Background

According to the Centers for Disease Control and Prevention (CDC), one in eight people living with HIV in the United States is undiagnosed, and more than one third of all new HIV infections are transmitted by people who do not know that they have HIV. HIV self-tests, which can be done at home or in other private settings, are a confidential way for people to learn their HIV status, and this knowledge can help connect them to lifesaving preventative tools and treatment. Because of COVID-19 lockdowns and closures, HIV self-testing increased over the past two years, and it has proven to be a cost-effective way to make HIV testing more accessible in regions where healthcare is often a challenge—including in communities with limited access to affordable medical testing, rural communities and those that are disproportionately affected by HIV.

Solution and Impact

The CDC Foundation is funding 53 community-based organizations in this program to help increase access to HIV self-testing in communities across the country. Their programs establish or expand upon HIV self-testing programs by:

• Procuring and distributing HIV self-test kits to clients
• Distributing other HIV risk reduction products
• Developing communication products that educate clients about HIV self-testing
• Equipping trusted influential messengers
• Hosting or supporting local events
• Developing educational campaigns
• Collaborating with state and/or local health departments
• Collaborating with medical clinics, SSPs or other community-serving organizations
• Developing safe spaces for clients

Learn more about the 53 community-based organizations we support.

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $9M with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS or the U.S. Government.

The United States is in the midst of a growing opioid epidemic. As a result of sharing contaminated needles, HIV transmission rates have also increased. In response, the Centers for Disease Control and Prevention (CDC) is providing tools that can reduce harm in communities experiencing high rates of HIV transmitted by needles. Syringe Services Programs (SSPs) can support communities by offering services such as testing for HIV and other infectious diseases, access to clean needles and connection to treatment upon request. Unfortunately, there is a significant stigma surrounding SSPs and the people who use them. This project aims to leverage social media to educate communities about the benefits of SSPs, dispel misinformation and garner support at a grassroots level. CDC is funding the CDC Foundation to implement public health interventions based on social media messaging and engagement in target communities. The CDC Foundation is partnering with the Public Good Projects (PGP), a nonprofit with expertise in implementing public health interventions on social media.

Project Overview

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.

Project Goals:

The PROTECT study is a three-year programmatic assessment that seeks to evaluate the impact of TPT across six countries—Haiti, Kenya, Nigeria, Uganda, Ukraine, and Zimbabwe—among PLHIV, using individual-level clinical data to measure the following outcomes:

• New TB diagnosis after TBT completion

• Mortality among PLHIV who completed TPT

Additional objectives:

• Mortality among PLHIV who completed TPT

• To evaluate the prevalence of isoniazid resistance among PLHIV

• To evaluate the effectiveness of isoniazid TPT in a setting with a high MDR TB burden

• To evaluate the effectiveness of 36-months (or lifelong TPT) as compared to 6 months of isoniazid treatmen

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.

Program Partners

• CDC's Division of Global HIV & TB (DGHT)
• Emory University
• CDC country offices
• Ministries of Health
• Implementing Partner Organizations: 
  • Catholic Medical Mission Board – Haiti
  • Eastern Deanery AIDS Relief Program – Kenya
  • Georgetown Global Health Nigeria – Nigeria
  • Makerere University School of Public Health – Monitoring and Evaluation Technical Support (MakSPH-METS) – Uganda
  • Public Health Center, Ministry of Health – Ukraine
  • Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) - Zimbabwe

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