Division of Global HIV & TB (DGHT)
2017 DGHT SNAPSHOT
- Developed the evidence base through CDC-supported Population-based HIV Impact Assessments (PHIA) data to show HIV epidemic control is within reach in 5 African countries.
- Supported life-saving antiretroviral treatment (ART) for 7.3 million men, women, and children living with HIV, with more than half of those on PEPFAR-supported treatment.*
Supported life-saving ART for more than 388,000 children under the age of 15 around the world.*
*As of September 30, 2017; U.S. President’s Emergency Plan for AIDS Relief
- Used findings from the CDC-supported PHIA conducted in 9 countries to assess national HIV incidence, treatment coverage, and viral suppression, and measure impact of HIV programs.
- Led a robust laboratory quality improvement and accreditation mentoring program — building strong networks across Africa and Asia.
Year In Review
DGHT’s global leadership ensured progress toward HIV epidemic control as part of PEPFAR, as well as improvements in finding, curing, and preventing TB worldwide. By applying rigorous scientific and technical expertise, and persistently using data and technical know-how in program planning and assessment, DGHT increased HIV and TB program impact and cost effectiveness.
In partnership with Ministries of Health (MOH) around the globe, DGHT collaborated peer-to-peer in translating country-specific data into real-world solutions to affect positive health outcomes. Our partnership approach demonstrated that countries can develop the capacity needed to respond to infectious disease, ultimately protecting Americans and minimizing future U.S. government investment.
Approaching HIV Epidemic Control
As seen through CDC-supported Population-based HIV Impact Assessments (PHIA) data, HIV epidemic control is within reach in Lesotho, Swaziland, Malawi, Zambia, and Zimbabwe. However, attention to continuing ARV therapy is central to reaching epidemic control goals. Epidemic control seemed unthinkable in 2003 when PEPFAR started, but now is seen as an achievement within reach. To have done so without a vaccine or a cure for HIV/AIDS demonstrates the tenacity and will of the PEPFAR program and our implementing partners.
As of September 30, 2017, CDC supported life-saving ART for over 7.3 million people living with HIV – which is one-third of all people on treatment worldwide and more than half of those on PEPFAR-supported treatment. As part of PEPFAR, we supported life-saving ART for more than 388,000 children under the age of 15 around the globe. To curb the spread of HIV, CDC supported voluntary medical male circumcision procedures for 7.2 million men in Southern and Eastern Africa cumulatively – nearly half of all procedures supported by PEPFAR to date through September 30, 2017.
DGHT introduced and made available a Rapid Incidence Test that simultaneously diagnoses HIV infection and identifies recent infection. This important information allows programs to identify and target those who are newly HIV-positive and at highest risk for transmitting HIV while strengthening partner notification efforts. CDC is currently performing a field evaluation of Rapid Incidence Testing in Guatemala with the goal of increasing the number of those undiagnosed and to prevent transmission to uninfected partners.
These achievements represent significant progress toward a 2020 global goal of HIV epidemic control, and demonstrate that our efforts to increase access to effective HIV prevention programs — as well as to HIV treatment, are working.
Finding, Curing, and Preventing TB Worldwide
DGHT focused on those countries with high TB burden, including countries that have strong U.S. business and community ties, are directly connected to the U.S.-based TB epidemic, and have PEPFAR’s commitment to TB as a key component of a global HIV response.
By developing innovative program strategies, leveraging PEPFAR platforms, and using proven diagnostic and treatment tools to find, cure, and prevent TB, DGHT addressed technical and operational challenges in high-burden TB countries that undermine progress toward achieving global TB targets.
However, challenges remain. Two billion people – or one- quarter of the world’s populations — are infected with TB worldwide. Multi-drug-resistant TB and extensively drug- resistant TB are now reported in 105 countries — underscoring the urgent need to find, cure, and prevent future person-to- person, airborne transmission. Current estimates suggest that, by 2050, multi-drug-resistant TB alone will cost the global economy $17 trillion in lost productivity.
Our global leadership in research, technical expertise, and engagement in on-the-ground programs combine to help detect the most vulnerable to TB infection, to break the cycle of transmission, to lower the mortality rate of those living with HIV through TB treatment, and to protect Americans living around the world.
Strong Labs Save Lives
Reliable laboratory systems are critical to the delivery of quality health care services. By strengthening and improving laboratory systems for HIV and TB platforms, country partners enhance their capacity and further their abilities to better respond to these and other diseases. Yet many parts of the world continue to struggle with fragile lab systems. With our partners’ support, we have built the capacity of more than 700 labs, accredited to international standards, in more than 40 countries. This increased capacity enables our partners to identify and prevent the spread of HIV and other diseases that threaten health and safety across the globe.
The Power of Data
Data provide powerful insights that allow us to target HIV prevention and treatment to those needing it most and to measure our impact. DGHT plays a leading role in designing and enhancing surveillance systems that enable countries to understand which populations and geographic areas require urgent HIV attention and services, and to make fast course corrections if need be.
