1. TB is one of the world’s oldest diseases, yet it continues to kill millions of people each year. Why has it remained a persistent threat?
That’s a good question. TB is preventable, treatable, and curable — we’ve had a cure since the 1940s. The World Health Organization declared TB a global health emergency in 1993. And yet today, TB persists: 2 billion people — a fourth of the world’s population — are infected with TB, there are nearly 10 million active cases each year, and 1.5 million deaths. In fact, TB ranks alongside HIV as the leading cause of death from infectious disease worldwide.
The problem is this: TB is an airborne infectious disease that spreads and thrives under conditions that affect the poorest and most marginalized in our society, those who are often without a strong political voice to demand better results. It spreads easily in crowded environments without adequate ventilation or infection control measures in place. Young children and people with poor nutritional status, HIV, and other complicating illnesses are at greater risk of becoming ill from TB, and poor access to quality health services create barriers to their timely diagnosis and successful treatment.
WHO estimates that we still haven’t found a third of the people with active TB in order to get them into care and onto treatment, and untreated TB patients drive ongoing transmission in their communities. While we have several medications to treat patients who we know have TB, currently available regimens can be difficult to take successfully: they require multiple pills a day for multiple months, with potentially unpleasant side effects. In addition, incomplete or incorrect courses of treatment select for bacterial resistance, leading to strains known as multidrug-resistant (MDR) or extensively drug resistant (XDR) TB. MDR and XDR TB are increasingly taking human and economic tolls around the world and threaten the utility of our existing drug regimens and global health security as a whole.
2. Young women and girls bear a disproportionate burden of the HIV/AIDS epidemic. Describe this burden and the steps DGHT is taking to address HIV in this population.
Every year, an astonishing 380,000 adolescent girls and young womenCdc-pdfExternal are infected with HIV. That’s more than 1,000 every day. In sub-Saharan Africa alone, one in four new HIV infectionsCdc-pdfExternal occurs among young women and girls. In the hardest hit countries, girls account for more than 80 percent of all new HIV infections among adolescents. AIDS is the leading cause of death for girls aged 15-19 in eastern and southern Africa. And, due to great successes in child survival, many of these countries are seeing a large increase in their youth population — those aging into young adulthood — adding urgency to further accelerate our responses.
If we are to turn the tide on HIV globally, we must act now to confront the HIV crisis among young women and girls. And, although we have a number of tools, the reality is that it won’t be easy. There is no magic bullet – no easy answer.
Here at CDC’s Division of Global HIV & TB, we know that the root causes that give rise to this disproportionate burden of HIV among young women and girls are complex – poverty, access to education, violence and other gender inequities. Our approach must be equally layered. It will also require us to be creative, vigilant, and tireless.
To that end, we are working in a number of ways to make an impact:
- Creating a supporting, empowering environment
- Addressing gender-based violence
- Expanding access to treatment for HIV-positive girls and young women
- Helping men control HIV can also help young women
- Partnering through PEPFAR to reach young women and girls
As a global health community, we must commit ourselves to reversing the HIV epidemic among girls, so they can grow up to lead a generation free of AIDS.
3. About a year ago, the CDC brought Global TB into the division, creating a new Division of Global HIV & TB – which you lead. Can you speak the importance of this shift, including expanded opportunities to address HIV and TB?
Bringing most of our global TB resources together under a single division, a division that already had strong field staff and footprints in a number of highly affected countries, allows CDC to better leverage our consolidated expertise and our ongoing relationships in country and with external partners to have greater impact. This change also gives CDC the opportunity to further elevate the visibility of our global TB work and demonstrate that addressing global TB is a priority for the entire agency. Our global TB efforts address the spectrum of global TB, multidrug-resistant TB, and HIV-associated TB in high priority countries.
Additionally, it’s important to understand the relationship between HIV and TB. TB now ranks alongside HIV/AIDS as the world’s top infectious disease killer, claiming 1.5 million lives each year. The two diseases hide behind stigma and discrimination in some of the world’s most marginalized and vulnerable populations, leading to major barriers in diagnosis and treatment. Co-infection with HIV and TB is also a problem. Tuberculosis can lead to dangerous complications for people living with HIV making it essential that we treat the diseases in tandem. The World Health Organization reportedExternal that people living with HIV are from 26 to 31 times more likely to develop TB than people without HIV.
It’s shameful that today, with the great strides made in the global HIV response, that TB — a preventable and curable disease — remains the leading cause of death for people living with HIV in the developing world. Adoption of 2015 WHO HIV Treatment Guidelines, urging treatment for all immediately upon HIV diagnosis, is also a promising strategy to prevent active TB cases among those living with HIV and greatly reduce the overall burden of TB in a country.
CDC is dedicated to seeing an end to both of these diseases. The strategic move to consolidate HIV and TB resources and expertise across the agency will increase our impact for both. In countries with dual epidemics, a tandem response makes sense: progress against one equals progress against the other.
4. What gives you the greatest hope that we can end HIV and TB?
In the fight against HIV, we have made remarkable scientific achievements —allowing us to envision a brighter future. At this time—nearly 35 years into the epidemic—we have more tools and knowledge than ever before to fight HIV. Maximizing these tools requires working together to confront and overcome the challenges that remain. With the global population of young people expected to dramatically increase over the next five years, we must also step up efforts to help both young men and young women stay HIV-free, especially in the developing world. We must continue to invest in new solutions—including longer acting medications for prevention and treatment, an effective HIV Vaccine, and ideally a cure for HIV.
For TB, what I am personally reassured by is that we may be on the cusp of a paradigm shift in global TB. The world recognizes the threat of TB and MDR TB, and recent viral epidemics such as Ebola, pandemic influenza, and Zika have opened new dialogues about global health security and the role of TB prevention and control programs within these. We are at a point of convergence, where increasing political will and attention to this epidemic can drive the innovations we need to end it.
We’ve seen great leadership from the World Health Organization and the Stop TB Partnership in putting out a strategy and an implementation plan that lays out a detailed vision for what is required to End TB by 2035. The plans calls for scaling up what works, but it also calls for specific innovations in diagnostics, drugs, and vaccine development that really could change the game in the fight against TB. In scaling up what works, their plan is essentially a road map, with the nuance and detail required to guide tailored response in each country — to meet them where they are, take into account the realities of their TB epidemic, and target interventions to have the greatest impact.
No single organization can win the battles against HIV or TB. Therefore, CDC stands with our U.S. government colleagues and global partners in efforts to scale-up what we know works, to ensure the best tools and strategies are accessible to those who need them the most, and to continue to drive innovation for better solutions.
To me, the biggest question that remains is: will we mobilize enough collective will, or will we instead give into the dangerous complacency of having done ‘more than before’, and in doing so allow these diseases to thrive and continue to affect future generations? Will we finish the job?