Beginning around 1995, the United States experienced a steady decline in the rate of tuberculosis. But in the last three years, health experts have noticed something disturbing -- the rate of decline has been cut in half. That means more people are turning up with TB.  Where are these new cases coming from?  VOA's Melinda Smith reports on how the global migration of a once-curable disease has motivated scientists to go back to the laboratory.

Fifty-two-year-old Jesse Eubanks waits for someone to come who is very important to him.

"I feel like I'm being locked up in jail,? he jests.

Jesse Eubanks is partially joking. But he is clearly frustrated with having to wait at home for the arrival three days a week of Baltimore city health employee Linda Ellison.

As she watches, Jesse swallows a handful of pills.  In the four months she has been visiting, she says he has made a remarkable transition. "[He] wasn't doing well, very weak and all, but I can see a very good progress now, very good."

Jesse is one of 34 tuberculosis patients reported last year in Baltimore, Maryland.   Because his TB is confirmed, he must participate in the city's Directly Observed Therapy program. 

By delivering the medicine in person, the health care worker makes sure treatment is carried out.

DOTS, as it is often called, was pioneered in Baltimore 30 years ago when tuberculosis was out of control.  In a 15-year period, Directly Observed Therapy led to a 70 percent reduction in Baltimore's TB rate, and four of the city's five tuberculosis clinics were shut down. The World Health Organization endorses Directly Observed Therapy.

But Dr. Richard Chaisson of Johns Hopkins University's Center for Tuberculosis Research says many countries do not participate in DOTS because the program is so labor-intensive.  He thinks that is a mistake. "It's actually cheaper to hire extra people and go out and treat people effectively because you have fewer failed treatments, fewer relapses, and fewer cases of drug resistant tuberculosis."

Tina Ward, a tuberculosis patient, has months to go before her medical care is finished.  Standard TB treatment takes six to nine months.  Advanced cases that are multi-drug resistant -- and are treatable - can take 18 to 24 months of care. 

When patients do not take their medicine on schedule or do not get it on a regular basis, the bacteria becomes even more difficult to stamp out. 

Dr. Kenneth Castro, the Director of TB Prevention at the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia says slacking off from regular dosing is dangerous:

"You either interrupt treatment because you feel better, think you no longer need the drugs, that gives rise to mutations that normally occur.  And then the population of bacteria that takes over are these drug-resistant bacteria," explains the doctor.

Meanwhile, Jesse Eubanks lives a few kilometers away from a man who just might be able to help him. 

His name is Jacques Grosset, a professor at the Johns Hopkins University School of Medicine.   Dr. Grosset is passionate about the benefits of a drug called Moxifloxacin.  He says research on mice and preliminary clinical trials with humans have shown the drug may cut treatment time from six months to four, and perhaps even shorter in the future. "It's a big revolution!  It means we are permitted to think 'new'!" says Dr. Grosset.

Since 2005, TB among the white population in the United States has continued to decline. But it remains steady within the African-American community, and shows the greatest increase among immigrants.  At least half of all new cases of tuberculosis in the United States are among the foreign-born.  Most come across the border from Mexico or from Vietnam and the Philippines. 

Without proper medical care in the early stages of TB, health experts say, there are few options left once the disease becomes drug resistant.

Even Dr. Jacques Grosset fears that his 'miracle' drug, Moxifloxacin, has limitations. "Moxifloxacin is now one of the key drugs to treat multi-drug resistant [TB], but moxifloxacin alone is not able to cure.  You have to have the combination of drugs.  We need plenty of new drugs."

Every expert we talked with agreed: the development of those new drugs cannot happen without a financial commitment by pharmaceutical companies and governments willing to pay for their purchase.  Dr. Kenneth Castro adds, "The reality with tuberculosis is: you pay now or pay later -- and pay lots more later -- both in terms of monetary investment and human lives that it's going to cost."