Ebola-Prep TBOX Plus

The challenge

The Central African Bundibugyo virus (BDBV) outbreak has occurred in a highly challenging setting. The epicentre of the outbreak in eastern Democratic Republic of the Congo (DRC) is a geographically remote area characterised by insecurity, limited healthcare infrastructure and a mistrustful population. Displacement and extensive cross-border movement provide opportunities for dissemination of the virus. 

Tracking the spread of infection is held back by the lack of validated point-of-care diagnostics, while limited community-based surveillance is a missed opportunity to catch cases early.  The region also lacks IT systems capable of integrating diverse data sources to provide a holistic, up-to-date picture of the spread of infection. Patient care is undermined by the lack of BDBV-specific therapeutics. 

Enhancing the response to the outbreak therefore requires an integrated approach that addresses multiple shortcomings.

The project

The Ebola-Prep TBOX Plus project builds on the Ebola-Prep TBOX project previously funded by Global Health EDCTP3. Initially focused on developing a toolbox of innovations to control other ebolavirus infections, the new project is shifting its attention to BDBV and to delivering practical aids to support the response to the Central African outbreak. 

The project is focusing on four key areas:

• Community engagement: Research into current community knowledge, attitudes and practices relevant to BDBV, to support development of culturally appropriate communications materials in local languages, focusing on points of entry and at-risk forest communities in the Republic of Congo. The project will also train frontline workers in community engagement and risk communication.
• Diagnostic development and evaluation: The project is establishing a highly sensitive laboratory-based detection system at sites in the DRC, Republic of Congo and Uganda. Through a multisite field trial, it will also evaluate multiple commercial and laboratory-developed tests, including a remote molecular assay developed by the project that can be deployed at sites with minimal laboratory infrastructure, such as district-level health facilities and border posts. 
• AI-enabled surveillance: The project is enhancing surveillance by facilitating and creating new reporting mechanisms. It is developing a One Health reference glossary and multilingual AI-based system to capture BDBV-related information from a wider range of sources. Focusing on sites in the DRC and Republic of Congo, it is working with communities to enhance community-based surveillance through a specially developed app for use by community health workers and other community-based groups. 
• Advancing an antibody-based therapeutic: The Ebola-Prep TBOX project has been developing a broad-spectrum Ebola antibody-based therapeutic generated by inoculation of horses with a cocktail of viral antigens. The resulting polyclonal antibodies are isolated and processed to generate a preparation capable of neutralising a range of viruses. In this project, the team is using the same development pathway to identify immunogenic BDBV antigens and to develop and test a therapeutic preparation with activity against BDBV. 

Ebola-Prep TBOX Plus is one of four projects funded through an emergency call for proposals launched in response to the Bundibugyo Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda in 2026.

Impact

The Ebola-Prep TBOX Plus project is developing a range of tools to support a more effective response to the BDBV outbreak. It will:

• Provide evidence-based and culturally appropriate materials to raise awareness of BDBV and infection prevention among vulnerable key populations in Central and Western Africa. 
• Develop an innovative new diagnostic and generate data on a range of other potential tools to inform policymakers' decision-making on diagnostic use.
• Enhance community-level reporting of possible cases and strengthen local surveillance systems.
• Develop a novel antibody-based targeted BDBV therapeutic to the point that it can be tested in people. 

Collectively, these activities have the potential to accelerate case detection, enabling treatment and isolation to begin sooner and reducing the risk of further transmission, while also enhancing awareness among hard-to-reach communities and potentially providing a new treatment option for those with confirmed BDBV infections.