DATE:
September 9, 2025
07
TO:
Board of Supervisors
SUBJECT
Title
AUTHORIZE ACCEPTANCE OF FUNDING FOR TUBERCULOSIS CONTROL AND TREATMENT, AND APPLY FOR ADDITIONAL FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency, Public Health Services operates a Tuberculosis Program (TB Program) that detects, mitigates, and prevents the spread of Tuberculosis (TB) in our community through treatment, case management, contact investigation, and education. The County TB Program is supported by a combination of federal, State, and local funding.
TB is a communicable bacterial disease transmitted from person-to-person through shared indoor air space. San Diego County has higher rates of active TB than both California and the United States. The County TB Program provides critical, core mandated active TB case management, case consultation, case contact investigations, and preventive linkage to care services for TB case contacts diagnosed with latent TB infection (LTBI) through contact investigations. Additionally, the County convenes a successful public-private partnership that has resulted in extensive collaboration with the Federally Qualified Health Clinics and larger health systems throughout the county to improve access to preventive LTBI care that reduces cases of active TB.
Today's actions request the San Diego County Board of Supervisors authorize the acceptance of TB Control Cooperative Grant funds from the Centers for Disease Control and Prevention for approximately $1,739,979, the acceptance of TB control local assistance funds from the California Department of Public Health for approximately $777,900, and the pursuit of future funding opportunities to support the TB Program.
This item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind. These efforts support our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by ensuring the County will continue to receive federal, State, and other funding to administer necessary programs to reduce the spread of disease and improve health outcomes in San Diego County.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants.
2. Authorize the acceptance of annual allocation of $1,739,979 from the Centers for Disease Control and Prevention for the period of January 1, 2026, through December 31, 2026, for tuberculosis control and treatment services, and authorize the Deputy Chief Administrative Officer, Health and Human Services Agency, or designee, upon receipt, to execute all required documents, including any annual extensions, amendments and/or revisions that do not materially impact the services or funding level.
3. Authorize the acceptance of annual allocation of $777,900 from the California Department of Public Health for the period of July 1, 2025, through June 30, 2026, for tuberculosis control and treatment services, and authorize the Deputy Chief Administrative Officer, Health and Human Services Agency, or designee, upon receipt, to execute all required documents, including any annual extensions, amendments, and/or revisions that do not materially impact the services or funding level.
4. Authorize the Deputy Chief Administrative Officer, Health and Human Services Agency, or designee, to pursue future funding opportunities to support the Tuberculosis Program including but not limited to, funding for prevention, treatment, case management, contact investigation, education, and research.
EQUITY IMPACT STATEMENT
The County of San Diego (County) Health and Human Services Agency, Public Health Services, Tuberculosis Program (TB Program), as well as the San Diego County TB Elimination Initiative, focus on providing and expanding equitable access to healthcare. Examples include offering transportation services to medical appointments, housing for individuals experiencing homelessness while receiving treatment, and treatment for uninsured and underserved populations.
In 2024 alone, the County TB Program provided TB case contact investigation involving over 4,800 individuals exposed to infectious TB. The TB program provided critical education, testing, and follow-up care, preventing additional cases of active TB in San Diego. Furthermore, the County's public-private partnership for TB elimination has resulted in latent tuberculosis infection care implementation in Federally Qualified Health Clinics and health systems across the county that serve our diverse populations and prevent active TB cases in our community.
SUSTAINABILITY IMPACT STATEMENT
Authorizing funding acceptance for tuberculosis control and treatment services supports the County of San Diego (County) Sustainability Goal #2, to provide just and equitable access to County services, particularly in the investment of historically underserved communities that are disproportionately impacted by tuberculosis (TB). These actions also support Sustainability Goal #3 by transitioning to a green, carbon-free economy, by continuing to transition delivery of services to telehealth platforms whenever possible without sacrificing quality and thereby decreasing vehicle mileage for clients and employees. Additionally, today's actions support Sustainability Goal #4, by protecting the health and well-being of everyone in the region, ensuring access to medical care for those with TB who need care.
FISCAL IMPACT
Recommendation #2: Authorize Acceptance of Approximately $1,739,979 from the Centers for Disease Control and Prevention
Funds for this request are included in the Fiscal Year (FY) 2025-2027 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $1,245,619 and estimated revenue of $869,990 in both FY 2025-26 and FY 2026-27. The funding source is the Centers for Disease Control and Prevention. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $375,629 annually in FY 2025-26 and FY 2026-27, for a total of $751,258. The funding source for these costs will be existing Realignment. The public benefit for providing these core mandated services far outweighs the B-29 unrecoverable costs. There will be no change in net General Fund costs and no additional staff years.
