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Evaluating Tuberculosis Preventive Treatment in People Living with HIV

PROTECT logo

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.

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HIV/AIDS
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Evaluating Tuberculosis Preventive Treatment in People Living with HIV
CDC’s Center for Global Health
Emory University
Bill & Melinda Gates Foundation
Haiti
Kenya
Nigeria
Ukraine
Uganda
Zimbabwe
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To determine the impact of Tuberculosis preventative treatment among populations living with HIV.
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Tuberculosis

Integrating Genomic Data into Surveillance in Senegal

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Miranda Bodfish
Global Health
Global Health Security
global health
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Integrating Genomic Data into Surveillance in Senegal
Harvard Chan School of Public Health
Senegal
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To scale and integrate genomic epidemiology approaches into real world malaria control and elimination surveillance and decision-making strategy in Senegal, a malaria endemic country.
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Malaria

Consolidating Tuberculosis Analytics and Evidence Tools

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. 

1097
Miranda Bodfish
Global Health
Epidemiology and Surveillance
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Consolidating Tuberculosis Analytics and Evidence Tools
CDC’s Center for Global Health
Bill & Melinda Gates Foundation
United States of America
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To create comprehensive documentation on effective and efficient country engagement approaches for tuberculosis data and evidence-related activities.
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Tuberculosis

Diseases

Diseases

We are living in an interconnected world where an outbreak of infectious disease is just a plane ride away. As a global leader in research, CDC provides technical expertise and engagement in on-the-ground programs to help detect diseases, break the cycle of transmission, and to lower the mortality rate of those living with disease.

Vietnam - Influenza (flu)

NEED

Vietnam is at high risk for emerging influenza viruses with pandemic potential.

INTERVENTION

Strengthen the surveillance system for Severe Viral Pneumonia, the primary system for detection of novel influenza viruses and other emerging respiratory pathogens in humans

Estimate the economic burden of influenza in Vietnam

Introduce seasonal flu vaccine and implement national scale up

TYPE OF ACTIVITIES 

Disease specific (Influenza)

APPROXIMATE FUNDING NEED

$3.8 million

Vietnam - Tuberculosis (TB)

NEED

Among 30 high-burden TB countries in the world, Vietnam ranks sixteenth, with an estimated 124,000 new TB patients in 2017 alone, including 7,100 cases of multidrug-resistant TB and 12,000 TB-related deaths.

INTERVENTION

Rapidly reduce TB burden in Ho Chi Minh City and other priority provinces through demonstration projects and scale up

Prevent TB among US-bound immigrants and refugees from Vietnam

TYPE OF ACTIVITIES 

Disease specific (TB)

APPROXIMATE FUNDING NEED

$2.3 million

Haiti - Cholera

NEED

While Haiti is recording the lowest levels of suspected cholera cases since 2011, cholera remains a public health threat and gains made since the last outbreak must be maintained.

INTERVENTION

Interrupt cholera transmission by enhancing Haiti’s laboratory cholera surveillance and response capacity and implementing water, sanitation and hygiene projects

TYPE OF ACTIVITIES 

Disease specific (Cholera)

APPROXIMATE FUNDING NEED

$4.1 million

Haiti - Neglected tropical diseases (NTDs)

NEED

Lymphatic filariasis is on the cusp of elimination in Haiti, one of only four countries in the Americas where the disease remains.

INTERVENTION

Eliminate lymphatic filariasis through mass drug administration, morbidity management and disability prevention and surveillance

ACTIVITIES 

Disease specific (Neglected tropical disease)

APPROXIMATE FUNDING NEED

$15 million

Sierra Leone - Malaria

NEED

Indoor bites from mosquitoes account for 80%–100% of overnight malaria transmission in Africa, and while built-environment modifications were once staples of malaria vector control, they have been neglected for at least the past two decades.

INTERVENTION

Implement a pilot study to assess the impact of new screening strategies on malaria vector control

TYPE OF ACTIVITIES 

Disease specific (Malaria)

APPROXIMATE FUNDING NEED

$232,000

Funding Needed
$25,432,000
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Emergency Preparedness

Emergency Preparedness

With 70 percent of countries still not fully prepared to respond to a public health emergency, it is more likely that infectious diseases will take root and spread across borders. Fast and effective response can stop a local outbreak from becoming a global epidemic.

The world has committed to building public health emergency operations centers capable of activating a coordinated response within 120 minutes of the identification of a public health emergency. CDC experts collaborate with the international community to improve their ability to prepare and respond to emergencies.

