Evaluating Tuberculosis Preventive Treatment in People Living with HIV

The CDC Foundation is collaborating with CDC to implement the Preventing Occurrence of Tuberculosis by Expanding Coverage of Tuberculosis Preventive Treatment among People Living with HIV (PROTECT). With funding from the Bill & Melinda Gates foundation, the CDC Foundation is working with CDC’s Division of Global HIV and Tuberculosis to evaluate the overall impact of the scale-up of Tuberculosis Preventive Therapy (TPT) on tuberculosis incidence and mortality among people living with HIV (PLHIV).

Tuberculosis (TB) remains the leading cause of morbidity and mortality among PLHIV. Despite advances in global HIV care and treatment and an extensive body of literature demonstrating the efficacy of TPT and antiretroviral therapy (ART) in PLHIV and the benefits of receiving both drugs in reducing TB-related morbidity and mortality, global scale-up of TPT has been minimal. In 2018, when TB accounted for one-third of all HIV-related deaths, the President’s Emergency Plan for AIDS Relief (PEPFAR) committed to providing at least one course of TPT to all 14.6 million PLHIV in care within three years. Though progress has been made towards that goal, with CDC providing technical assistance to several countries and their ministries of health, the overall impact of widescale TPT implementation in program settings on TB incidence and mortality is not known.

PROTECT will be implemented in six countries; three retrospective countries (Nigeria, Kenya, Ukraine) that already scaled up TPT among PLHIV and three prospective countries (Haiti, Uganda, Zimbabwe) that are currently scaling up TPT among PLHIV.

This project aims to achieve the following objectives:

1. To describe TB incidence at 12 months and 24 months among PLHIV who have initiated TPT versus those who did not initiate TPT; and
2. To describe all-cause mortality at 12 months and 24 months among PLHIV who have initiated TPT versus those who did not initiate TPT.

This project draws on CDC’s expertise in TB surveillance and program evaluation, as well as its strong partnerships with countries and global partners. CDC and participating countries will share lessons learned and best practices with countries scaling up TPT for PLHIV through project-specific workshops and existing networks. Countries will work closely with CDC to share results in-country to guide program decisions and disseminated to the global community through abstracts, manuscripts, and other opportunities.

Read our recent blog highlighting the work we're doing to combat tuberculosis.