Mexico
Tuberculosis is a public health problem in Mexico and remains of great interest to the United States, given the shared borders and immigration flow between the two countries. According to the World Health Organization (WHO) Global TB Report 2006, Mexico had nearly 34,000 TB cases in 2004, with an estimated incidence rate of 32 cases per 100,000 people. The National TB Control Program (NTP) began implementing Directly Observed Therapy, Short-Course (DOTS) in selected demonstration areas in 1996, and according to WHO estimates, DOTS population coverage was 92 percent in 2004.
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Note: All data are for 2004 except where noted otherwise. Source: Global Tuberculosis Control: WHO Report 2006. |
USAID Approach and Key Activities
In 2000, USAID and the Mexican Secretariat of Health signed a $16 million bilateral grant agreement to strengthen TB prevention efforts. Between 2000 and 2005, additional USAID funds for TB programming in Mexico averaged $1.3 million per year. Together, USAID and the NTP have developed a plan focusing on 13 target states (Baja California, Chiapas, Chihuahua, Coahuila, Guerrero, Jalisco, Michoacán, Nuevo León, Oaxaca, Zacatecas, Sonora, Tamaulipas, and Veracruz). These states include those along the U.S.-Mexico border and those with the highest TB rates and largest concentrations of migrants. More recently, USAID has begun working with local and binational nongovernmental organizations to further support control efforts and to mitigate the effects of TB in vulnerable populations.
USAID's TB strategy is to collaborate with public and private entities in priority regions in Mexico where 70 percent of reported TB cases occur. USAID focuses on the following objectives: 1) expanded and strengthened quality DOTS activities at the national and state levels; 2) expanded TB research; and 3) improved advocacy, communication, and social mobilization.
USAID's strategy includes the following:
- Promoting collaboration and augmenting capacity and coordination among governmental and nongovernmental stakeholders
- Promoting TB health education as part of a national awareness campaign and emphasizing community-based social mobilization
- Strengthening TB diagnostic and treatment practices among health workers and establishing an incentives program for NTP personnel
- Strengthening the national network of TB laboratories by building a systematic quality assurance program to improve capabilities in smear microscopy and drug resistance testing and by purchasing laboratory equipment
- Improving DOTS services for migrants by strengthening national and international referral systems and organizing community activities
- Expanding DOTS coverage and treatment success rates by augmenting community health worker networks and capacities
- Developing performance indicators for project monitoring and evaluation and developing information management systems for program evaluation, data management, and analysis
- Supporting an operations research project, as well as a national TB drug resistance survey
USAID Program Achievements
Although implementation of many aspects of the USAID TB program have been delayed, full implementation of a wide variety of technical components are now contributing to substantial improvements in TB control and prevention in Mexico. Achievements to date include the following:
- Implemented a model community-based TB program through Project Concern International
- Trained 267 health workers and 521 other health professionals in DOTS
- Supported five TB grants that are operating in multiple states around the country
- Improved TB-HIV/AIDS care and prevention, treatment of patients with multidrug-resistant TB, and TB control and testing in high-risk populations
- Assisted two university partnerships in TB research and control — the first between the University of Texas, El Paso, and the Autonomous University of Ciudad Juárez, and the second between the University of Texas Health Science Center in San Antonio and the Autonomous University of Tamaulipas
- Distributed throughout the country crucial laboratory equipment for diagnostics; computers and audio-visual equipment for management and training; and vehicles to enable TB program supervisors to conduct monitoring and evaluation activities
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2004 will be reported in the 2007 global report.
Source: Global Tuberculosis Control: WHO Report 2006. |
Partnerships
Within the Mexican Secretariat of Health, USAID collaborates with the Division of Prevention and Control of Microbacteria, the National Center for Epidemiological Surveillance, the Institute of Epidemiological Diagnosis and Reference, and the National Institute of Respiratory Diseases. USAID also collaborates with state health secretariats, the
U.S. Centers for Disease Control and Prevention (cross-border migration issues), the Pan American Health Organization (TB research), and Project Concern International (community-based TB activities).
September 2006
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