DTBE in Ethiopia
Capital City: Addis Ababa
Area*:1.1 million sq. km (472,000 sq. mi.)
Population (est.), 2011*: 82 million
Estimated TB Incidence, 2010**: 261/100,000
Estimated TB Prevalence, 2010**: 394/100,000
Adult HIV Prevalence Rate, 2009***: 2.1%
Number of people living with HIV (PLHIV), 2009***: 980,000
Percent of tested TB patients who were HIV+, 2010**: 15%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
Ethiopia has the seventh highest tuberculosis (TB) burden and one of the highest TB mortality rates in the world. Low TB case detection and HIV-testing rates are challenges to ensuring prompt diagnosis and treatment of TB, especially among people living with HIV (PLHIV). The Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination (CDC/DTBE) provides technical support to CDC/Global AIDS Program (GAP) Ethiopia, the Federal Ministry of Health (FMOH) and partners to expand TB/HIV efforts. DTBE’s programmatic focus in Ethiopia is to support CDC/GAP in efforts to prevent TB/HIV through technical assistance and programmatically relevant research. Key activities include improving the diagnosis and treatment of pediatric TB/HIV cases, supporting scale-up and evaluation of TB screening in PLHIV, and TB/HIV integration activities.
Recent Accomplishments & Ongoing Collaborations
Multidrug-resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations
Pediatric TB/HIV Surveillance Evaluation: TB is difficult to diagnose among PLHIV, even more so in children. There has been little research on optimal screening and diagnosis of TB among children with HIV. DTBE, in collaboration with the International Center for AIDS Care and Treatment Program (ICAP), conducted an evaluation of HIV diagnosis and treatment in 12 pediatric TB care settings throughout Ethiopia. The evaluation found that while HIV testing among children with TB has scaled-up, gaps remain for HIV testing in infants, who require Polymerase Chain Reaction (PCR)-based HIV testing for accurate diagnosis. Missed opportunities for preventing TB among children include a lack of routine screening of all child contacts of patients with TB and limited use of isoniazid preventive therapy (IPT) in children with HIV.
Intensified TB Case Finding Among PLHIV: Using sputum bacteriology as a gold standard, DTBE evaluated commonly available screening tests for pulmonary TB in people with HIV attending urban voluntary counseling and testing clinics in Addis Ababa, and Ethiopia. The results suggested that screening for a combination of symptoms best rules out TB in people with HIV. This study was included in a recent patient-level meta-analysis of TB screening studies, and the results of that meta-analysis are modifying World Health Organization (WHO) global policy.