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Impact of CDC-Tuberculosis Preventative Treatment Studies

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global health
Impact of CDC-Tuberculosis Preventative Treatment Studies
United States of America
To enhance the informativeness and impact of the CDC-Tuberculosis Preventative Treatment studies by funding technical experts to partner in the production of updated protocols, updated statistical analysis plans and a multi-country meta-analysis.
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Evaluating Tuberculosis Preventive Treatment in People Living with HIV

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the word PROTECT with a red ribbon as the letter O

Preventing TB with a safe and effective regimen: Tuberculosis (TB) is the leading cause of death in people living with HIV worldwide, accounting for one-fourth of all HIV-related deaths. TB can be prevented with a 3- or 6-month regimen of a safe and effective treatment.

Providing preventive treatment:The President’s Emergency Plan for AIDS Relief (PEPFAR) has committed to provide at least one course of TB preventive treatment (TPT) to all people living with HIV (PLHIV) in care. By the end of 2022, over 10 million PLHIV received TPT globally through PEPFAR programs.

Measuring the impact: PROTECT project will work to measure the impact of TPT on TB incidence and mortality. Additionally, some countries will evaluate the prevalence of isoniazid resistance and the added benefit of lifelong TPT (36 months).

Obtaining data: The estimated sample size ranges from 20,000 to 200,000 PLHIV per country. This evaluation includes an analysis of secondary data that was recorded electronically in routine programmatic conditions. Outcomes will be adjusted for age, sex, antiretroviral therapy, CD4 cell count, viral suppression, and TPT regimen.
 

Sharing lessons learned and best practices: Findings will be shared with national stakeholders, affected communities, and global programs to help inform additional scale-up of TPT for PLHIV.

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.

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global health
Evaluating Tuberculosis Preventive Treatment in People Living with HIV
Haiti
Kenya
Nigeria
Ukraine
Uganda
Zimbabwe
To determine the impact of Tuberculosis preventative treatment among populations living with HIV.
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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. 

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Consolidating Tuberculosis Analytics and Evidence Tools
United States of America
To create comprehensive documentation on effective and efficient country engagement approaches for tuberculosis data and evidence-related activities.
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COVID-19 Response

COVID-19 Response

Partners Needed in the Coronavirus Response

In January 2020, the Centers for Disease Control and Prevention (CDC) requested the CDC Foundation activate our Emergency Response Fund to provide support to rapidly emerging response needs related to COVID-19. Support from individuals and organizations provides much needed funding to meet response needs where federal and state funding is not available or available quickly enough to meet the need.

Funds raised by the CDC Foundation through our Emergency Response Fund are being used to meet fast-emerging needs identified by CDC and public health authorities to help respond to the public health threat posed by this virus. These include additional support for state and local health departments, support for the global response, logistics, communications, data management, personal protective equipment, critical response supplies and more.

Learn how your contributions are making an impact.

For more information on how you can partner with the CDC Foundation, please contact Laura Croft, vice president for advancement, at 404.523.1788 or lcroft@cdcfoundation.org.

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coronavirus
United States of America
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The Ending the HIV Epidemic Fund

HIV Epidemic Fund

We have a unique, once-in-a-generation opportunity to leverage data, scientific tools and technology to eliminate HIV in the United States by 2030. The national initiative Ending the HIV Epidemic: A Plan for America is focused on the highest burden 48 counties, Washington, D.C., and San Juan, Puerto Rico, as well as seven states with the highest rural HIV burden. These jurisdictions together account for more than 50 percent of new HIV diagnoses in recent years.

The U.S. Department of Health and Human Services (HHS) is leading the End of the HIV Epidemic initiative. This plan aims to reduce the number of new HIV diagnoses by at least 90 percent within 10 years.

Importantly, this plan will leverage scientific advances in HIV prevention, diagnosis, treatment and care by coordinating the highly successful programs, resources and technical expertise of the Centers for Disease Control and Prevention (CDC) and other HHS agencies.

Success requires the involvement of the public, philanthropic and private sectors. The CDC Foundation’s Ending the HIV Epidemic Fund is designed to build on and extend public funding, enabling individual and organizational donors to support this historic opportunity to eliminate HIV in the United States.

Digital Education Strategy and Campaign

Need

It can be difficult to reach audiences most susceptible to HIV with effective messaging.

Intervention

Develop innovative digital campaigns to reach those living with and most vulnerable to HIV, in coordination with state and local partners, for maximum impact.

Type of Activities

Campaigns to increase diagnosis, link people to treatment, prevent HIV transmission, and respond quickly to outbreaks.

Approximate Funding Need

Funding needs are variable depending on specific activity.

Innovative Models of Community Care

Need

While traditional care approaches work for reaching some communities, reaching all those most vulnerable will require disruptive, innovative approaches.

Intervention

Design care delivery systems that deliver comprehensive, evidence-based prevention and treatment services, including support for syringe services programs.

Type of Activities

Prevention

Approximate Funding Need

Funding needs are variable depending on specific activity.

Rural Access to Treatment and Care

Need

Many rural communities lack sufficient access to preventive healthcare services, including PrEP, and HIV testing in their locations.

Intervention

Expand opportunities for care in rural communities by mobilizing and promoting programing and technologies such as community-based pharmacies, home-based HIV testing, and greater utilization of telemedicine.

Type of Activities

Linkage to Care

Approximate Funding Need

Funding needs are variable depending on specific activity.

Key Facts
2030 is the target for eliminating HIV in America
Plan aims to reduce HIV diagnoses 75% in 5 years
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HIV
United States of America
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Integrated Serosurveillance Center and Serologic Surveillance in Nigeria

Nigeria program

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.

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Global Health
Integrated Serosurveillance Center and Serologic Surveillance in Nigeria
Nigeria
To scale capacity for integrated serosurveillance in Africa and to conduct integrated serologic surveillance using stored samples from Nigeria’s HIV Impact Survey.
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Strengthening Global Cardiovascular Health Systems Phase 2

1068
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Global Health
Strengthening Global Cardiovascular Health Systems Phase 2
Bangladesh
China
Ethiopia
India
Nigeria
Thailand
Turkey
To reduce the burden of cardiovascular diseases in low- and middle-income countries by providing technical expertise, facilitating technical packages, building Field Epidemiology Training Program (FETP) workforce capacity; establishing a consortium of experts; and collaborating with governmental agencies and partners.

Monitoring and Evaluation of Typhoid Conjugate Vaccination Campaign

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global health
Monitoring and Evaluation of Typhoid Conjugate Vaccination Campaign
Zimbabwe
To assess the acceptability, safety, feasibility and cost of a Typhoid Conjugate Vaccine (TCV) delivered as part of a ministry-led campaign in Harare, Zimbabwe. This evaluation will provide lessons learned and recommendations for future use of TCV in outbreak settings, and to inform typhoid control strategies.

Laboratory Surveillance for Pneumococcal Meningitis in India

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global health
Laboratory Surveillance for Pneumococcal Meningitis in India
India
United States of America
To strengthen laboratory surveillance for pneumococcal meningitis and serotyping in India to understand the impact of a pneumococcal conjugate vaccine rollout.
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