,government agencies1 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 7through its ,congressionally ,directed ,medical ,research ,program71 and other ,federal agencies that engage in international tuberculosis activities to ensure accountability and transparency1 reduce duplication of efforts and ensure appropriate integration and coordination of tuberculosis services into other ,united ,states-supported health programs4 7g7 ,priority ,to ,end ,,tb ,strategy ,in furnishing assistance under subsection 7d71 the ,president shall give priority to-- 7#a7 building and strengthening tuberculosis programs to diagnose and treat all people sick with ,,tb1 and ensuring everyone who is sick with tuberculosis have access to quality diagnosis and treatment2 7#b7 direct1 high-quality integrated services for all forms of tuberculosis1 as described by the ,world ,health ,organization1 which call for the coordination of active case finding1 treatment of all forms of tuberculosis disease and infection1 patient support1 and tuberculosis prevention2 7#c7 individuals co-infected with ,,hiv and other co-morbidities1 and other individuals with tuberculosis who may be at risk of stigma2 7#d7 strengthening the capacity of health systems to detect1 prevent1 and treat tuberculosis1 including ,,mdr-,,tb and ,,xdr-,,tb1 as described in the ,international ,standards for ,tuberculosis ,care1 and the latest international guidance related to tuberculosis2 7#e7 research and development of innovative diagnostics1 drug therapies1 and vaccines1 and program-based operational research2 7#f7 the ,stop ,tuberculosis ,partnership's ,global ,drug ,facility1 and the ,global ,alliance for ,tuberculosis ,drug ,development1 and other organizations promoting the development of new products and drugs for tuberculosis2 and 7#g7 ensuring tuberculosis programs can serve as key platforms for supporting national respiratory pandemic response against existing and new infectious respiratory disease4 7h7 ,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 burdens or rates of tuberculosis and other affected countries to implement the ,end ,,tb ,strategy1 the ,stop ,,tb ,global ,plan to ,end ,,tb1 their own national strategies and plans1 other global efforts to control ,,mdr-,,tb and ,,xdr-,,tb4 7i7 ,annual report on tuberculosis activities ,not later than ,december #ae of each year until the goals specified in subsection 7b77#a7 are met1 the ,president shall submit an annual report to the appropriate congressional committees that describes ,united ,states foreign assistance to control tuberculosis and the impact of such efforts1 including-- 7#a7 the number of individuals with active tuberculosis disease that were diagnosed and treated1 including the rate of treatment completion and the number receiving patient support2 7#b7 the number of persons with ,,mdr-,,tb and ,,xdr-,,tb that were diagnosed and treated1 including the rate of completion1 in countries receiving ,united ,states bilateral foreign assistance for tuberculosis control programs2 7#c7 the numbers of people trained by the ,united ,states ,government in tuberculosis surveillance and control2 7#d7 the number of individuals with active ,,tb disease identified as a result of engagement with the private sector and other nongovernmental partners in countries receiving ,united ,states bilateral foreign assistance for tuberculosis control programs2 7#e7 a description of the collaboration and coordination of ,united ,states anti-tuberculosis efforts with the ,world ,health ,organization1 the ,stop ,,tb ,partnership1 the ,global ,fund to ,fight ,,aids1 ,tuberculosis and ,malaria1 and other major public and private entities2 7#f7 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 ,prevention and the ,office of the ,global ,,aids ,coordinator1 for the purposes of combating tuberculosis2 7#g7 the constraints on implementation of programs posed by health workforce shortages1 health system limitations1 other components of successful implementation1 and strategies to address such constraints2 7#h7 a breakdown of expenditures for patient services supporting ,,tb diagnosis1 treatment1 and prevention1 including procurement of drugs and other commodities1 drug management1 training in diagnosis and treatment1 health systems strengthening that directly impacts provision of ,,tb services1 and research2 and 7#i7 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 that have adopted the latest ,world ,health ,organization guidelines on strengthening surveillance systems and preventative1 diagnostic1 and therapeutic methods1 including the use of rapid diagnostic tests and orally administered tuberculosis treatment regimens2 7,b7 the number of adults and children receiving tuberculosis preventive therapy1 including people with ,,hiv and all close contacts1 disaggregated by sex and1 as possible1 income or wealth quintile1 and the establishment of effective tuberculosis infection control in all relevant congregant settings1 including hospitals1 clinics1 and prisons2 7,c7 a description of progress in implementing measures to reduce tuberculosis incidence1 including actions-- 7i7 to expand active case finding and contact tracing to identify and reach vulnerable groups2 and 7ii7 to expand tuberculosis preventive therapy1 engagement of the private sector1 and diagnostic capacity2 7,d7 a description of progress to expand diagnosis1 prevention1 and treatment for all forms of tuberculosis1 including in pregnant women1 children1 and other high-risk individuals and groups at greater risk of ,,tb1 including migrants1 prisoners1 miners1 people exposed to silica1 and people living with ,,hiv_/,,aids1 disaggregated by sex2 7,e7 the rate of successful completion of tuberculosis treatment for adults and children1 disaggregated by sex1 and the number of individuals receiving support for treatment completion2 7,f7 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,g7 a description of tuberculosis commodity procurement challenges1 including shortages1 stockouts1 or failed tenders for tuberculosis drugs or other commodities2 7,h7 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,i7 the number of people trained by the ,united ,states ,government to deliver high-quality tuberculosis surveillance1 laboratory services1 prevention1 treatment1 and care2 7,j7 a description of how supported activities are coordinated with-- 7i7 country national ,,tb plans and strategies2 and 7ii7 tuberculosis control efforts supported by the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria1 and other international assistance funds1 including in the areas of program development and implementation2 and 7,k7 for the first #c years of the report required under this subsection1 a section that describes the progress in recovering from the negative impact of ,,covid-#ai on tuberculosis1 including whether there has been the development and implementation of a comprehensive plan to ensure tuberculosis activities recover from diversion of resources1 the continued use of bidirectional ,,tb-,,covid testing1 and progress on increased diagnosis and treatment of active tuberculosis4 7j7 ,annual report on tuberculosis research and development ,the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 and in coordination with the ,national ,institutes of ,health1 the ,centers for ,disease ,control and ,prevention1 the ,biomedical ,advanced ,research and ,development ,authority1 the ,food and ,drug ,administration1 the ,national ,science ,foundation1 and the ,office of the ,global ,,aids ,coordinator1 shall submit an annual report to ,congress that-- 7#a7 describes current progress and challenges to the development of new tools for the purpose of tuberculosis prevention1 treatment1 and control2 7#b7 identifies 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 describes research investments by type1 funded entities1 and level of investment4 7k7 ,evaluation report ,not later than #b years after the date of the enactment of the ,end ,tuberculosis ,now ,act of #bjba1 and every #e years thereafter until #bjcf1 the ,comptroller ,general of the ,united ,states shall submit a report to the appropriate congressional committees 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 4