At a glance
Despite being preventable and curable, tuberculosis (TB) remains one of the deadliest infectious diseases in the world. U.S. CDC collaborates with Ministries of Health (MOH), TB and HIV programs, and implementing partners to prevent, diagnose, and treat TB in the United States and worldwide.
Overview
Tuberculosis is a leading infectious disease killer in the world, with nearly 30,000 people falling ill and over 3,500 people losing their lives to TB each day.[1] Today, nearly 2 billion people—one quarter of the world's population—may be infected with TB.
In partnership with country governments and multilateral organizations, CDC works in high TB burden countries to develop and implement solutions to end this persistent global public health threat. CDC global efforts measurably accelerate progress towards the 2030 global End TB targets to reduce TB incidence by 80 percent and TB deaths by 90 percent compared to 2015 levels and to eliminate catastrophic costs for households affected by TB.
United Nations and PEPFAR commit to ending TB
CDC worked with U.S. and global partners to develop and support the United Nations (UN) political declaration to end TB. Member nations approved this declaration at the September 2023 UN General Assembly's High-Level Meeting on TB. With the declaration, CDC joined interagency partners as the U.S. government launched a new initiative to detect two million active TB cases over the next five years. The initiative also aims to prevent at least 500,000 TB-related deaths among people living with HIV (PLHIV). In support of these historic commitments from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to help end TB as a global public health threat, CDC has partnered with national TB and HIV programs. These partnerships aim to adopt more sensitive screening tools and innovative approaches, including:
- Computer-aided TB detection using digital radiographs.
- Advanced forms of x-rays.
- Novel diagnostic tools and approaches.
Preventive treatment
TB is the leading cause of death among PLHIV, who are 16 times more likely to develop TB than people without HIV[1]. TB preventive treatment (TPT), when combined with effective HIV treatment, has been shown to prevent the progression of TB disease. TB treatment can also reduce TB-related deaths among PLHIV by nearly 80 percent.
In 2018, the UN held the first High-Level Meeting on TB, where member states committed to provide TPT to six million PLHIV by 2022. With support from PEPFAR, CDC worked in close partnership with national HIV and TB programs to scale up TPT in partner countries worldwide. This work exceeded the UN goal and saving millions of lives by providing TPT to 8.1 million PLHIV, including over 410,000 children living with HIV. Through CDC’s peer-to-peer partnerships with national HIV and TB control programs, TPT has become the standard of care for PLHIV in countries with PEPFAR-supported programs.
Infection prevention and control
TB infection prevention and control (IPC) measures are crucial to decrease TB burden worldwide. IPC measures significantly reduce TB-related illness and death among patients, healthcare workers, and PLHIV. These efforts improve quality and safety in the delivery of healthcare services.
CDC builds on decades of experience and existing TB IPC platforms, including:
- Mentorship models.
- Toolkits for preventing the spread of airborne respiratory infections in healthcare settings.
- Other evidence-based approaches to reduce transmission.
Measurably reducing the spread of TB and other respiratory infections
In collaboration with Ministries of Health and national TB control programs, CDC implemented the TB IPC toolkit in 18 PEPFAR-supported countries across Africa, Asia, Central America, and the Caribbean. These TB IPC partnerships, platforms, training curriculums, and toolkits measurably reduce the spread of TB, COVID-19, and other respiratory infections in healthcare facilities.
Screening and diagnosis
Each year, around 30% of adults who become ill with TB remain undiagnosed and untreated, leading to millions of preventable deaths. This results in poorer health outcomes, and an increased spread of TB in affected communities[1]. Each person who is undiagnosed and untreated can expose up to 10–15 additional people per year to TB infection, with each of these contacts at higher risk of progressing to TB disease[2].
CDC works with partner countries to:
- Expand access to better screening.
- Improve evidence-based approaches to finding and identifying new TB infections.
- Enhance testing strategies to optimize diagnostics.
- Provide training and technical support to increase access to faster and more reliable diagnostic tools.
