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.

Currently there are numerous tools and activities used to assist countries in the collection of and use of routine tuberculosis (TB) surveillance, costing, and program data. However, implementation of such activities can place an extensive burden on Ministries of Health and implementing partners and may not occur in an efficient manner. With funding from the Bill & Melinda Gates Foundation, the CDC Foundation is working with the Centers for Disease Control and Prevention (CDC) Division of Global HIV and Tuberculosis to conduct a review of globally-endorsed TB data generation and analysis tools. The goal of this project is to document effective and efficient approaches to the use of TB data generation and analysis tools, in order to optimize the manner in which donors and partners invest in and provide technical support to country TB programs. This project draws on CDC’s expertise in TB surveillance and program evaluation, as well as its strong partnerships with countries and global stakeholders. These stakeholders will provide input into this review, with a view to consolidating data collection and analytical methods for more efficient use. Findings will be synthesized into a framework that will be used to improve the efficiency of TB data generation globally and increase country use of TB data to prioritize resource allocation for effective program implementation. 

Tuberculosis (TB) is the world’s deadliest infectious disease. In 2018, the largest number of new TB cases occurred in the South-East Asian region, with 44 percent of new cases. Viet Nam ranks 11th among the 30 high-burden countries, with an estimated 174,000 TB patients in 2018. Over the past decade, Viet Nam has dramatically reduced the prevalence of smear-positive TB among adults, the most infectious type of TB. However, the TB burden based on the recent prevalence survey remains high, and the government of Viet Nam and CDC have recognized that intensified interventions are needed in order to “bend the curve” and accelerate the decline in TB prevalence.

This project is an important partnership between the Taiwan Centers for Disease Control (CDC); Ministry of Health and Welfare, R.O.C; the U.S. Centers for Disease Control and Prevention (CDC); and the CDC Foundation to support Viet Nam in their goal to move towards TB elimination. This project focuses on addressing TB in Ho Chih Minh City, Viet Nam by drawing on the collective public health expertise, experience and resources of Taiwan, Viet Nam, and the U.S. so that by working together, there can be more impact.  

The overall project objectives are to:

• Evaluate current capacity and feasibility and develop a diagnosis and treatment model to find and cure adult and pediatric TB cases in Ho Chi Minh City using the most effective strategies demonstrated in the initial Zero TB Viet Nam pilot project; and
• Help accelerate local elimination through TB prevention and detection efforts by expanding latent TB infection treatment to high-risk groups.

In 2019, the project organized a Trilateral Forum focused on catalyzing regional partnerships towards ending TB in Viet Nam. The forum convened key partners including the National TB Program, the Ho Chih Minh City Department of Health (DoH), Pham Ngoc Thach Hospital, (responsible for the TB program in the south), Taiwan Ministry of Health and Welfare, Taiwan CDC, U.S. CDC, and local implementing partner Friends for International TB Relief (FIT). The Forum officially established a regional partnership to end TB in Ho Chih Minh City, and participants held technical exchanges in support of national planning, identifying program gaps and sharing lessons learned related to case finding, treatment and engaging the private healthcare sector in TB interventions.

Many low- and middle-income countries lack the data necessary to fully describe disease threats in their countries and monitor the impact of public health efforts to prevent and control disease.

Serosurveillance—which involves monitoring the presence or absence of antibodies or proteins in the blood serum of a population—provides an objective biological measure for estimating population susceptibility, exposure and immunity. Serologic data are increasingly used to guide public health policy and strategy, from support of vaccine introduction to verification of disease elimination.

Currently, serosurveillance is often focused on a single disease. Integrated serosurveillance (multi-disease serologic surveillance) is a cost-effective approach that can dramatically scale up the availability of data for public health action, including for diseases currently unmonitored.

CDC has developed an approach to integrated serosurveillance for multiple diseases of public health importance using a multiplex bead assay platform. The platform can simultaneously measure up to 100 different disease-specific markers from a single dried blood spot, creating novel opportunities to establish integrated nationally representative serosurveillance programs. If well implemented, integrated serosurveillance could increase the quality and breadth of data available for infectious disease modeling and efforts to describe transmission risks. Data collected through integrated serosurveillance can also inform implementation of prevention opportunities across multiple diseases. 

But, implementation of integrated serosurveillance requires coordination of subject matter expertise and ongoing technical assistance to ensure generation of high-quality data for public health decision making. CDC’s vision is to expand capacity to implement this approach around the globe where data from integrated serosurveillance could drive critical aspects of public health programs.

In Nigeria, the Nigeria CDC has identified integrated serosurveillance as a priority for generating high-quality supplemental information to augment the existing surveillance network, and for their overall public health response. With funding from the Bill and Melinda Gates Foundation, the CDC Foundation is working with CDC and other partners to strengthen the capacity of Nigeria’s National Reference Laboratory to conduct integrated serosurveillance multiplex bead assay technology. The support is part of a multi-partner effort that includes multiple CDC programs, donors and partners.  

As results are available, CDC is working with the Nigeria CDC and government partners to analyze multiplex testing data and apply results to advance public health programs. In addition, CDC is applying lessons learned from Nigeria and previous projects to develop the tools and technical assistance capacity needed to accelerate the implementation of integrated serosurveillance in other countries.