Presenters from the Metro Nashville TB Elimination program told the Board of Health that rising social-risk factors are making cases more complex and resource-intensive, and urged prioritizing TB positions in the upcoming budget.

Dr. Avis Turner, the TB elimination physician, and Sabrina Cook, the TB-clinic nurse practitioner and program director, described the program's six subclinics and patient-centered services including directly observed therapy (DOT) and electronic DOT. Epidemiologist Colton McKay said data modernization is underway to digitize decades of paper records and better target grants and outreach.

McKay said the county saw a dip in TB rates around 2020'21 followed by increases at the state and local level. He said behavioral risk factors have trended upward over the last decade and that "in 2025, we we saw that 79 percent of our cases ... had at least one of the following: housing insecurity, a language barrier, some sort of substance use, passive incarceration, or a mental health disorder." He added that those vulnerabilities increase the resources required for contact investigations and outreach.

Cook said the program logged 35 cases last year and currently "we really have 1 TB disease nurse" supported in part by an agency nurse while cross-training proceeds; she estimated a typical nurse caseload at about 17 active cases. Presenters said contact investigations can be large (an index case with up to 100 contacts in some instances) and that outreach staff use multiple strategies to locate and engage patients.

Turner illustrated the workload with a case study of a patient who required prolonged isolation and nearly a year of therapy because of immunosuppression and drug interactions; staff provided housing assistance, meals, documentation for short-term disability and frequent check-ins to support treatment adherence.

Program leaders described vulnerabilities in staffing and funding: they praised experienced staff but said recruiting is difficult because potential hires fear working with TB. Cook said the program recently relied on a grama-style supplement to bridge cuts in one funding stream and that the department is requesting more stable local support.

Board members thanked the team and said they would consider TB positions as a top-priority improvement request during the FY27 budget process.