How the CDC is scaling up TB prevention for people with HIV
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How the CDC is scaling up TB prevention for people with HIV

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This is a guest post by the Division of Global HIV & TB at the Centers for Disease Control and Prevention.

Tuberculosis (TB) and HIV are a deadly combination. In addition to the being the top infectious disease killer in the world, TB is the #1 cause of death for people living with HIV (PLHIV), accounting for 2 in 5 deaths among those living with HIV in 2016. Because of their weakened immune system, people living with HIV are both more likely to become infected with TB and more likely to develop active TB. In fact, people living with HIV are up to 30 times more likely to develop TB disease than someone without the virus.

The good news is that we have powerful treatment and prevention tools that can dramatically reduce these dire health outcomes.

A CDC program in Mozambique. (Photo credit: CDC)

A CDC program in Mozambique. (Photo credit: CDC)

Research tells us that HIV antiretroviral treatment (ART) alone can reduce the risk of developing TB disease in people living with HIV. We also know that combining ART and TB preventive therapy (TPT) has great benefits. Independent of ART, TPT treatment for people with HIV reduces the number of patients who die in the 5 years after completing therapy by nearly 40 percent.

What’s more, combining ART and TPT can dramatically reduce the risk of death for those living with both diseases – by as much as 80 percent.

Yet, despite evidence of lives and costs saved, implementation of TPT around the world remains uneven, insufficient, and under-used, keeping these powerful therapies out of reach for millions who need it.

Photo credit: CDC

According to the World Health Organization (WHO), under 25% of people living with HIV have ever started TPT, despite WHO recommendations calling for expanded access since 1993. Meanwhile, TB continues to cause senseless deaths among people with HIV. In 2016, nearly 400,000 people with HIV died from TB, a preventable and curable disease.

Recognizing the urgent need to accelerate the global response to these dual epidemics, CDC, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has launched a newly-intensified initiative aimed at scaling up TPT in countries with high burden of both TB and HIV.

“For too long we have seen how antiretroviral medicines have transformed the global health landscape, allowing millions with HIV to live longer and healthier lives only to die from TB,” said Hank Tomlinson, PhD, Acting Director of CDC’s Division of Global HIV & TB. “We have treatments that we know work. We must move quickly to expand access to these lifesaving treatments. And we must act now.”

A lung with miliary tuberculosis. (Photo credit: Yale Rosen/Flickr)

CDC’s Work to Accelerate Global TPT Uptake

Earlier this year, WHO released new guidelines, calling for expanded TB testing and preventive treatment globally. Building on existing PEPFAR infrastructure, CDC is at the forefront of efforts to accelerate TPT uptake around the world.

As part of this effort, CDC is conducting baseline assessments among TPT programs in high burden countries – to identify gaps, determine best practices and replicate successful efforts worldwide. Using technical guidance, trainings, mentorship efforts and program innovations, CDC’s goal is to help countries rapidly expand life-saving TB prevention therapy to millions more people living with HIV.

Photo credit: CDC

The ultimate goal is to ensure that TPT is included as an essential component of the routine services being provided to people living with HIV. Anyone receiving ART should also be on TPT, after being screened and ruled out for active TB disease.

For example, in Malawi, a country with a high TB burden, CDC assisted in efforts to identify eligible candidates for TPT, then helped the government launch a program to reach them. Today, CDC works to support the

country’s goal of putting more PLHIV on lifelong TPT. So far, this pilot program has brought 100,000 people onto TPT and aims to reach an additional 200,000 people by the end of the year.

CDC’s Broader Efforts to Fight HIV and TB in Tandem

This newly accelerated TPT initiative is just one component of CDC’s global work to align TB and HIV efforts – to accelerate progress against both diseases. In more than 30 high burden countries, CDC is working hand-in-hand with government partners, community groups, and health organizations to bolster access to ART.

CDC is also leading efforts to expand HIV testing for TB patients and intensify routine TB screening among those living with HIV. In 2017, CDC supported TB screenings for 4.7 million people with HIV, including 400,000 children and supported HIV treatment for 140,000 people living with both HIV and TB disease.

“Ending these epidemics demands that we, as a global community expand our efforts. TB preventive therapy is an effective, low cost, high-impact intervention that can save lives,” said Susan Maloney, MD, MPH, and Chief of the Global TB Branch in CDC’s Division of Global HIV & TB. “Without action, we risk undermining the progress we’ve made against this deadly dual epidemic. With effective treatment, TB can be cured, HIV managed, and millions of lives saved.”

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