Global Tuberculosis
Closing TB GAPS for people living with HIV:
TB Guidance for Adaptable Patient-centered Service
TB GAPS Objectives
With support from the U.S. Centers for Disease Control and Prevention (CDC), Baylor College of Medicine (BCM) and Texas Children’s Hospital (TCH) are implementing a project – the Tuberculosis Guidance for Adaptable Patient-centered Service (TB GAPS) – which aims to find and prevent TB in children and youth. BCM and TCH’s Global TB Program and BCM Children’s Foundation partners will work to determine the most cost-effective prevention strategy and promote best practices to sustain impact. TB GAPS will run from September 2020 through September 2026 in five sub-Saharan African countries (Eswatini, Lesotho, Malawi, Tanzania, and Uganda).
FIND
Assess the performance of novel TB screening and diagnostic algorithms among children, adolescents, and adults living with HIV and presenting for routine care across a network of family-centred HIV clinics in five SSA countries as compared to the current internationally-recommended symptom-based screening and diagnostic strategy.
PREVENT
Compare the proportion of people living with HIV who initiate and complete TB preventive therapy (TPT) in the context of a patient-centred differentiated service delivery model, allowing selection of TPT regimen and randomly providing enhanced adherence support versus the standard of care for TPT and adherence support.
COSTING
Evaluate the cost-effectiveness of comparative TPT regimens for the prevention of TB disease among children, adolescents and adults living with HIV.
SUSTAIN
Disseminate and promote uptake of evidence-based best practices, with emphasis on CDC-priority countries.
Why This Project is Relevant and Important
While TB is often seen as an airborne disease of the past, it remains the top infectious disease killer worldwide. TB is the ninth leading cause of death worldwide, the leading cause of death from a single infectious agent, and responsible for nearly 40% of mortality among people living with human immunodeficiency virus (PLHIV). TB is an important and underestimated cause of child mortality globally. Less than 50% of children with TB are accurately diagnosed and reported. This significant TB case detection gap in all children is likely magnified in children and adolescents living with HIV.
There are an estimated 10 million tuberculosis (TB) cases worldwide each year, including 1.1 million among children aged 0–14 years and a similar number among people living with HIV (PLHIV).
Recent evidence suggests that each year approximately 640,000 children with TB are not diagnosed or treated. Among those untreated, case fatality rates approach 22% in all children and increase to 44% in children <5 years of age. In 2018, global estimates suggested there were 1.5 million TB deaths worldwide, including 251,000 deaths among PLHIV and 205,000 deaths among children, including 32,000 in children and adolescents living with HIV. These epidemiologic realities demand earlier diagnosis and treatment to improve outcomes.
Helpful Information
TB GAPS Echo Hub
TB GAPS Annual Newsletter
Sponsors and Donors
This project is supported by the U.S. Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement number GH002278. The mark 'CDC' is owned by the U.S. Department of Health and Human Services (HHS) and is used with permission. Use of this logo is not an endorsement by HHS or CDC of any particular product, service, or enterprise.