Haiti

NEED

Hit by multiple natural disasters over the past decade, preparedness and emergency response capacity are critical in Haiti.

INTERVENTION

Fully operationalize an Emergency Operations Center in Haiti by finalizing interoperability of information technology and purchasing equipment, developing table top exercises and continuing training of EOC personnel

TYPE OF ACTIVITIES 

Emergency preparedness

APPROXIMATE FUNDING NEED

$464,000

Sierra Leone

NEED

Preserving the informational legacy of the Ebola epidemic gives a unique opportunity to analyze the mortality impact of Ebola, improve future Ebola responses and build research capacity in Sierra Leone.

INTERVENTION

Improve secure access to the Sierra Leone Ebola Database

TYPE OF ACTIVITIES 

Emergency preparedness

APPROXIMATE FUNDING NEED

$900,000

Sierra Leone

NEED

Operational support of the National EOC will cease in June 2019 and additional planning is needed to ensure this support is successfully transitioned to the MoHS.

INTERVENTION

Build country ownership for the National Emergency Operations Center

TYPE OF ACTIVITIES 

Emergency preparedness

APPROXIMATE FUNDING NEED

$750,000

Funding Needed
$2,114,000
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Workforce Development

Workforce Development

Central to public health workforce development is CDC’s Field Epidemiology Training Program (FETP), which trains field epidemiologists in developing countries. Graduates of these programs have the skills to collect, analyze and interpret disease information, using evidence to take quick action and save lives.

Individual countries and ministries of health own the program, which are tailored to meet the needs of each country, recognizing differences in disease burdens, cultures, priorities, partners, capacities and public health systems.

India

NEED

A key priority of the Global Health Security Agenda and a major strategic objective of CDC India is the development of strong cadres of public health workers.

INTERVENTION

Expand the India Field Epidemiology Training Program to increase country capacity for disease surveillance and outbreak investigation

TYPE OF ACTIVITIES 

Workforce development

APPROXIMATE FUNDING NEED

$1.5 million

Vietnam

NEED

Key to addressing the challenges of outbreak detection, prevention and response in Vietnam is the development of a public health workforce with solid practical epidemiological skills.

INTERVENTION

Expand the Field Epidemiology Training Program in Vietnam

TYPE OF ACTIVITIES 

Workforce development

APPROXIMATE FUNDING NEED

$1.6 million

Haiti

NEED

Improve Haiti's public health workforce capacity in business administration to ensure proper management of public health projects.

INTERVENTION

Support the Field Epidemiology Training Program and provide community health workers with surveillance training and training in business management software

TYPE OF ACTIVITIES 

Workforce development

APPROXIMATE FUNDING NEED

$4.6 million

Sierra Leone

NEED

Currently, the Field Epidemiology Training Program relies on technical support from international mentors to maintain program quality.

INTERVENTION

Strengthen the Field Epidemiology Training Program so that graduates can serve as mentors for future cohorts

TYPE OF ACTIVITIES 

Workforce development

APPROXIMATE FUNDING NEED

$3.1 million

Funding Needed
$10,800,000
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Haiti
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Laboratory

Laboratory

In today’s healthcare system, 70 percent of medical decisions depend on laboratory test results. Strong clinical laboratories provide the foundation for accurate and timely disease diagnosis, prevention and control to improve public health and safety.

CDC improves laboratory quality and safety, informatics and data science, and workforce competencies to safeguard both patient and public health.

Nigeria

NEED

Nigeria has more malaria cases than any other country, with a prevalence of 27 percent among children under five years of age.

INTERVENTION

Implement proactive community detection of malaria, pneumonia and diarrhea

TYPE OF ACTIVITIES 

Laboratory

APPROXIMATE FUNDING NEED

$5 million

India

NEED

Acute febrile illness affects thousands of people every year in India, leading to severe morbidity and mortality.

INTERVENTION

Establish a tiered diagnostic system for seven acute febrile illness pathogens among hospitals across the country

TYPE OF ACTIVITIES 

Laboratory

APPROXIMATE FUNDING NEED

$880,000

Vietnam

NEED

The ministry of health has limited capacity to detect unusual or emerging pathogens in the course of outbreak investigations.

INTERVENTION

Establish a national public health reference laboratory network with the capacity for advanced diagnostic testing that produces credible results

TYPE OF ACTIVITIES 

Laboratory

APPROXIMATE FUNDING NEED

$1.2 million

Haiti

NEED

In order to accurately identify and detect pathogens, Haiti’s laboratory quality systems need improvement.

