The Problem

Tuberculosis in America is at a 13-year high — and the treatment system is losing people it doesn't have to lose.

TB is a curable disease. Treatment works. But treatment takes six to nine months of uninterrupted therapy, and that's where the system breaks. For patients navigating housing instability, low-wage work, transportation gaps, or language barriers, the interruption isn't clinical — it's structural.

The National Picture

Four consecutive years of rising cases.

10,388

U.S. tuberculosis cases reported in 2024 — the highest annual total since 2011, and the fourth consecutive year of increases following the pandemic-era trough.

Source: CDC, Reported Tuberculosis in the United States, 2024 (published Dec. 19, 2025), National TB Surveillance System.

15.4 vs. 0.8

TB cases per 100,000 persons — the rate among non-U.S.-born persons (15.4) compared to U.S.-born persons (0.8). This is not a small disparity. It is one of the widest in U.S. public health.

Source: CDC Provisional 2025 Tuberculosis Data (published Mar. 23, 2026), National TB Surveillance System.

These national trends mirror the structural drivers FERI-TB was founded to address across Virginia and Maryland: housing instability, poverty, and fragmented access to care. When these barriers are present, treatment interruption becomes far more likely — increasing community transmission risk and worsening outcomes for patients.

Key Barriers

These barriers are not peripheral. They are the drivers.

The following are the barriers we see most consistently across Virginia and Maryland — the ones that turn a treatable disease into an interrupted course.

01
Housing instability & homelessness Disrupts directly observed therapy (DOT and video-DOT) and daily medication routines. Patients without a stable address are patients the surveillance and support systems lose contact with.
02
Economic hardship Forces patients to prioritize immediate survival needs — hourly wages, childcare, rent — over the long, invisible timeline of a nine-month treatment course.
03
Transportation barriers In rural Virginia and urban Maryland, unreliable or unavailable transportation is one of the most common causes of missed appointments and interrupted therapy.
04
Stigma and fear Especially among immigrant and refugee communities, stigma delays initial engagement with care and erodes the trust needed to complete a long treatment course.
05
Mental health & substance use Untreated behavioral health conditions complicate adherence to a demanding daily medication schedule — and often go unaddressed within the TB care pathway.
06
Language and cultural barriers When TB education isn't delivered in the languages and cultural contexts patients trust, understanding drops — and so does adherence.
07
Fragmented care coordination Patients moving between hospitals, health departments, primary care, and social services fall through the gaps between systems that don't communicate with each other.

Why It Matters

Adherence isn't a preference. It's the difference between recovery and resistance.

When TB treatment is interrupted or incomplete, three things happen — all of them serious. First, the patient's own outcomes worsen: incomplete treatment often means a longer, harder second course. Second, community transmission risk rises, especially in dense living situations. Third, and most concerning, incomplete treatment is the primary driver of drug-resistant TB, which is dramatically more expensive to treat and more dangerous to the community.

Every barrier we help a patient overcome isn't just a good deed. It's an act of public health.

Tuberculosis in America is at a 13-year high — and the treatment system is losing people it doesn't have to lose.

Four consecutive years of rising cases.

These barriers are not peripheral. They are the drivers.

Adherence isn't a preference. It's the difference between recovery and resistance.

The problem is structural. So is the response.