Develop, Implement, and Evaluate Evidence-based, Innovative Approaches to Prevent, Find, and Cure Tuberculosis in High-Burden Settings

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The End TB Strategy envisions a world free of tuberculosis (TB)—zero deaths, disease and suffering due to TB by 2035. This requires reducing the global TB incidence from >1250 cases per million people to <100 cases per million people within the next two decades.Each year, an estimated 10 million people develop TB disease, and an estimated 1.6 million TB people die from TB – the leading cause of death from any infectious disease. In 2017, 90% of all estimated new TB cases were adults (15 years of age or older), and 9% were persons living with HIV (PLHIV) with 72% living in Africa. Despite being preventable and treatable, large gaps in detection and treatment of TB cases remain; of the estimated 10 million new TB cases in 2017, only 6.4 million TB cases were officially reported.Drug-resistant TB is on the raise, posing significant programmatic challenges. Worldwide, an estimated 580,000 multi-drug-resistant (MDR) TB cases emerge annually. Unfortunately, there are substantial gaps in MDR TB detection and treatment. Approximately 1 of 5 persons needing MDR TB treatment actually receive it, and among those who do receive treatment, less than half (48%) who start treatment finish successfully. These rates are driven by treatment failure, loss to follow-up, and premature death.Globally, it is estimated that 1.7 billion people (about one fourth of the world’s population) are infected with TB and form the next generation of future TB cases. Expanding testing and treatment of TB infection is critical to achieving our elimination goals. However, in high-burden countries, the implementation of tuberculosis preventive treatment (TPT) remains a low priority.The purpose of this NOFO is to develop, implement, and evaluate evidence-based, innovative approaches in collaboration with CDC to:prevent TB infection, disrupt TB transmission, and halt progression of TB disease in high-burden settings;find TB infection and TB disease in all populations, including those most vulnerable (i.e., children, displaced persons, healthcare workers, economically disadvantaged, PLHIV, persons with other co-morbid conditions [alcohol use disorders, diabetes mellitus, persons who use illicit substances, undernourished] and elderly)optimize treatment for TB infection, TB disease, TB/HIV, and MDR TB through new treatment and adherence modalities;improve the use of routinely collected data to monitor and evaluate TB program performance;promote operations research (i.e., local solutions for local problems) for broader application, adoption, and integration into routine TB care and treatment practice.

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