APHL develops and promotes best practices, guidelines and resources for diagnosis and determining drug resistance to Mycobacterium tuberculosis through close relationships with CDC’s Division of Tuberculosis Elimination (DTBE). TB remains problematic globally as well as domestically and APHL continues to work to understand and meet the needs of public health laboratories as new technology continues to emerge and funding becomes tighter.

Education and Training Resources

The “Essentials for the Mycobacteriology Laboratory: Promoting Quality Practices” are a set of free, interactive modules to promote competency, quality and safety in common mycobacteriology testing practices.

Designed for laboratorians at all levels of experience, each module in the series is complimented by references and resources. Modules are also available in PDF format (with and without narrative notes) for use in laboratory training programs.

TB Drug Susceptibility Testing

In 2015, APHL in collaboration with CDC established a National PHL Drug Susceptibility (DST) Reference Center for MTB (http://www.aphl.org/aphlprograms/infectious/tuberculosis/TB-DST/Pages/default.aspx provide quality-assured drug susceptibility testing for eligible US public health laboratories. The reference center serves as an extension of CDC’s Division of TB Elimination Laboratory Branch providing services that are harmonized with and complementary to those available at CDC.

The TB subcommittee has developed and published white papers on Issues in Mycobacterium tuberculosis Complex (MTBC) Drug Susceptibility Testing covering current guidelines, recommendations and research findings.

TB Self-Assessment Tool

In 1995 APHL and CDC developed and published Mycobacterium Tuberculosis: Assessing your Laboratory, a tool designed to assist laboratories in the assessment of the quality of their laboratory’s TB diagnostic practices.
The tool was updated in 2013 to reflect profound changes to TB diagnostics and was also converted to an electronic TB self-assessment tool. Laboratories are encouraged to incorporate the use of this tool (PDF)/ Electronic (http://www.aphl.org/aphlprograms/infectious/tuberculosis/Pages/tbsatool.aspx, TB self-assessment tool)**) into their current Quality Assurance practices as a means to determine the existence of areas within individual laboratories that may be in need of improvement.
**You will be asked to provide your email address after which you will receive a unique password. In order to track your laboratory’s improvement, results will be saved under individual usernames (your email address) and passwords. Laboratory-specific results will be accessible only to you.

CDC TB Cooperative Agreement

The Laboratory Upgrade Component of the CDC TB Cooperative Agreement facilitates improvements in TB laboratory performance. The amount of money distributed between 68 state, territory and local public health laboratories is based on the CDC funding formula.

The TB Cooperative Agreement Toolkit consists of a table of the performance indicators, a glossary of defined terms, a turnaround time calculator and three data templates designed to aid laboratories in the process. Completion of these forms will fulfill the data requirements of the TB Cooperative Agreement Application. 

Publications and Resources

Survey Reports

2010 National TB Laboratory Services Survey Report (2012) 
2010 National TB Laboratory Services Survey Report: Biosafety (2015)

Conference Proceedings

9th National Conference on Laboratory Aspects of TB (2015)
8th National Conference on Laboratory Aspects of TB (2013)
7th National Conference on Laboratory Aspects of TB (2011) (http://www.aphl.org/conferences/proceedings/Pages/7th-National-Conference-Laboratory-Aspects-of-Tuberculosis-2011.aspx, 7th National Conference on Laboratory Aspects of TB)
6th National Conference on Laboratory Aspects of TB (2010) (http://www.aphl.org/conferences/proceedings/Pages/6th-National-Conference-Laboratory-Aspects-of-Tuberculosis-2010.aspx, 6th National Conference on Laboratory Aspects of TB)
5th National Conference on Laboratory Aspects of TB (2008) http://www.aphl.org/conferences/proceedings/Pages/5th-National-Conference-Laboratory-Aspects-of-Tuberculosis-2008.aspx, 5th National Conference on Laboratory Aspects of TB)

Training Resources

Essentials for the Mycobacteriology Laboratory: Promoting Quality Practices

Issue Briefs/Fact Sheets

Issues in MTBC Drug Susceptibility Testing: PZA (2016)
Issues in MTBC Drug Susceptibility Testing: EMB (2016)
2010 PHL Expansion of Nucleic Acid Amplification Testing for MTBC (2015)
Laboratory Considerations for Use of Cepheid Xpert® MTB/RIF Assay (2013)
Tuberculosis: A Serious Re-Emerging Threat (2010)
Eliminating TB in the US Depends on PHL Data (2009)

Reports/Recommendations/Best Practices

Guidelines for Submission of Sputum Specimens for TB Testing (2010)
Core TB Laboratory Services for Public Health Laboratories (2009)

Lab Matters Articles/APHL Blog Posts

One Year Later: PHL Reference Center for MTB Drug Susceptibility Testing (2016)
Identifying and treating latent TB Cases is critical for TB Elimination (2016)
The Tenacity of Tuberculosis: MDR TB (2015)
California: Reference Center for TB Drug Susceptibility Testing (2015)
TB Vanquished by Lab System (2014)


World Health Organization Tuberculosis (TB)
Drug-Resistant TB: Surveillance and Response (WHO)


CDC DTBE Laboratory Information
National Plan for Reliable Tuberculosis Laboratory Services Using a Systems Approach (2005)
Tuberculosis Laboratory Aggregate Reports

Other Resources

FIND Diagnostics-TB
Evidence-based Tuberculosis Diagnosis
Critical Path to TB Drug Regimens
Mastering the Basics of TB Control- Development of a Handbook on TB Diagnostic Methods, ECDC (2011)

Archived APHL Publications

TB Drug Susceptibility Testing-Expert Panel Meeting (2007)
The Future of TB Laboratory Services (2004)