Three broad steps are defined as integral in meeting this goal:

1. More effective use of existing prevention and control methodologies

1. Identify and educate high-risk population groups within geographic areas
2. Institute TB screening programs targeted to high-risk groups as well as healthcare workers, and friends and relatives who come into contact with high-risk populations
3. Speed up case reporting by health-care providers
4. Directly-observed therapy including compliance incentives or quarantine measures, where appropriate
5. Periodic measurement and assessment of methodologies

1. Develop shorter, safer, more effective and more economical means of preventing the emergence of clinical disease from the infected state
2. Develop test methodologies that are sensitive to factors leading to an increased incidence of developing the disease
3. Develop more effective methods for preventing transmission of infection to uninfected persons
4. Develop new drugs to address concerns about cost, MDR-TB, adverse reactions, and patient compliance
5. Develop diagnostic techniques that are rapid, sensitive, specific, and require less resources

1. Disseminate new technologies to a wide audience
2. Educate how to use new technologies, including demonstration projects and funding for locally adopted programs
3. Develop state-of-the-art network and communication technologies

ii. Organizations involved in the TB effort in San Francisco include the following:

1. San Francisco Department of Public Health, Division of TB Control, which collaborates with The Francis J. Curry National Tuberculosis Center.
2. San Francisco General Hospital, Mycobacterial Disease Research Group, operates a TB Clinic funded by the City and County of San Francisco.
3. The Francis J. Curry National Tuberculosis Center is one of three Model Tuberculosis Centers funded by the CDC’s Division of Tuberculosis Elimination. The Center provides training, technical assistance, demonstration projects and enhanced program activities.
4. The University of California, San Francisco, Division of Pulmonary and Critical Care Medicine collaborates with The Francis J. Curry National Tuberculosis Center.
5. The California State Department of Health Services; Tuberculosis Control Branch collaborates with The Francis J. Curry National Tuberculosis Center.
6. The Stanford Center for Tuberculosis Research conducts research integrating molecular biology, conventional epidemiology and disease control measures. The San Francisco Department of Public Health, San Francisco General Hospital, and The Francis J. Curry National Tuberculosis Center have used this approach since 1990 in San Francisco.

ii. Research now focuses on using molecular epidemiology and traditional epidemiologic techniques to identify strains of TB and thus the common source of infection responsible for TB outbreaks. Research is needed to discover more effective and less toxic drugs, as well as alternatives to daily therapy regimens. Research is needed to develop tests which will identify those who harbor living tubercle bacilli (i.e. are infected) but have not yet developed the disease and to develop tests for other factors affecting the probability of an infection leading to disease. Research is also needed into more effective methods to prevent transmission of infection and to develop cheaper, more effective and shorter drug regimens.

iv. The Francis J. Curry National Tuberculosis Center has developed the elements of a model surveillance system. The Stanford Center for Tuberculosis Research, through their epidemiologic studies, has pursued the hypothesis that the clinical and epidemiologic manifestations of TB may be specifically associated with the transmissibility and tissue tropism properties of particular strains of TB bacteria. Some of their researchers have concluded that nearly 1/3 of new TB cases in 1991 and 1992 resulted from recent infection as opposed to reactivation of latent infection acquired earlier in life. This fact, along with the increasing incidence of MDR-resistant TB suggests that more aggressive control measures are necessary. Surveillance is focused on risk groups, such as newly arrived immigrants and refugees, hospitals, homeless shelters, jails, prisons, residential facilities, nursing homes, mental institutions, substance-abuse treatment centers, dialysis units, home health-care agencies, and communal living situations (NTC, Stanford).