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TB Notes 2, 2004


Interactions Between CDC’s Global AIDS Program (GAP) and International Research and Programs Branch (IRPB)

The NCHSTP Global AIDS Program (GAP), which began in 1999 as the LIFE initiative, is now working to combat the burden of HIV/AIDS in 25 countries around the globe, including 17 in Africa, 5 in Asia, and 3 in the Caribbean and South America. GAP seeks to partner with many in-country institutions, including ministries of health, official nongovernmental organizations, international organizations, the private sector, universities, as well as other divisions at CDC. To date, GAP has focused on three program areas: (1) prevention, (2) care and treatment, and (3) surveillance and infrastructure development. 

In January 2003, in his State of the Union address, President Bush announced a new proposal to provide US $15 billion for care and treatment of persons with human immunodeficiency virus (HIV) in 14 countries. This initiative, known as the President’s Emergency Plan for AIDS Relief (PEPFAR),,

aims by 2007 to prevent 7 million new HIV infections, to treat 2 million infected persons with antiretroviral treatment (ART), and to provide care and support to 10 million persons living with or affected by HIV, including orphans and vulnerable children. PEPFAR activities will be concentrated in 14 countries (Botswana, Ethiopia, Guyana, Haiti, Ivory Coast, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia) and one regional office (in the Caribbean) hardest hit by the HIV epidemic. GAP is working to coordinate efforts in the 14 initiative countries along with other agencies of the Department of Health and Human Services, the State Department, the Department of Defense, and others.

The International Research and Programs Branch (IRPB) of DTBE has been working with GAP to ensure that TB is included in the package of care and treatment services of the PEPFAR initiative. This is particularly important since TB is the leading opportunistic infection among persons with HIV in many countries, and accounts for up to 40% of all AIDS-related deaths in some of the hardest-hit countries. Key activities include intensive TB case finding in HIV-infected persons at risk of TB disease, HIV testing and counseling of TB patients so that they know their HIV status and can benefit from care and treatment programs, isoniazid preventive therapy to prevent the development of TB disease among HIV-infected persons, and efforts to ensure that national TB programs and national AIDS control programs work in a coordinated and collaborative fashion.

IRPB has been working with the TB/HIV team at GAP on many activities, including (1) providing technical guidance to PEPFAR countries as they prepare their 1-year and 5-year strategic plans, (2) providing TB/HIV guidance to CDC participants in Core Team visits to initiative countries, and (3) participating in PEPFAR planning meetings on strategic information and building laboratory capacity. Along with GAP, IRPB also works with international partners to ensure that there is coordination with other global HIV/AIDS treatment initiatives, such as the “3 x 5” initiative ( recently proposed by the World Health Organization (WHO).

IRPB has undertaken a number of specific TB/HIV projects in several countries in conjunction with partners in GAP. These include the support of a TB/HIV research station as part of the BOTUSA Project in Botswana, Current projects include a study of new diagnostic methods in children with both TB disease and HIV infection, a trial to evaluate the optimal duration of isoniazid preventive therapy, and an ongoing 3-year study to assess trends in the annual risk of infection using a new sampling methodology. IRPB staff are involved in establishing a pilot test of integrated TB/HIV activities at eight sites in Ethiopia. Plans are underway to design studies to evaluate the impact of nationwide ART programs in Botswana and Brazil on the epidemiology of TB in these countries. In Viet Nam, plans are underway to assess the referral mechanisms between the TB control program and the HIV program in two provinces.

IRPB will continue to work with GAP and other national and international partners to ensure that TB issues are included in PEPFAR and other global HIV/AIDS treatment initiatives.

—Reported by Lisa Nelson, MD
Div of TB Elimination


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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