For example, CDC-supported Population-based HIV Impact Assessments currently provide the clearest picture to-date of the HIV epidemic in several sub-Saharan countries. They offer critical information on the state of the HIV epidemic. PHIA data inform planning and the decisions surrounding real world, real time public health solutions, as well as future programs responding to people and places with unmet needs.
PHIA are implemented under the leadership of MOHs and by PEPFAR, CDC, and ICAP at Columbia University. CDC lends its expertise in epidemiology, laboratory science, and data analysis to help our partners design and implement the surveys, and then to rapidly implement the results for program improvement. In 2017, CDC and our partners were in various stages of PHIA collection, analysis, and program application across nine countries.
- Aberle-Grasse J and Hader. S. Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review. PLOS Medicine. 2017. http://dx.doi.org/10.1371/journal.pmed.1002253.External
- Agolory S, Auld A, Odafe S, et al. High rates of loss to follow-up during the first year of pre-antiretroviral therapy for HIV patients at sites providing pre-ART care in Nigeria, 2004–2012. PLoS ONE. 2017; 12(9): e0183823.
- Auld A, Shiraishi R, Oboho I, et al. Trends in prevalence of advanced HIV disease at antiretroviral therapy enrollment — 10 countries, 2004–2015. MMWR. 2017; 66(21):558–563.
- Bicego G, Bock N, Parekh, B, et al. Swaziland HIV Incidence Measurement Survey (SHIMS): a prospective national cohort study. The Lancet, HIV. 2017; 4(2): e83-e92.
- Bock, N. Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis. PLoS One. 2017. 24;12(1):e0170641.
- Jobarteh K, Shiraishi R, Malimane I, et al. Community ART Support Groups in Mozambique: The Potential of Patients as Partners in Care. PlosOne. 2016. http://dx.doi.External org/10.1371/journal.pone.0166444/
- Pathmanatha,I, Date A, William Coggin,W, et al. Rolling out Xpert MTB/RIF® for tuberculosis detection in HIV-positive populations: An opportunity for systems strengthening. African Journal of Laboratory Medicine. 2017; 6(2):pii:a460.
- Pathmanathan, I, Dokubo, E, Shiraishi, R, et al. Incidence and Predictors of Tuberculosis Among HIV-infected Adults After Initiation of Antiretroviral Therapy in Nigeria, 2004-2012. PLoS One. 2017; 12(3):e0173309.
- Shah N, Auld S, Brust J, et al. Transmission of Extensively Drug-Resistant TB in South Africa. New England Journal of Medicine (NEJM). 2017; DOI: 10.1056/NEJMoa1604544.
DGHT is focused on two epidemics of global importance – the threats of HIV and TB. We:
- Work on the frontlines in over 50 countries, where our “experts in action” are positioned to respond to in-country health threats. Over 1,500 preeminent CDC public health experts — including epidemiologists, medical officers, and health economists – live and work in-country to support program efforts.
- Use scientific rigor in data collection and analysis to put the clearest focus on the most vulnerable populations by identifying those at highest risk, as well as advising on the means for improved treatment and sustainable preventative efforts. CDC-supported PHIA is a critical tool measuring global progress and the precision targeting of human and financial resource.
- Maintain long-standing relationships with MOHs and engagement with a variety of global partners that are instrumental in mission success. While CDC is relied upon to provide deep subject matter knowledge, our partnership approach ensures that countries develop the capacity needed to respond in their own way to infectious disease outbreaks, minimizing future U.S. government investment.
Attaining HIV Epidemic Control and Sustainability: Having moved from an emergency response to HIV to mature programs, many PEPFAR-supported countries are now positioned to assume greater financial, management, and program implementation responsibilities. DGHT will concentrate on sustaining in-country partners’ momentum in combating HIV and building sustainable public health systems. We will transition from supporting direct service delivery to a technical assistance role.
Tracking Global Progress and Target Programs: PEPFAR, CDC, and our partners plan to expand the number of PHIA studies from 9 to 23, while revisiting those partner countries with more significant PEPFAR investments every three to four years with a PHIA. This effort will build stronger data and will hone precise decision-making in HIV programming, and the efficient use of resources to provide treatment to those living with HIV and to identify those “most difficult to find.”
Sustained Strategy to Find, Control, and Prevent TB: 3 critical milestones — the release of WHO’s End TB Strategy and its bold targets for decreased TB morbidity and mortality; the momentum gained through the first Ministerial Meeting on TB in Moscow in November 2017; and the additional momentum from the first High Level TB Meeting in conjunction with the 2018 United Nations General Assembly. We will capitalize on this momentum by intensifying efforts, including employing proven diagnostic and treatment tools to strengthen in-country programs, developing innovative strategies in high- burden TB countries, and leveraging funding sources in select priority high- burden countries.