Representatives from each TB COE and CDC’s Division of TB Elimination formed a workgroup to guide the design of the needs assessment. The group selected a mixed-methods approach for data collection using an online survey and key informant interviews. The workgroup developed survey and key informant interview questions based on previous assessments and knowledge of the TB workforce landscape. This report focuses on results of the survey. One of the TB COE’s affiliate universities received an exemption, and one received a non-research determination from their respective local Institutional Review Boards (IRBs). The other TB COE’s affiliate universities did not require submission of the project to their local IRB. Informed consent was obtained for all participants. This activity was reviewed by the CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy [see, e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.].

The survey had 46 questions—40 closed- and 6 open-ended. The survey included 3 sections: (1) background demographics, such as location, occupation, and years working in TB, (2) training and education needs, and (3) medical consultation needs. Respondents could choose to complete either or both of the last two sections based on the services applicable to their job duties. Eight public health staff volunteered to pilot-test the survey prior to launching, to assess survey length, clarity, and ease of the online platform. A link to the survey was sent via email to the TB COE distribution lists. The survey was open to individuals working in some capacity on TB within the United States, Puerto Rico, and the U.S. Virgin Islands. Staff could be in non-public health settings (e.g., community health center, hospital, laboratory, and private practice) or public health settings (state or local health department staff responsible for TB) and did not have to be clinical health care providers. The survey remained open for 3 weeks, took approximately 20 minutes to complete, and was administered via the Qualtrics platform. Participants could skip questions.

This article focuses on the training and education data from the assessment. Questions about preferred training topics were presented in a matrix-style series. Each matrix had multiple row item questions with three available response categories: “not needed,” “needed,” and “highly needed.” We analyzed how ranking of preferred training topics varied when looking at “highly needed” responses. We also examined preferred training topics by individual row items and averages across training topic categories. Averages were calculated by dividing the mean number of responses of “highly needed” by the mean number of responses to individual row items. We used Pearson’s chi-square tests of statistical significance to examine associations between responses of “highly needed” training topics and demographic characteristics (i.e., profession, years working in TB, percent effort on TB activities, local TB epidemiology, and public health versus non-public health sector), and those with p-values <.05 were considered significant. Survey responses were analyzed using SPSS (version 27; IBM). We used an inductive approach to code open-ended questions and counted repeated themes to capture prevalence.

Of individuals who were sent the survey link, 1,706 initiated the survey. Response rates are not available because the number of people invited to the survey is unknown, as staff were asked to share the survey link with colleagues who also work on TB. Those who did not begin the training and education section were dropped from the sample. This removed 224 respondents (13% of the sample), leaving a total of 1,482 participants for analysis. Group analysis revealed no significant differences in the final sample. No TB COE region or demographic group was disproportionately affected by this removal.

The purpose of this needs assessment was to identify gaps related to TB training, resources, and medical consultation among the U.S. TB workforce to inform the development of educational resources. Preferences for TB education and training were additionally examined by demographic and professional subgroups. The results highlighted four priority areas for training and education:

Results of the TB COE needs assessment survey provide critical information on workforce needs to advance TB elimination efforts in the United States. Findings highlight the importance of engaging in a dual approach to tackle TB and LTBI. Partnership between the public health sector and private providers is a recommended strategy for U.S. TB prevention and control by the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Coalition of America (formerly the National Tuberculosis Controllers Association) (Cole et al., 2020). Our findings suggest a need for education and training resources specifically designed to help public health entities engage with private providers. In addition, respondents indicated an ongoing need to update TB providers with information about the changing treatment options for drug-susceptible and drug-resistant TB. As TB cases have historically declined in the United States, cases become more complex (Vaisman et al., 2020) and resources are needed that address comorbidities and specific populations, including for LTBI.

Regarding preferred training and education formats, survey results demonstrate the need to develop and disseminate resources in a variety of formats. For instance, short, concise job aids focused on key messages can be helpful for busy providers (Grudniewicz et al., 2016). In addition, tailoring training—such as by role, experience level, or setting—was identified as a need by respondents both directly through open-ended survey responses and based on preferences differing by participant subgroups. Previous research that reports assessments of the U.S. public health workforce, while not specific to TB, also identified training needs related to multisector partnerships and varying training needs by work setting (Balio et al., 2023; McKeever et al., 2019).

The present needs assessment is subject to at least three limitations. First, survey respondents may not have been representative of all staff involved in TB service delivery. Thus, these findings may not reflect the needs of everyone in the TB workforce. Our sample is largely made up of nurses and staff who work in a health department setting, so our findings may reflect preferences from those groups more than others. Second, the survey was lengthy and may have influenced respondents’ choice on which survey sections to complete, further impacting the representative makeup of the survey sample. Third, the assessment was conducted prior to the onset of the COVID-19 pandemic. During this time, many in-person activities shifted to online, virtual, and telephone formats (Burzynski et al., 2020), and this experience may have influenced training preferences. In addition, the pandemic resulted in vast personnel turnover within the public health sector (Leider et al., 2023; Shen et al., 2024), and changes in the TB workforce since the assessment may result in evolving training needs.

Preferences were identified related to TB training and education resources among the U.S. TB workforce, including the format of educational products and topic areas to inform the development of resources. Results were used to guide the TB COEs in planning their yearly training and education offerings and provided CDC with data on national trends. The findings also guided future priorities for TB training and education, and the COEs shared reports of jurisdiction-specific findings with health department TB programs throughout the United States for awareness. In addition, the priorities identified for training and education among public health staff working at health departments may be applicable across public health program areas, beyond TB.

The findings from this needs assessment have several implications for public health educational practice. Programs that offer training and education support to health workforce staff should routinely assess the needs of staff to ensure topics of high priority are covered. This work also underscores the preferences of health workforce staff for education and training offerings that are tailored to different staff roles, settings, experience, and skill levels, particularly for those working in disease or health topic areas with a multifaceted workforce. In addition, providing training opportunities in a range of delivery methods and educational materials in a variety of formats may improve staff’s ability to engage with education and training offerings. While the instruments used for the present needs assessment were developed specifically for TB, other program areas could consider asking workforce staff about preferences relating to the format and delivery of training and education services in their own assessments. This would follow the approach outlined in CDC’s QTS, which could be considered by others planning education and training offerings for health workforce staff, regardless of subject matter. Overall, these findings can help programs plan training and education offerings for health workforce staff development.