Key Achievements in Tuberculosis: Fiscal Year (FY) 2003
Advances in TB Control in Europe and Eurasia
USAID TB investments in the Europe and Eurasia region supported activities in 14 countries
in 2003. These programs helped host countries control TB effectively and efficiently through implementing the directly observed treatment, short course (DOTS) strategy.
In 2002, an evaluation of USAID investments in seven countries in the region indicated that
USAID support for TB control contributed to a number of significant achievements in the
preceding five years. DOTS has expanded with improved results; political support for
DOTS-based TB control has increased in all countries; and there has been progress in managing
multidrug-resistant (MDR) TB. Significant achievements have included the following:
- USAID programs have contributed to substantial progress across the region with respect to
standardization of TB treatment regimens and increased use of sputum-smear microscopy in
diagnosing TB.
- In Russia, a high-level TB working group was established and helped decrease opposition to
the DOTS approach.
- DOTS coverage in Kosovo has reached 100 percent.
- In demonstration sites in Russia, Uzbekistan, and Kosovo, treatment success rates are approaching or have surpassed the WHO target of 85 percent.
- In Kazakhstan, where USAID has supported the nationwide DOTS program since 1998, TB-related
mortality has declined by 37 percent. USAID and the U.S. Centers for Disease
Control and Prevention (CDC) estimate that more than 20,000 TB deaths were prevented between
1998 and 2003.
- In Latvia, an international electronic surveillance system for MDR TB and clinical capacity for
managing MDR TB have been developed with USAID support. MDR TB decreased from 54 to
28 percent of all TB cases.
Building DOTS Capacity in the Public and Private Sectors
Since 1999, USAID TB support in the Philippines has included DOTS expansion and training in three isolated regions of the country covering 48 municipalities and three cities. In 2002, USAID launched a new initiative to strengthen diagnosis and treatment of TB by private sector providers in 25 selected sites nationwide. Activities included DOTS training for 3,900 health personnel and the establishment of TB microscopy quality assurance centers in three provinces. As a result, 7 million people (9 percent of the population) are covered by DOTS. USAID support to the Department of Health has helped increase DOTS coverage in the public sector by approximately 10 percent. Case detection rates increased from about 50 to 70 percent between 2000 and 2001.
Improving and Expanding DOTS
Since 2001, USAID has supported TB activities in Haiti and the Dominican Republic, both of which have high TB burdens. When USAID began its support for Haiti’s TB program, only 92 institutions – about 15 percent of the country’s health care facilities – provided DOTS, and cure rates as low as 40 percent were common. Technical assistance, training, logistics, and supervisory support provided by USAID expanded DOTS to 168 clinics, and increased the cure rate to 70 percent. In the Dominican Republic, USAID is helping regions that bear 67 percent of the national TB burden to expand and strengthen DOTS through decentralization and better integration of DOTS in primary health care services. Norms and training modules have been updated and printed, and nearly 800 health personnel have been trained in DOTS. More than 500 health posts are currently implementing DOTS and coverage
has increased from 10 to 40 percent as a result of USAID assistance. Advances have also been achieved in diagnosis and treatment, with the number of smear microscopy tests increasing from 10,000 to nearly 28,000 and cure rates in DOTS areas increasing from 45 to 55 percent.
Increasing DOTS Coverage
India has more tuberculosis cases than any other country in the world. With technical input from WHO and in partnership with the Tamil Nadu State TB Program and the Tuberculosis Research Center, USAID financial support has helped increase training capacity at the Model Center of Tuberculosis Control, Training, and Research. USAID provides direct support for DOTS implementation in Haryana state, where treatment success and case detection rates of 83 percent and 64 percent, respectively, were achieved in 2002. Full coverage of Haryana’s 22 million people will be achieved by the end of 2004. With USAID support, DOTS coverage nationwide increased from 50 percent in 2002 to 65 percent in 2003. The goal is to achieve full national coverage by 2005.
The Global TB Drug Facility
The financial and technical support of USAID’s Bureau for Global Health has been a major contributor to the success of the Global Drug Facility (GDF), which is committed to providing inexpensive TB drugs to countries in need. USAID and other donor contributions have helped to bring about a 30 percent decline in the average price of a full course of TB treatment drugs to about $10 and to provide drugs for more than 1.6 million patients in 30 countries. USAID technical assistance has also ensured that pharmaceutical management receives appropriate attention. USAID provides TB drug management expertise to Stop TB and the GDF for country audits and monitoring visits. In-country monitoring ensures that GDF drugs are distributed in accordance with requirements (which include free availability) and that progress towards global TB goals is demonstrated. In fiscal year 2003, in-country
assessments were performed in Azerbaijan, Bosnia-Herzegovina, Egypt, Haiti, Kosovo, and Macedonia.
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