,,ii #aaith ,,congress #b;d ,session ,s4 #dgea ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #aa1 #bjbf,mr4 ,young 7for himself and ,mrs4 ,shaheen7 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 #bjbf4 #b4 ,assistance to combat tuberculosis 7a7 ,in general ,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 finds the following3 7#a7 ,the international spread of tuberculosis 7referred to in this section as ,,tb7 and the deadly impact of ,,tb's continued existence constitute a continuing challenge4 7#b7 ,additional tools and resources are required to effectively diagnose1 prevent1 and treat ,,tb4 7#c7 ,effectively resourced ,,tb programs can serve as a critical platform for preventing and responding to future infectious airborne and respiratory disease pandemics4 7#d7 ,the ,america ,first ,global ,health ,strategy sets out ambitious goals to address ,,tb that are aligned with global goals to reduce incidences and mortality rates of ,,tb4 7b7 ,policy 7#a7 ,major objectives regarding tuberculosis ,it is a major objective of the foreign assistance program of the ,united ,states to help end the ,,tb public health emergency through accelerated actions-- 7,a7 to support the diagnosis and treatment of all adults and children with all forms of ,,tb2 and 7,b7 to prevent new ,,tb infections from occurring4 7#b7 ,other policies regarding tuberculosis ,it is the policy of the ,united ,states1 in countries in which the ,united ,states has established a foreign assistance program under this ,act1 particularly in countries with the highest rates of ,,tb and other countries with high rates of infection and transmission of ,,tb-- 7,a7 to reduce mortality1 incidence1 and health costs caused by ,,tb1 including by providing support for-- 7i7 developing and using innovative new technologies and therapies 7including molecular diagnostics7 to increase active case finding and rapidly diagnose and treat children and adults with all forms of ,,tb 7including latent ,,tb71 alleviate suffering1 and ensure ,,tb treatment and preventative therapy completion2 7ii7 expanding diagnosis and treatment for individuals with all forms of ,,tb 7including children7 and expanding prophylaxis treatment to at-risk individuals 7including children71 household contacts1 individuals with latent ,,tb1 and individuals living with ,,hiv2 7iii7 ensuring high-quality ,,tb care by closing gaps in care cascades1 implementing continuous quality improvement at all levels of care1 and providing related patient support2 7iv7 sustainable procurement of ,,tb commodities to avoid interruptions in supply2 and 7v7 avoiding the procurement of ,,tb commodities of unknown quality and the payment of excessive ,,tb commodity costs2 and 7,b7 to ensure1 to the greatest extent practicable1 that ,united ,states funding supports activities that simultaneously emphasize-- 7i7 the development of comprehensive person-centered programs1 including diagnosis1 treatment1 and prevention strategies to ensure that-- 7,i7 all individuals sick with ,,tb receive quality diagnosis and treatment through active case finding2 and 7,,ii7 individuals at high risk for ,,tb infection are identified and treated with prophylaxis treatment in a timely manner2 7ii7 robust ,,tb infection control practices are implemented in all congregate settings1 including hospitals and prisons2 7iii7 the deployment of diagnostic and treatment capacity-- 7,i7 in areas with the highest ,,tb burdens2 and 7,,ii7 for highly at-risk and impoverished populations1 including for patient support2 7iv7 program monitoring and evaluation based on critical ,,tb indicators1 including indicators relating to infection control1 the numbers of patients accessing ,,tb treatment and patient support1 and prophylaxis treatment for those at risk1 including all close contacts1 and treatment outcomes for all forms of ,,tb2 7v7 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 ,,tb active case finding1 contact tracing1 and patient support2 7vi7 coordination with domestic agencies and organizations to support an aggressive research agenda to develop vaccines as well as new tools to diagnose1 treat1 and prevent ,,tb globally2 7vii7 linkages with the private sector on-- 7,i7 research and development of a vaccine1 and on new tools for diagnosis and treatment of ,,tb2 7,,ii7 improving current tools for diagnosis and treatment of ,,tb1 including telehealth solutions for prevention and treatment2 7,,iii7 training healthcare professionals on the use of the newest and most effective diagnostic and therapeutic tools2 and 7,,iv7 transparency and accountability2 7viii7 the reduction of barriers to treatment and diagnosis costs1 including through-- 7,i7 training health workers to ensure integration into country's