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 2025 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 WHO-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.
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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. 

The World Health Organization (WHO) estimates there are 10 million TB cases worldwide each year including 1.1 million cases among children 0-14 years of age and a similar number of cases among 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, WHO estimated 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.

Information of interest

TB GAPS Echo Hub

Download here the instructions to set up your iECHO account

TB GAPS Quarterly Report

Please check back here for our first quarterly report in the first quarter of 2023.

Sponsors and donors

Contact us

To learn more about the project or to reach the administrative team, please contact TBGAPS-PROJECT@bcm.edu

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