CDC in South Sudan
A group of Frontline-Field Epidemiology Training Program (FETP) participants celebrate their graduation in July 2022. Photo by Gildo Okure/AFENET
The Centers for Disease Control and Prevention (CDC) established an office in South Sudan in 2006 to work on HIV prevention through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). CDC partners with the Ministry of Health (MOH) to focus on national responses to HIV, tuberculosis, diarrheal diseases and cholera, Ebola preparedness, measles, polio, and COVID-19. CDC’s partnership and investments help strengthen disease surveillance capabilities, laboratory systems, data and health information management systems, and the public health workforce.
Global Health Security
CDC partners with the MOH to develop sustainable national systems for disease surveillance, emergency preparedness and outbreak response, immunizations, laboratory capacity, strategic information, and workforce development. In response to the 2018 Ebola outbreak in the Democratic Republic of Congo, CDC and the MOH leveraged existing PEPFAR resources to establish the country’s first National Public Health Emergency Operations Center (PHEOC). The PHEOC was critical to South Sudan’s Ebola preparedness and response activities between 2018 and 2020. CDC uses the Extension for Community Healthcare Outcomes (ECHO) Project, a Zoom-based learning platform, to train healthcare workers in epidemiology, disease surveillance, diagnostics, treatment and case management, and prevention. The ECHO Project initially focused on HIV and TB trainings and later expanded to include Ebola and COVID-19 trainings for healthcare workers. Due to existing partnerships and structural investments, South Sudan was prepared to rapidly activate the PHEOC in response to the COVID-19 pandemic.
CDC expanded the Extension for Community Healthcare Outcomes (ECHO) Project to 54 healthcare facilities since 2018
CDC’s history of PEPFAR partnerships and programs provided the foundation to rapidly mobilize technical support, leadership, and coordination in response to COVID-19. In January 2020, the MOH began preparing for national pandemic response and later activated the PHEOC in March 2020. The first case of COVID-19 in South Sudan was confirmed on April 5, 2020. In the early stages of the pandemic, CDC supported data management and developed surveillance and vaccination reporting modules within the District Health Information Software 2 (DHIS2) platform. CDC also helped leverage existing resources, such as the PHEOC, ECHO platform, and laboratory infrastructure for COVID-19 response. CDC continues to focus support on strengthening disease surveillance, health promotion, laboratory diagnostics and systems, emergency management, communications, and border health. CDC and partners support the MOH’s COVID-19 vaccine rollout through technical planning, coordination of vaccine donations, establishment of a vaccine reporting system, and vaccine delivery.
South Sudan partnered with the MOH to expand existing laboratory infrastructure for COVID-19 testing. This support helped identify more than 17,200 cases and contributed to effective case management
Field Epidemiology Training Program (FETP)
FETP strengthens the capacity of the public health workforce to detect, respond, and control disease outbreaks at the source. Participants at the county, state, and national levels develop critical skills in data collection, analysis, and translation of data into evidence-based recommendations. In November 2021, CDC partnered with the MOH, WHO, and African Field Epidemiology Network (AFENET) to establish FETP-Frontline. CDC plans to expand FETP to include FETP-Intermediate and FETP-Advanced cohorts. FETP graduates are involved in real-time disease surveillance, outbreak investigation, rapid response, and partner coordination.
Before establishing FETP in 2021, trainees from South Sudan participated in Kenya’s FETP-Advanced cohort. Fifteen graduates from Kenya’s FETP now hold key positions at the South Sudan MOH, WHO country office, and international non-governmental organizations
As of 2021, nearly 170,000 people live with HIV in South Sudan. More than 9,300 new cases were diagnosed and 8,900 deaths occurred in 2021. As a key implementer of PEPFAR, CDC works with the MOH, WHO, UN, the Global Fund, and other partners to build a sustainable national HIV response program and achieve the UNAIDS 95-95-95 goals for epidemic control. CDC supports comprehensive HIV programs including HIV testing services, prevention of mother-to-child transmission, and anti-retroviral treatment (ART). CDC’s primary goals in South Sudan include:
- Increasing access to quality services for people living with HIV
- Reaching high viral load suppression (a low amount of HIV in the body) among people living with HIV by minimizing treatment interruptions and re-engaging people whose treatment was interrupted
- Enhancing laboratory capacity and coverage of viral load and early infant diagnosis testing
- Enhancing the quality and availability of HIV program data and use of data to inform program decisions
TB is one of the leading causes of death for people living with HIV. CDC works with the MOH and other partners to screen for TB among people receiving treatment for HIV and ensure that people living with co-infections are treated for both diseases.