wider healthcare system2 7,,ii7 requiring that all relevant grants and funding agreements include access and affordability provisions2 7,,iii7 supporting campaigns for ,,tb patients regarding local ,,tb care for prevention1 diagnosis1 and treatment2 7,,iv7 monitoring cost barriers to accessing ,,tb care for prevention1 diagnosis1 and treatment2 and 7,v7 increasing support for patient-led and community-led ,,tb outreach efforts2 7ix7 support for local and country-level1 sustainable accountability mechanisms to measure local progress and ensure commitments made by governments and relevant stakeholders are met2 and 7x7 support for the inclusion of ,,tb diagnosis1 treatment1 and prevention activities into primary health care1 as appropriate4 7c7 ,authorization 7#a7 ,in general ,the ,president is authorized to furnish assistance1 on such terms and conditions as the ,president may determine necessary to carry out this section1 for the prevention1 treatment1 control1 and elimination of ,,tb4 7#b7 ,priority for assistance ,in furnishing assistance under paragraph 7#a71 the ,president shall prioritize-- 7,a7 building and strengthening ,,tb programs-- 7i7 to increase the diagnosis and treatment of individuals who are sick with ,,tb2 and 7ii7 to ensure that such individuals have access to quality diagnosis and treatment2 7,b7 direct1 high-quality care for all forms of ,,tb1 including diagnosis1 coordination of active case finding1 treatment of all forms of ,,tb disease and infection1 patient support1 and ,,tb prevention2 7,c7 treating individuals co-infected with ,,hiv1 other immune compromising co-morbidities1 and other high-risk individuals with ,,tb who may be at risk of stigma2 7,d7 strengthening the capacity of health systems to detect1 prevent1 and treat ,,tb1 including ,,mdr-,,tb and ,,xdr-,,tb2 7,e7 researching and developing innovative diagnostics1 drug therapies1 and vaccines1 and program-based research2 7,f7 ensure integration of lab systems for molecular diagnostic networks for monitoring and response for productive use of laboratory capacities and healthcare facilities2 7,g7 supporting the procurement of cost-effective and quality ,,tb diagnostics and treatments1 including annual support for the ,global ,drug ,facility1 and assisting local country capacity building and sustainability to control all forms of ,,tb2 and 7,h7 ensuring ,,tb programs can serve as key platforms for supporting national respiratory pandemic response with respect to existing and new infectious respiratory diseases4 7d7 ,establishment of goals ,the ,president1 in consultation with the appropriate congressional committees and in pursuit of the policies described in subsection 7a71 shall establish goals to-- 7#a7 detect1 cure1 and prevent all forms of ,,tb globally during the period beginning on ,january #a1 #bjbg1 and ending on ,december #ca1 #bjcj1 specifically by working to-- 7,a7 reduce1 by #bjcj-- 7i7 the ,,tb incidence rate by #hj percent 7from #bjae levels72 and 7ii7 the ,,tb mortality rate by #ij 7from #bjae levels7 percent2 7,b7 ensure that-- 7i7 #ij percent of incident ,,tb cases are diagnosed and initiated on treatment2 7ii7 #ij percent of incident drug resistant-,,tb cases are diagnosed and initiated on treatment2 and 7iii7 there is #ij percent treatment success rate for drug sensitive-,,tb and drug resistant-,,tb2 and 7,c7 provide ,,tb preventive treatment to #cj1jjj1jjj individuals2 and 7#b7 update the ,national ,action ,plan for ,combating ,multidrug-,resistant ,tuberculosis4 7e7 ,coordination 7#a7 ,in general ,the ,president shall consult1 as appropriate1 with partner nations and relevant international organizations1 nongovernmental organizations1 and the private sector with respect to the development and implementation of a coordinated and complementary ,united ,states global ,,tb response program4 7#b7 ,bilateral assistance ,in providing bilateral assistance under this section1 the ,president1 acting through the ,secretary of ,state1 shall-- 7,a7 catalyze support for research and development of new tools to prevent1 diagnose1 treat1 and control ,,tb worldwide1 particularly to reduce the incidence of1 and mortality from1 all forms of drug-resistant ,,tb2 7,b7 consider the incidence of ,,tb infections when determining assistance priorities to countries and regions2 7,c7 ensure ,united ,states programs and activities focus on finding individuals with active ,,tb and provide cost-effective and quality diagnosis and treatment1 including through sustainable digital health solutions1 and reaching individuals at high risk with prophylaxis treatment2 and 7,d7 ensure coordination among relevant ,federal departments and agencies that engage in international activities relating to ,,tb-- 7i7 to ensure