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

The challenges of tuberculosis (TB) control in the U.S. military are similar to those in other low-incidence populations; in addition, the U.S. Military Health System must account for geographic separation, frequent staff turnover, deployments to TB-endemic areas, and residence in congregate settings. The objective of this evaluation was to use a TB cohort review process to assess indicators of the quality and effectiveness of the TB control program in the U.S. Army. Ten cases of TB disease occurred at U.S. Army installations in 2011; all were pulmonary. Two cases occurred among the active component U.S. Army, a rate of 0.4 per 100,000 population; no case was attributable to infection acquired during deployment. Eight (80%) were foreign born. Seven (70%) were smear positive and one (10%) had multi-drug resistant TB. One (10%) case died. All (100%) of the nine remaining cases completed therapy. The median time from onset of symptoms to diagnosis was 98 days, but there was substantial variability (range 21-444). This is the first report of the cohort review methodology being applied to a military population. Most performance indicators in the U.S. Army met or approached national standards.