Recommendation #3: Authorize Acceptance of Approximately $777,900 from the California Department of Public Health
Funds for this request are included in the FY 2025-2027 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $1,072,612 and estimated revenue of $777,900 for FY 2025-26. The funding source is the California Department of Public Health. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $294,712. The funding source for these costs will be existing Realignment. The public benefit for providing these core mandated services far outweighs the B-29 unrecoverable costs. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
Public Health Services presented these recommendations to the Health Services Advisory Board at its meeting on August 5, 2025.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency (HHSA), Public Health Services, operates a Tuberculosis Program (TB Program) that is supported by a combination of federal, State, and local funding. Since 1982, the Centers for Disease Control and Prevention (CDC) has awarded federal funds to the County, under a Tuberculosis Control Cooperative Agreement, and on March 16, 1999 (3), the County began to accept funding for Tuberculosis Control Local Assistance from the California Department of Public Health (CDPH).
Tuberculosis (TB) is a communicable bacterial disease transmitted from person-to-person through shared indoor air space. The infectious period usually lasts weeks to months, and treatment can take 6 to 18 months. TB leads to isolation from family and friends while contagious, and exclusion from the workplace, which can result in unemployment, lost wages, risk for poverty, and homelessness. Groups disproportionately affected by TB include people born outside the United States (U.S.), those who have experienced homelessness, and persons with diabetes, kidney failure, cancer, and HIV infection. Complications are most common in children under the age of five and the immunocompromised, and can result in strokes, hearing and vision loss, and developmental disabilities. One in six people with active TB in California die within five years of diagnosis and 14% do not survive treatment.
The County TB Program detects, mitigates, and prevents the spread of TB in our community through treatment, case management, contact investigation, and education. In 2024, TB incidence in San Diego County was 7.5 cases per 100,000 persons, which is higher than California's rate of 5.4 cases per 100,000 persons and approximately 2.5 times higher than the National TB incidence rate. In 2024, the County reported 247 new active TB cases, a 2% increase compared to 242 cases in 2023, and the fourth consecutive year of rising TB diagnoses. Potential reasons for the increase include resumption of normal activities after COVID-19, resumption of travel and migration between California and other parts of the world with higher rates of TB, and people seeking health care and providers and public health programs resuming testing for TB.
Only a small portion of TB-infected individuals develop the disease immediately. Most people infected with TB harbor the undetected bacteria in their bodies, which is referred to as latent TB infection (LTBI). Without treatment, these individuals have a 10% risk of progression to infectious TB disease in their lifetimes. According to the County 2025 Tuberculosis Elimination in San Diego County Fact Sheet, among people with LTBI, only an estimated 25% are aware of their infection and 15% receive treatment.
Diagnosing and treating LTBI is a critical component of TB prevention, as CDPH reports that 85% of active TB cases in California began as LTBI and could have been prevented. CDPH estimates 175,000 San Diego County residents have LTBI. The County TB Program provides critical, core mandated active TB case management, case consultation, case contact investigations, and preventive linkage to care services for TB case contacts diagnosed with LTBI through contact investigations. Additionally, the County convenes a successful public-private partnership which has resulted in extensive collaboration with the Federally Qualified Health Clinics and larger health systems throughout the county to improve access to preventive LTBI care that reduces cases of active TB.
Despite the high prevalence of TB disease in the San Diego region compared to both California and the U.S., the County TB Program meets or exceeds state and national quality measures, including in the National TB Indicators Project (NTIP). The County performance on the 2024 NTIP shows 93.7% of TB patients with positive microbiological diagnosis initiated treatment within seven days of specimen collection. Moreover, 77.2% of contacts exposed to infectious TB started LTBI treatment, surpassing state and national rates of 67.7% and 75.6% respectively.
Today's actions request the San Diego County Board of Supervisors authorize the acceptance of TB Control Cooperative Grant funds from the CDC for approximately $1,739,979, the acceptance of TB control local assistance funds from CDPH for approximately $777,900, and the pursuit of future funding opportunities to support the TB Program, including but not limited to, funding for prevention, treatment, case management, contact investigation, education, and research.
A waiver of Board Policy B-29 is being requested because the revenues described above do not fully offset the costs for the countywide TB Program. The benefits of providing these services far outweigh the unrecovered costs as treatment and prevention of TB are core functions and critical to protect the public's health. These services are available to all San Diego County residents with TB, regardless of insurance status, which ensures anyone can seek care for TB. Without the countywide services provided by the TB program, untreated TB would more easily spread throughout San Diego County.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today's proposed actions support the Equity (Health) and Community (Quality of Life) initiatives in the County of San Diego 2025-2030 Strategic Plan. This is accomplished by preventing and controlling the spread of tuberculosis and providing equitable access to health services for residents.
Respectfully submitted,
EBONY N. SHELTON
Chief Administrative Officer
ATTACHMENT(S)
N/A
SUBJECT:
AUTHORIZE ACCEPTANCE OF FUNDING FOR TUBERCULOSIS CONTROL AND TREATMENT, AND APPLY FOR ADDITIONAL FUNDING OPPORTUNITIES (DISTRICTS: ALL)
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COUNTY OF SAN DIEGO
AGENDA ITEM
BOARD OF SUPERVISORS
PALOMA AGUIRRE
First District
JOEL ANDERSON
Second District
TERRA LAWSON-REMER
Third District
MONICA MONTGOMERY STEPPE
Fourth District
JIM DESMOND
Fifth District
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