accountability and transparency2 7ii7 to reduce duplication of efforts2 and 7iii7 to ensure appropriate incorporation and coordination of ,,tb prevention1 diagnosis1 and treatment into other ,united ,states-supported health programs4 7f7 ,assistance for tuberculosis partnerships ,the ,president1 acting through the ,secretary of ,state1 is authorized-- 7#a7 to provide resources to monitor and disseminate epidemiological information about tuberculosis1 drug resistant ,,tb1 ,,mdr-,,tb1 and ,,xdr-,,tb2 7#b7 to provide resources directly to countries with high rates of ,,tb-- 7,a7 to directly improve the capacity of such countries to prevent1 diagnose1 and treat ,,tb on a local level2 and 7,b7 to develop and implement the national strategies and plans of such countries to control ,,tb and eliminate ,,mdr-,,tb and ,,xdr-,,tb using the goals described in subsection 7d77#a72 7#c7 to leverage the contributions of donors to facilitate the activities described in paragraphs 7#a7 and 7#b7 while increasing the capacity of the ,united ,states to monitor and disseminate relevant information2 and 7#d7 to utilize longstanding ,united ,states partnerships and resources to address ,,tb domestically and internationally4 7g7 ,reports 7#a7 ,annual report on activities regarding tuberculosis ,not later than ,december #ae of each year until the earlier of the date on which the goals specified in subsection 7d77#a7 are met or ,december #ca1 #bjcb1 the ,president shall submit a report to the appropriate congressional committees that describes ,united ,states foreign assistance to control ,,tb and the impact of such assistance1 including-- 7,a7 the number of individuals with active ,,tb that were diagnosed and treated1 including the rate of treatment completion and the number of individuals receiving patient support2 7,b7 the number of individuals with ,,mdr-,,tb and ,,xdr-,,tb that were diagnosed and treated1 including the rate of treatment completion1 in countries receiving bilateral foreign assistance from the ,united ,states for programs to control ,,tb2 7,c7 the number of individuals trained by the ,united ,states ,government in ,,tb surveillance and control2 7,d7 the number of individuals with active ,,tb identified as a result of engagement with the private sector and other nongovernmental partners in countries receiving ,united ,states bilateral foreign assistance for ,,tb control programs2 7,e7 a description of the amount of funds provided1 activities carried out1 and any collaboration and coordination of ,united ,states anti-,,tb efforts with partner nations and relevant international organizations1 nongovernmental organizations1 and the private sector1 including the amount of funding provided to such entities2 7,f7 a description of the collaboration and coordination between the relevant ,federal departments and agencies1 including the ,centers for ,disease ,control and ,prevention and the ,office of the ,global ,,aids ,coordinator1 to combat ,,tb and1 as appropriate1 include treatment of ,,tb in primary care2 7,g7 the constraints on implementation of programs posed by health workforce shortages1 health system limitations1 barriers to digital health implementation1 other challenges to successful implementation1 and strategies to address such constraints1 including local commitments to sustain ,,tb control efforts2 7,h7 a breakdown of expenditures for patient care supporting ,,tb diagnosis1 treatment1 and prevention1 including procurement of drugs and other ,,tb commodities1 drug management1 training in diagnosis and treatment1 health systems strengthening that directly impacts the provision of ,,tb prevention1 diagnosis1 treatment1 and research2 and 7,i7 for each country and each project site receiving bilateral ,united ,states assistance for the purpose of ,,tb prevention1 treatment1 and control-- 7i7 the number of individuals screened for ,,tb disease 7including screenings utilizing quality new rapid diagnostic tests7 and the number evaluated for ,,tb infection using active case finding outside of health facilities2 7ii7 the number of individuals with active ,,tb disease that were diagnosed 7including diagnoses made through using quality new rapid diagnostic tests7 and treated with safe and effective oral regimens1 including the rate of treatment completion and the number receiving patient support2 7iii7 the number of adults and children1 including individuals with ,,hiv and close contacts1 who are evaluated for ,,tb infection1 the number of adults and children started on treatment for ,,tb infection1 and the number of adults and children completing such treatment1 disaggregated by sex and1 if possible1 income or wealth quintile2 7iv7 the establishment of effective ,,tb infection control in all