1. CDC Activities in TB/HIV Research Perspectives on Using Research to Strengthen and Inform Programs
Charles D. Wells, MD
Chief, International Research and Programs Branch
Division of Tuberculosis Elimination
U.S. Centers for Disease Control and Prevention
14 February 2005

2. TB/HIV Research at CDC Mission
To conduct applied practical research for improving TB & HIV program capacity for better control of HIV-associated TB
To evaluate impact of interventions
To contribute to broader evidence base for TB/HIV policy, guidelines, recs. (dx & rx)
Groups
DTBE – IRPB, TBTC, MLB, etc.
GAP – C&TB, S&IDB, country-level programs
Partners – MOH, USAID, WHO, MRC, KNCV, IUATLD, NIH, PATH, etc.

3. Major Areas of Focus Surveillance Epidemiology TB case finding
OR capacity building
TB prevention
MDRTB / HIV
Diagnosis
Treatment

4. Surveillance NTP strengthening and foundation for research
TB recording/reporting - ETR & ETR.net
Patient-based – WHO core data
7 SS African countries
HIV data collection
Thailand – electronic reporting, HIV and DR surveillance in 4 HB provinces + BMA
TB/HIV surveillance capacity building project (PEP)
DR surveillance – Botswana with ↑ DR
New tools - Oraquick® on sputum (Botswana)

5. Epidemiology Epidemiological studies HIV risk factors - Botswana
Treatment default - Botswana & S Africa
Impact of ARV’s on TB epi – Brazil
Thailand TB/HIV observational cohort study
Prospective, comprehensive
Evaluate mortality risk factors
Impact of interventions
Evaluating tools: ARTI - Botswana,
Latin squares sampling - ↓ sample size, trends
ARV and IPT program roll out

6. TB Case Finding TB screening in context of HIV CT (VCT) settings
IPT pilot, Botswana,
CXR limited value in asymptomatic attendees
Comparing enhanced TB screening to current standards - Ethiopia
Yield of CXR screening – Vietnam and Kaliningrad
Integrating TB screening in roll out of diverse HIV CT program in SA
Broader evaluation of TB CF among focus countries

7. Operations Research Capacity Building
Adapting general TB OR training for NTPs
USAID supported
Course + proposals/funding + mentorship
10 trainings, 200 staff, 55 proposals
Modified for TB/HIV OR training
More targeted lectures and field exercise
FSU/Baltics – 11/04
3 national projects – treatment adherence, nosocomial transmission, cross-referral
Africa TB/HIV OR course – Malawi, 6/04

8. TB Prevention IPT pilot – Botswana, 2000-2001
600/1000 started IPT, 70% completed
Symptom screen sufficient
MOH IPT program roll out, 2003
>8,000 enrolled on IPT
Info system, evaluation late 05
DR monitoring – , 1999, 2002, late 2005
IPT trial of duration (6 mos vs. 3 yrs), 11/04
N=1800; R/DB/PC; builds on IPT program
TBTC Study 26, on-going
3 mo H/RPT vs. 9 mo H; 4000 enrolled
Substudies – viral hep, peds PK

9. MDR TB / HIV E Europe (Russia, Baltics)
TB screening and PT OR (Orel and Kaliningrad)
Baltics – rapid dx, evaluate PT strategies
Africa
Botswana - DRS ‘05 to evaluate link of DR with HIV
South Africa – MRC leadership
MDR TB outcome studies (effects of HIV)
ARV’s + MDR TB treatment – MRC/CDC
Airborne Infection Research (AIR) Facility
Transmission/IC intervention studies

10. Diagnosis Smear negative study Prospective, case-control study
Abx non-response predictive of cx+ TB
Sero-diagnostic studies, Botswana
Adult: 4 assays, 15% dx by blood cx alone
Peds: 2 assays; 16% micro confirmation
Algorithms for TB diagnosis
TB/HIV cohort study (MGIT), Thailand
FIND collaboration – evaluate MGIT feasibility (GAP/DTBE)
Line-probe assay - rapid dx of R res, Latvia/Vietnam
Feasibility & CE

11. TB Treatment Operational (ARV access/delivery)
HIV CT in TB clinical settings (Opt out – Botswana)
MRC/CDC project in KZN of ARV initiation among hosp. TB patients (3/05)
Clinical
TBTC Study 27
HRZE vs. HRZMox, 50% enrolled, 2 mo cx conv.
TBTC Study 28
HRZE vs. MoxRZE, 2 mo cx conv., 4/05
Empiric treatment studies