At the African Services Committee (ASC) clinic in Harlem, workers at times waive the fee for patients at risk of TB, such as Ibrahim, a man in his late 20s, who asked that his real name not be used. After he arrived in New York from Burkina Faso two years ago, it was determined that he was a potential candidate for TB. With no health care, his case might have gone undetected if he’d had to pay the full price.

Lillian Agyei, testing coordinator at ASC, said that since the clinic started charging most patients, the number of visits had dropped dramatically. In 2009, about 4,500 people were tested for tuberculosis. Last year, only 534 clients sought the service, according to internal statistics. Agyei said these were mostly people who needed the test for administrative reasons related to employment or study, not individuals who found themselves at risk of infection.

The ASC director, Kim Nichols, said the dramatic fall in people being tested could hamper efforts to battle the disease. “There will be those few cases that we would have treated or screened in previous years who will not be picked up on until they have active TB, or have already infected other people in their households,” she said. “You lose the opportunity to intervene before a person develops active symptoms.”

Nichols said the drop in screenings at ASC is the result of municipal and federal budget cuts, which have been enforced despite confirmed cases in the New York area rising from 651 in 2012 to 656 in 2013, according to the latest figures.

"You hope it’s not a trend,” Lee Reichman, executive director of the New Jersey Medical School Global Tuberculosis Institute and former New York City health director, told Al Jazeera.

Reichman oversaw the city's response to the TB outbreak of the late 1980s and 1990s, in which more than 12,000 people died. At the time, authorities scrambled to spend $1 billion to quell the epidemic. Now, he said, the numbers are still in their “early stages.”

“If we don’t do something about it, [this] may increase more. It may actually affect the rate. It’s a warning sign,” he said.

Even though some experts fear cases could increase, the New York City Health Department's Bureau of Tuberculosis Control reduced operating hours at two chest clinics in 2013. The NYC Health Department did not respond to Al Jazeera’s request for comment, but according to the 2013 annual report, the hours were cut “due to decreased use and financial constraints."

At the Charles P. Felton National Tuberculosis Center at Harlem Hospital, operations have been discontinued and testing resources diverted to other clinics in New Jersey, Florida, Texas, California and Minnesota.

Bill Bower, former director of education and training at the center and an assistant professor at Columbia University, said the decision by the Centers for Disease Control and Prevention (CDC) was taken in response to local rates nearing national averages. From a case rate of 220 per 100,000 residents in 1991, exceeding that of many developing nations, central Harlem now registers 4.8.

“TB incidence in Harlem … had been reduced considerably. It was time to spread state-of-the-art TB care, training, materials and medical consultation across the country," he said in an email.

But health care professionals at ASC said community organizations like theirs are left to pick up the slack while government providers take “a back seat.”