CDC is supporting a 5-year project focused on strengthening national capacity for integrated HIV/AIDS health data collection, use, and dissemination. CDC’s priority is to support the MOH to launch a DHIS-2 and establish an HIV Electronic Medical Record System
Laboratory Systems Strengthening
Since 2006, CDC has partnered with Global Fund to support South Sudan’s National Public Health Laboratory by strengthening laboratory infrastructure, staffing, and technical capacity. CDC and Kenya’s National HIV Reference Laboratory also support the South Sudan MOH to monitor viral load among people receiving treatment for HIV. In partnership with CDC’s country office in Kenya, CDC South Sudan started a quality assurance program for HIV rapid testing. Other CDC-supported activities include implementation of laboratory quality management systems, biosafety, blood safety, staff trainings, and guideline development.
Through PEPFAR, CDC partnered with the MOH and WHO to revise national ART guidelines in South Sudan. These guidelines reflect a transition to a new treatment regimen and the use of innovative approaches to HIV service scale-up in settings with limited resources
Every year, vaccines prevent more than 2-3 million deaths among children younger than age 5. In South Sudan, CDC works with the MOH, WHO, AFENET, and UNICEF to strengthen immunization systems and provide technical support. CDC supports workforce capacity-strengthening for national and state immunization programs as part of the Expanded Program on Immunization. To strengthen workforce capacity and immunization systems, health professionals from across the country participate in trainings on routine immunization, disease surveillance, cold-chain logistics, data management, communication, and other supplemental activities.
As part of the Expanded Program on Immunization (EPI), 56 trainees from across South Sudan were trained in vaccine-preventable disease surveillance, cold-chain logistics, data management, and communication
- 2 U.S. Assignees
- 8 Locally Employed
- Population: > 11.3 million
- Per capita income: $1,090
- Life expectancy: F 60 / M 57 years
- Infant mortality rate: 61/1,000 live births
Sources: World Bank 2021, South Sudan; World Bank 2015, South Sudan; Population Reference Bureau 2021, South Sudan
Emerging Infectious Diseases Journal: South Sudan Articles All Issues | CDC
HIV and TB:
- Status of HIV Case-Based Surveillance Implementation — 39 U.S. PEPFAR-Supported Countries, May–July 2019 | MMWR
- Scaling up HIV testing among contacts of index patients in 20 countries, 2016-2018 | MMWR
- Implementation and scale-up of tuberculosis preventive treatment among people living with HIV in South Sudan, 2017–2019 | WHO Bulletin
- High HIV and syphilis prevalence among female sex workers in Juba, South Sudan
- Novel Approaches for Estimating Female Sex Worker Population Size in South Sudan
- Impact of Policy and Funding Decisions on COVID-19 Surveillance Operations and Case Reports — South Sudan, April 2020–February 2021 | MMWR
- Risk factors for hospitalization and death from COVID-19: a prospective cohort study in South Sudan and Eastern Democratic Republic of the Congo | BMJ Open
- Case Definitions Used During the First 6 Months of the 10th Ebola Virus Disease Outbreak in the Democratic Republic of the Congo — Four Neighboring Countries, August 2018–February 2019 | MMWR
- Analysis of performance of the Ebola virus disease alert management system in South Sudan: August 2018 to November 2019
- Lessons learned from implementation of a national hotline for Ebola virus disease emergency preparedness in South Sudan