CDC leads global efforts to screen and test all PLHIV covered by PEPFAR so they can start life-saving treatment. In 2023, CDC screened 9.3 million PLHIV for TB—60% of all PLHIV screened for TB through PEPFAR.
Children and adolescents
Children and adolescents are up to 10 times more likely to develop TB disease than adults. Data show that infants and young children are more likely than older children and adults to develop life-threatening forms of TB disease. Despite this, 51 percent of all children and 58 percent of children under five with TB go undiagnosed, untreated, or unreported.1 This results in preventable deaths in this vulnerable population.
CDC experts help to develop and use evidence-based approaches that integrate TB screening into services and programs serving children. CDC's work measurably improves efforts to diagnose TB in children. In 2023, 83 percent of all children living with HIV at PEPFAR-supported facilities were screened for TB.
CDC also supports the scale-up of evidence-based treatment and prevention approaches, including TPT for the 1.3 million children who develop TB each year.
CDC leads efforts to treat children with TB
Since 2017, CDC has led efforts to ensure more than 410,000 children worldwide have access to and complete lifesaving TPT at PEPFAR-supported facilities in 33 countries.
CDC also works with partners and MOH in several countries to evaluate innovative TB screening approaches. Together they aim to develop more sensitive diagnostic tools to improve the quick and accurate identification of TB cases among children and adolescents living with HIV.
As one example, CDC worked with partners to establish a Centre of Excellence that provides a global, virtual community of learning platform with twelve MOH in sub-Saharan Africa to share information and best practices for child and adolescent in the highest TB burden countries.
Treatment
Although TB disease is treatable with antibiotics, treatment adherence can be challenging. To be effective and avoid risk of drug-resistant TB, a combination of medications must be taken daily for four to six months. Globally, in 2022, TB treatment coverage was 70 percent among all ages, with only 49 percent treatment coverage among children aged 0–14 years[1].
By working closely with MOH, CDC helps:
- Implement high-quality treatment programs.
- Broaden access.
- Improve linking people to care.
- Assess patient costs.
- Optimize TB and DR TB treatments.
- Improve adherence to treatment.
CDC is also providing specialized expertise in support of partner countries’ adoption of people-centered service delivery models. This includes dispensing multiple months of medication and using digital technologies to help those on treatment stay on treatment.
Drug-resistant TB (DR TB)
DR TB is a growing threat found in every country and poses a serious challenge to eliminating TB worldwide. DR TB is deadlier, much costlier, and more difficult to treat. It is estimated that 410,000 people worldwide have rifampicin-resistant TB each year[[1]].
Many of these DR TB cases remain undiagnosed and untreated, which further exacerbates the problem. For example, in 2022 only two in five people with rifampicin-resistant*[A] TB were diagnosed and started on appropriate treatment2.
CDC supports governments and partners in over 30 countries with high rates of TB and DR TB. CDC works to build and enhance laboratory capacity and diagnostic networks, and to improve the diagnosis and treatment of DR TB. CDC’s evidence-based efforts to combat DR TB include mobile screening, molecular diagnostics, and point-of-care treatment monitoring to improve adherence and treatment outcomes. CDC also collaborates with partners to advance TB genome sequencing to better understand circulating and emerging drug resistance in countries with high rates of DR TB.
Keep Reading:2024 Drug Resistant TB Factsheet
Closing remaining gaps
Did you know?
Every dollar invested to prevent TB will return $40 globally and $59 in low- and middle-income countries saved by 2050, making it one of the highest returns on investments in public health.
Investments in TB spur economic development and enhance global health security, while saving lives and improving health in the U.S. and abroad[4].
TB efforts should focus on the most at-risk and hardest-to-reach populations, including children and people living with HIV, pregnant women, miners, mobile populations, and healthcare workers. Additional resources are needed to scale up effective tools and strategies, develop new treatment approaches and more effective diagnostics, strengthen surveillance systems, expand and enhance laboratory capacity, increase TB IPC measures, and develop an effective vaccine to eliminate TB. To end TB, the global community must urgently address this global public health threat on multiple fronts to create a healthier and more equitable world.