INTERVENTION

Improve pathogen detection by building public health laboratory capacity through expansion of Haiti’s specimen storage, operationalizing the country’s National Specimen Referral Network and building national and subnational laboratory capacity

TYPE OF ACTIVITIES 

Laboratory

APPROXIMATE FUNDING NEED

$2.9 million

Sierra Leone

NEED

Renovations, equipment, supplies and workforce development are needed for the Central Public Health Laboratory (CPHRL) to serve the five reference laboratories within Sierra Leone and provide leadership and guidance within the MOHS public health systems.

INTERVENTION

Sustainably renovate and operationalize the CPHRL

TYPE OF ACTIVITIES 

Laboratory

APPROXIMATE FUNDING NEED

$2 million

Funding Needed
$11,980,000
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India
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Surveillance

Surveillance

A pathogen can travel around the globe to major cities in as little as 36 hours. CDC experts are on the frontlines fighting diseases to protect Americans in the United States and abroad. CDC works around the clock to get the right information into the right hands at the right time.

CDC’s global activities protect Americans from major health threats, including Ebola, influenza, tuberculosis (TB) and malaria. CDC monitors disease outbreaks 24/7 around the world to prevent regional and global health crises that affect health, security and economic stability abroad and at home.

Nigeria

NEED

The existing surveillance systems in Nigeria are often fragmented, disease specific, inconsistent and in need higher quality control.

INTERVENTION

Establish an integrated diagnostics and surveillance system

TYPE OF ACTIVITIES 

Surveillance

APPROXIMATE FUNDING NEED

$2.1 million

Nigeria

NEED

A surveillance and response clinical telecommunications network is needed to allow for enhanced detection and surveillance of high-risk pathogens, improved capacity of healthcare professionals to implement infection prevention and control protocols and strengthened outbreak response capabilities.

INTERVENTION

Apply telehealth concepts to outbreak preparation

TYPE OF ACTIVITIES 

Surveillance

APPROXIMATE FUNDING NEED

$2.3 million

Vietnam

NEED

Unpublished AMR surveillance data show carbapenem resistance to be highly endemic in Vietnam and an urgent threat to public health.

INTERVENTION

Establish a national AMR surveillance system to strengthen Vietnam’s ability to improve response to resistant infections and improve patient safety

TYPE OF ACTIVITIES 

Surveillance

APPROXIMATE FUNDING NEED

$2.6 million

Haiti

NEED

While great strides have been made in Haiti’s ability to detect diseases and support a One Health approach, additional support for the national surveillance program is needed to ensure sustainability for priority diseases.

INTERVENTION

Support infectious disease investigations by strengthening the national and departmental/site-level surveillance programs, including the HIV/AIDS integrated case-based surveillance system

TYPE OF ACTIVITIES 

Surveillance

APPROXIMATE FUNDING NEED

$4.1 million

Funding Needed
$11,100,000
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Immunization

Immunization

Vaccines prevent an estimated 2.5 million deaths among children younger than age five every year. Still, one child dies every 20 seconds from a disease that could have been prevented by a vaccine. Why? Because one in five children in the world does not have access to the lifesaving immunizations that keep children healthy.

CDC is involved in one of the most effective of all global public health missions—vaccination against deadly diseases, which saves the lives of two to three million people every year. CDC works closely with a wide variety of partners to protect global citizens against contagious and life-threatening vaccine-preventable diseases.

Nigeria

NEED

Nigeria is hyper-endemic for hepatitis B virus (HBV) infection, with an overall population prevalence of chronic HBV infection of 12.2 percent (an estimated 20 million persons).

INTERVENTION

Improve timely hepatitis B birth dose vaccination in key Nigerian states

TYPE OF ACTIVITIES 

Immunization

APPROXIMATE FUNDING NEED

$2.7 million

Vietnam

NEED

There is a need to enhance Vietnam’s major immunization policy authorities for greater independence and technical expertise focused on linking decision-making to scientific evidence.

INTERVENTION

Strengthen the evidence-based decision-making capacity of national immunization policy authorities

Increase demand for and usage of existing, routinely recommended immunizations

Build economic analysis and financial planning capacity in the national immunization program

Strengthen sub-national capacity for surveillance and data management of vaccine-preventable diseases

TYPE OF ACTIVITIES 

Immunization

APPROXIMATE FUNDING NEED

$2.1 million

Funding Needed
$4,800,000
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