The Centers for Disease Control and Prevention (CDC) established an office in the Democratic Republic of the Congo (DRC) in 2002. CDC’s primary focus under the President’s Emergency Plan for AIDS Relief (PEPFAR) is to provide support to the DRC’s Ministry of Health (MoH) to expand access to quality patient-centered HIV/AIDS services including prevention of mother-to-child transmission (PMTCT) and HIV care and treatment, and to strengthen health systems including laboratory quality improvement, strategic information, surveillance, and capacity building. In 2015, the CDC Center for Global Health (CGH) expanded the DRC portfolio to include programs from the Division of Global Health Protection (DGHP) and consolidated existing projects in field epidemiology training (FETP), mpox, surveillance and research, influenza surveillance and response, public health laboratory strengthening, and emergency response capacity development within the Global Health Security Agenda (GHSA). The goal of GHSA activities is to strengthen public health institutions and to develop the capacity of the DRC to prevent, detect, and respond to public health emergencies. CDC DRC works with the MoH and other partners in DRC to ensure joint accomplishments are sustainable and aligned with DRC’s public health needs and priorities. Other areas of collaboration are with MoH polio eradication, malaria, COVID-19, Ebola and cholera response, and immunization program strengthening and technical assistance.

 

HIV and Tuberculosis

Through PEPFAR, the CDC Democratic Republic of the Congo (DRC) office works closely with the MoH and other in-country and international partners to improve the national program by building capacities needed to mount and sustain an effective national HIV response. Importantly, these activities support a data-driven, evidence-based approach that is tailored to the unique characteristics of the local epidemic for improved program performance and the most efficient use of resources. Specific program focused areas include: prevention of mother-to-child transmission (PMTCT), pediatric and adult HIV/AIDS care and treatment, tuberculosis/HIV control, orphans and vulnerable children (OVC), national laboratory systems strengthening, HIV surveillance, and HIV/AIDS data management systems. A strategic focus of this support is developing evidence-based and family-centered HIV prevention, and care and treatment services. CDC’s work supports integration and addresses tuberculosis (TB) diagnosis and treatment through systemic screening of patients attending HIV clinics with emphasis on linkage to HIV care and antiretroviral treatment (ART) for TB/HIV co-infected patients. CDC also supports cross-cutting activities by helping DRC make policy-level changes that are supportive of key technical areas including: measures against gender-based violence; workforce development; and public-private partnerships addressing health systems strengthening.

 

Global Health Security

As a country covering a wide geographic area with a large population base and porous borders with nine surrounding countries, DRC has a great need to build health security capacity and achieve compliance with the WHO’s International Health Regulations (IHR 2005). CDC is committed to improving global health security in DRC to prevent, detect, respond to and control infectious disease outbreaks within the country and at its borders for greater regional impact. The goals and objectives are aligned with the CDC Center for Global Health strategic priorities and the CDC Division of Global Health Protection 2019-2022 strategic plan.

National Public health Institute

CDC is working closely and supporting the MoH to implement the newly established National Public Health Institute (NPHI) in DRC. The NPHI will strengthen public health systems by coordinating various public health functions including preparedness and disease outbreak response, surveillance, laboratory systems, and workforce development. The NPHI will also serve as a crucial hub for information repository, expertise, and science in DRC.

Public Health Emergency Management

The DRC faces multiple public health events including infectious (cholera, measles, polio, Ebola, mpox, and plague) and non-infectious (mass population movements, volcano eruptions, and flooding). Some of these events have the potential for expansion both regionally and internationally. CDC has been supporting the DRC MoH to develop capacities to better prepare and respond to these public health events. CDC support is multifaceted including training of personnel in emergency management both in Atlanta (Training of Trainers (ToT)) and in-country. A total of five MoH staff have been trained in emergency management in Atlanta since 2017 and have been leading various trainings in DRC using standardized materials that CDC helped develop. CDC will continue this support to have several trainees that reflects the size of the country. CDC is also supporting the implementation of a national Public Health Emergency Operations Center (PHEOC) as the hub that will coordinate preparedness and response activities to various public health outbreaks CDC is also supporting the development of standard operating procedures (SoPs) for the functioning of the PHEOC. CDC has helped the development of a core group of trainers at the national level to train rapid response teams (RRTs (multi-disciplinary teams)) that can be deployed in the early stages of an outbreak. CDC also helped the MoH develop standardized training materials that will be used for the training of RRTs. Lastly, CDC has been supporting the DRC government in responding to various Ebola (five in the last three years), polio, and measles outbreaks by providing technical, logistical, and financial support.