relevant congregant settings1 including hospitals1 clinics1 and prisons2 7v7 a description of progress in implementing measures to reduce ,,tb incidence1 including actions-- 7,i7 to expand active case finding and contact tracing to reach vulnerable groups2 and 7,,ii7 to expand ,,tb prophylaxis treatment1 engagement of the private sector1 and diagnostic capacity2 7vi7 a description of progress to expand diagnosis1 prevention1 and treatment for all forms of ,,tb1 including in pregnant women1 children1 and individuals and groups at greater risk of ,,tb1 including migrants1 prisoners1 miners1 and individuals exposed to silica1 disaggregated by sex2 7vii7 the rate of successful completion of ,,tb treatment for adults and children1 disaggregated by sex1 and the number of individuals receiving support for treatment completion2 7viii7 the number of individuals1 disaggregated by sex1 receiving treatment for ,,mdr-,,tb1 including the proportion of those individuals who are being treated with safer and more effective oral regimens1 and any factors impeding the scale up of treatment1 and a description of progress to expand community-based ,,mdr-,,tb care2 7ix7 a description of ,,tb commodity procurement challenges1 including shortages1 stockouts1 or failed tenders for ,,tb drugs or other ,,tb commodities2 7x7 the proportion of health facilities with specimen referral linkages to quality diagnostic networks1 including established testing sites and reference labs1 to ensure maximum access and referral for second-line drug resistance testing1 and a description of the turnaround time for test results2 7xi7 the number of individuals trained by the ,united ,states ,government and its implementing partners to deliver high-quality ,,tb diagnostic1 preventative1 monitoring1 treatment1 and care2 7xii7 a description of how supported activities are coordinated with-- 7,i7 country national ,,tb plans and strategies2 and 7,,ii7 ,,tb control efforts supported by the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria1 and other international assistance programs and funds1 including in the areas of program development and implementation2 7xiii7 for the first #c years of the report required under this paragraph1 a description of the progress in recovering from the negative impact of ,,covid-#ai on ,,tb1 including-- 7,i7 whether there has been the development and implementation of a comprehensive plan to recover ,,tb activities from diversion of resources2 7,,ii7 the continued use of bidirectional ,,tb-,,covid testing2 and 7,,iii7 progress on increased diagnosis and treatment of active ,,tb2 and 7xiv7 for each country receiving ,united ,states bilateral assistance for the purpose of ,,tb prevention1 treatment1 and control1 the ,united ,states will track country government co-investment in ,,tb prevention1 treatment1 and control4 7#b7 ,annual report on tuberculosis research and development ,the ,president1 acting through the ,secretary of ,state1 and in coordination with the heads of other relevant ,federal departments and agencies1 shall1 not later than #a year after the date of the enactment of the ,end ,tuberculosis ,now ,act of #bjbf1 and annually thereafter until ,december #ca1 #bjcb1 submit a report to the appropriate congressional committees that-- 7,a7 describes the current progress and challenges to the development of new tools for ,,tb prevention1 treatment1 and control2 7,b7 identifies critical gaps and emerging priorities for research and development1 including rapid and point-of-care diagnostics1 shortened treatments and prevention methods1 telehealth solutions for prevention and treatment1 and vaccines2 and 7,c7 describes research investments by type1 funded entities1 and level of investment4 7#c7 ,evaluation report ,not later than #d years after the date of the enactment of the ,end ,tuberculosis ,now ,act of #bjbf1 the ,comptroller ,general of the ,united ,states shall submit a report to the appropriate congressional committees that evaluates the performance and impact of programs supported by ,united ,states bilateral assistance funding on the prevention1 diagnosis1 treatment1 and care of ,,tb1 including recommendations for improving such programs4 7h7 ,definitions ,in this section3 7#a7 ,appropriate congressional committees ,the term appropriate congressional committees means-- 7,a7 the ,committee on ,foreign ,relations of the ,senate2 and 7,b7 the ,committee on ,foreign ,affairs of the ,house of ,representatives4 7#b7 ,,mdr-,,tb ,the term ,,mdr-,,tb means multi-drug-resistant tuberculosis4 7#c7 ,,xdr-,,tb ,the term ,,xdr-,,tb means extensively drug-resistant tuberculosis4 4 7b7 ,sunset ,the amendment made by subsection 7a7 shall cease to have any force or effect beginning on ,january #a1 #bjcc4