Key Achievements in Tuberculosis: Fiscal Year (FY) 2002
Community TB Services in Malawi and Uganda
USAID has been supporting community TB treatment services in Malawi and Uganda. Malawi has already attained countrywide coverage, while Uganda is implementing services in 24 of 56 districts with plans for national coverage within two years. USAID is supporting the expansion of this approach in other African countries.
DOTS and Improved TB Control in India
Since 1998, USAID has contributed over $11 million to help implement, expand, and improve the directly observed treatment, short course (DOTS) strategy in India. Activities have provided training, technical support, and monitoring and evaluation in Tamil Nadu and Uttaranchal states, with future plans to carry out similar activities in Haryana. USAID has also supported operations research to monitor multidrug-resistant TB and to determine if DOTS can be improved by using community volunteers. USAID support complements other larger investments to improve TB control in India. A recent review reported steady progress over the past eight years in strengthening the national TB program. More than 200,000 health workers have been trained, and more than 40 percent of the population has access to TB services.
DOTS Strategy in Honduras and El Salvador
USAID has supported the implementation and expansion of the DOTS strategy in all health regions in Honduras. During 2001, 95 percent of the health facilities were fully implementing DOTS. The cure rate for the latest cohort was 85.4 percent. In El Salvador, USAID assistance helped the Ministry of Health achieve an 80 percent cure rate in 2001. All Ministry facilities implemented DOTS, and the laboratory network was greatly improved. DOTS training programs are also targeting private physicians, the Social Security Institute, and medical and nursing schools.
Global TB Drug Facility
As a member of the Stop TB partnership, USAID has supported the creation of the Global TB Drug Facility (GDF) in order to rapidly and efficiently provide inexpensive
TB drugs to countries in need. In 2002, USAID provided $2 million for drugs along with technical assistance for identifying recipient
countries. USAID also seconded a full-time drug logistics and management specialist to the GDF to provide drug management guidance to recipient countries. To date, the GDF has provided
drugs to 14 countries. The establishment of the GDF has resulted in a 30 percent drop in the price of TB drugs, thus making them more accessible for all countries.
International TB Training
Through its partnership with the TB Coalition for Technical Assistance, USAID took the lead in developing an international TB Task Force on Training. The goals of the Task Force, which includes the Stop TB partners, include developing a global strategy for building TB prevention and control capacity, setting quality standards, and developing training plans. USAID has funded ongoing regional programs in Latin America, Africa, Asia, Eurasia, and Europe to update and build the skills of national TB program staff. In the past year, 382 health care professionals from USAID target countries participated in these programs.
Meeting TB Challenges in Kosovo
USAID, partners from the European Union, and the private voluntary organization Doctors of the World have supported the tuberculosis program in Kosovo for the past two years. Despite the challenges presented by the lack of government and the separate health care systems for Albanians and Serbs, the region has more than 95 percent DOTS implementation and an 84 percent treatment success rate in new smear-positive patients.
Postwar Support for TB Programming in DR Congo
USAID has been involved in re-establishing the national tuberculosis program in Maniema and Kasai provinces of the Democratic Republic of the Congo. Funds have been provided to equip and strengthen laboratories, support technician training, and improve monitoring and supervision. USAID has initiated the process of extending DOTS into 63 health zones and has also supported training, the renovation of the National Reference Laboratory, and publication of the national tuberculosis policy.
Technical Assistance for TB Drug Management
The Agency supported activities to ensure that countries are prepared to manage large quantities of TB drugs. The first TB Drug Management Workshop examined the management
capacity of countries receiving or applying for large donations from the GDF. Since then the GDF has used the "Drug Management for Tuberculosis" tool, developed with USAID support,
to evaluate national drug management practices. Experts have helped teams in India, Indonesia, Kenya, Moldova, Tajikistan, and Togo make recommendations for streamlining drug distribution and monitoring proper drug utilization by national programs.
The "ProTEST" Initiative
In response to the growing problem of TB/HIV co-infection, USAID is looking for ways to provide more accessible services for people with co-infections. USAID is supporting WHO‘s "ProTEST" Initiative, which aims to deliver coordinated interventions for TB and HIV prevention and care. "ProTEST" uses voluntary counseling and testing as an entry point for access to a variety of HIV and TB interventions. Pilot project sites in Malawi, South Africa, and Zambia have served more than 70,000 individuals over the past four years.
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