 

Workforce Development

The Field Epidemiology& Laboratory Training Program (FELTP) trains health professionals and prepares them to respond to the challenges of detection, prevention, and control of potentially epidemic diseases including disease surveillance and proper management of epidemic responses. In 2012, discussions around a long-term program to strengthen national surveillance systems and enhance public health capacity by developing a critical mass of health professionals with advanced applied epidemiology skills took place between CDC, MoH, Ministry of Agriculture, and Kinshasa School of Public Health (KSPH). In February 2013, the first in-country FETP Advanced program cohort began. In May 2016, the Frontline program was implemented. The FETP Frontline is a three-month program with didactic sessions occurring in the provinces. The Advanced program is a two-year program with the MoH, Ministry of Agriculture. and Kinshasa School of Public Health (KSPH) in charge of recruitment of candidates. Didactic trainings occur at the KSPH. In July 2022, the Intermediate level program was initiated with a first cohort of 10 residents and completed all three levels of the FETP program, The Intermediate level program is a nine-month course that targets and builds capabilities of provincial level health professionals. For all three programs, the MoH and implementing partner AFENET oversee the field work. Since the inception, 429 field epidemiologists were trained, with 118 residents graduating from the Advanced program, and 321 from the Frontline program. During fiscal years (FY) 2020-2022, CDC supported:

• For FETP training:

• 89 participants in FETP Frontline trainings in three provinces: North Kivu (47), Lubumbashi (22), and Mbandaka (20).
• FETP frontline and Advanced Evaluations (findings shared with MoH and stakeholders involved in the program)
• Two-year training of 25 FETP Advanced Program residents

• For outbreak response:

• Strengthened workforce development through deployment of 30 graduates and residents through the AFENET Corps of Diseases Detectives (ACoDD) to support the COVID-19 response activities in Lubumbashi (Haut-Katanga) and Kinshasa
• Strengthened workforce development through deployment of 17 graduates and residents through the AFENET Corps of Diseases Detectives (ACoDD) to support post Ebola surveillance activities in North Kivu

• For Ebola activities:

• Support Ebola Virus Disease (EVD) response by strengthening points of entry (POE) capacities by conducted two cross border meetings with Republic of Congo (ROC) and Uganda, two cross border trainings and five Pop Cab (Population Connectivity across Border) meetings at the entry points of Port of Lufu, Beach Nogobila, Muanda, and Zongo, and two binational meetings with ROC and Uganda

 

Laboratory Systems Strengthening

Public health laboratories are a critical component of global communicable disease detection, prevention, control, and public health policy development. In DRC, development of functional laboratory systems is increasingly recognized as a key component of sustainable health care systems. However, access to reliable laboratory testing remains limited in resource-constrained countries. This can result in delayed diagnosis, misdiagnosis, and ineffective and inappropriate treatment and can eventually lead to increased morbidity and mortality. There is a need to improve the laboratory systems in country for early detection and response.

CDC, through PEPFAR and support coming from different divisions (Division of Global Health Protection (DGHP), Global Immunization Division (GID), Division of Parasitic Diseases and Malaria (DPDM), and the Division of High-consequence Pathogens and Pathology (DHCPP) bring strategies to develop effective laboratories and a functioning national laboratory system throughout the country with a competent workforce, effective leadership and management, development of policies and regulations that ensure quality of services, and sustainable interventions. CDC trained laboratory staff on different laboratory areas such as testing, quality assurance, equipment maintenance, waste management, biosafety and biosecurity, sample transport, and laboratory information systems. CDC participated in the development of many policy documents and norms to support the strengthening of the system.

 

Malaria

Under the U.S. President’s Malaria Initiative (PMI), CDC-DRC has assigned a resident advisor to DRC as part of an interagency team with USAID to support the MoH in implementing malaria prevention and control interventions. These interventions include providing long-lasting insecticide treated mosquito nets, preventing malaria in pregnancy, improving diagnostics and case management, surveillance, and monitoring and evaluation of malaria-related activities. Specific examples of CDC technical support have included assistance for the long lasting insecticidal net (LLIN) mass distribution campaign, guidance to the National Malaria Control Program (NMCP) in formulating/updating their monitoring and evaluation plan for malaria indicators, and assisting the National Malaria Control Program (NMCP) in updating their national treatment guidelines to include the use of injectable artesunate for the treatment of severe malaria cases as well as the use of rectal artesunate for pre-referral treatment in both primary health facilities and as part of the Integrated Community Case Management program.