Key Achievements in Tuberculosis: Fiscal Year (FY) 2004
Expanding and Strengthening DOTS
USAID provided support for expanding
and strengthening directly observed treatment, short course (DOTS)
programs in 39 countries in 2004. Funding for training, technical assistance,
improved monitoring and
supervision, and laboratory strengthening
produced impressive results in
the following countries:
- Cambodia – USAID supported pilot
community-based DOTS activities
in five districts of four provinces and
strengthened DOTS programs in six
other provinces and the city of Phnom Penh. In USAID-assisted districts,
sputum smear-positive case
detection rates ranged from 60 to 82
percent, compared with a national
average of 59 percent.
- Dominican Republic – USAID
supports DOTS implementation in
more than 900 public and private
health facilities in seven districts
and Santo Domingo. In these sites,
DOTS coverage is 73 percent.
Between 2002 and 2003, the smearpositive
case detection rate increased
by 20 percentage points from 53 to
73 percent, and the 2003 treatment
success rate reached 79 percent.
USAID has helped the national TB
program secure a two-year grant of
$2.6 million for DOTS expansion
from the Global Fund.
- Democratic Republic of the Congo –
USAID assists DOTS implementation
and strengthening in eight
provinces. Support includes training,
purchase of laboratory equipment
and supplies, and social mobilization.
Average treatment success rates in USAID-assisted provinces increased
from 65 percent in 2000 to 79
percent in 2003.
- India – In Haryana state, DOTS
coverage increased from 59 percent
to 100 percent between 2003 and
2004. From 2002 to 2003, the case
detection rate increased from 50 to 74 percent and the treatment success
rate from 82 to 84 percent.
- Indonesia – USAID support is closely
coordinated with the Indonesian
government, Global Fund resources,
and other donors. The program
focuses on the provinces of Central
and East Java, each with a population
exceeding 30 million. In
Central Java, the case detection rate
increased from 22 percent in 2002
to 27 percent in 2003, and the
treatment success rate is now 90
percent. The case detection rate in
East Java increased from 12 to 30 percent between 2002 and 2003
and the treatment success rate from
74 to 82 percent.
- Nigeria – USAID support for DOTS
expansion, training, and technical
assistance contributed to an increase
in the case detection rate from 16
percent in 2002 to 18 percent in
2003, the first year of significant
USAID investment in TB control.
- Russia – USAID funding helped
expand DOTS to 20 of Russia’s 88
territories and supported training
of more than 4,000 doctors, nurses,
laboratory technicians, and social workers. In Orel oblast, the treatment
success rate improved from 64
percent in 2002 to 77 percent in
2003. In Ivanov oblast, it improved
from 54 to 70 percent during the
same period.
- Uganda – USAID provides financial
and technical assistance to 16
districts through local government
units, faith-based organizations, the
Uganda People’s Defense Force, and private for-profit health facilities to
support implementation of community-based DOTS. In the USAID-supported districts, the case detection
rate increased from 45 percent
in 2001 to 53 percent in 2003. The
treatment success rate increased
from 51 to 60 percent during the
same period.
- Ukraine – USAID support for
DOTS implementation in Donetsk
oblast resulted in 100 percent coverage
of the area’s 5 million people.
Between 2002 and 2003, case
detection rates increased from 40 to
52 percent and treatment success
rates from 61 to 70 percent.
Community-Based TB Care
Working closely with WHO’s regional Africa and Western Pacific offices, USAID supported technical assistance, training, and planning activities to promote the implementation of community-based DOTS approaches and TB-HIV/AIDS collaborative activities. As a result, community-based TB care activities were implemented in three urban centers in the Democratic Republic of the Congo, in 12 of 76 districts in Kenya, in 34 of 56 districts in Uganda, and nationwide in Botswana, Tanzania, Zimbabwe, Senegal, Togo, and Ethiopia.
DOTS Plus to Fight MDR-TB in Latvia
The USAID-supported DOTS Plus project in Latvia has made impressive gains. Since 1998, USAID funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) have enabled Latvia to implement the "DOTS Plus" strategy for managing drug-resistant TB cases. As a result, multidrug-resistant TB (MDR-TB) among new TB patients decreased from 14.4 percent in 1994 (one of the highest rates in the world) to 8 percent in 2003. Among previously treated TB patients, it decreased from 54.4 percent in 1994 to 23 percent in 2003.The absolute number of MDR-TB patients in the country has been reduced by 40 percent since 1996. These remarkable results were achieved by strengthening the capacity of the Latvian State Center to serve as a national, and now international, training center in the treatment and management of MDR-TB. In addition to training Latvian clinicians, the Center has trained 159 clinicians and TB program managers from such countries as Kazakhstan, Uzbekistan, Ukraine, and the Philippines. In recognition of the Center’s quality and excellence in DOTS Plus, WHO designated it an official Collaborating Center for Research and Training in the Management of MDR-TB in November 2004.
Drug Resistance Surveys
USAID also supported critically important drug resistance surveys in 15 countries. These surveys are crucial in the fight against MDR-TB. Results from these and other studies, many supported by USAID, were incorporated into WHO’s Third Drug Resistance Report, a major report for tracking TB drug resistance. The report showed that Kazakhstan has the highest level of MDR-TB. USAID’s TB program in Central Asia is giving priority to this issue.
Drug Studies
In October, results from a USAID-supported study conducted by the International Union Against Tuberculosis and Lung Disease were published in The Lancet. The results have significant implications for improved and simplified treatment, providing strong evidence that a six-month continuation phase of treatment with isoniazid and ethambutol has higher rates of relapse after treatment than a four-month continuation phase using isoniazid and rifampicin. In 2004, USAID also entered into a partnership with the Global Alliance for TB Drug Development, an innovative public-private partnership with the mandate of developing new and improved TB drugs.
Improving Access to TB Drugs
Access to TB drugs of assured quality is a key component of DOTS. The Global TB Drug Facility (GDF) provides free or deeply discounted TB drugs to programs in need. In 2004, USAID provided $3 million (20 percent of the GDF’s annual revenue) for the purchase of TB drugs. As a result of this support and that of other donors, the GDF currently provides TB drugs to more than 3.2 million patients. GDF also plays a large role in strengthening recipient countries’ pharmaceutical management systems. USAID supports a full-time procurement adviser to the GDF as well as drug management technical assistance to GDF grant recipients. During 2004, USAID conducted assessment and monitoring visits to 14 of the 65 GDF-supported countries.
Multidrug-Resistant TB
USAID promotes access to and proper use of second-line TB drugs through "DOTS Plus," a strategy for the management of drug-resistant TB cases. Twenty DOTS Plus projects have been approved in 13 countries to treat more than 5,800 patients with multidrug-resistant TB (MDR-TB). Guidelines for implementing future DOTS Plus activities are being developed based on the experiences and outcomes of these pilot projects. USAID also provides critical support to the Green Light Committee (GLC), which promotes access to deeply discounted second-line TB drugs of assured quality and ensures that they will be properly used in DOTS Plus programs. The Global Fund requires that all proposals including second-line TB drugs be reviewed by the GLC. As a result, it is estimated that the GLC has saved Global Fund grantees almost $20 million compared with the cost of purchasing the drugs outside the GLC mechanism.
New Tools and Approaches
In TB research, USAID’s current priorities focus on new drug development, improved TB diagnostics, and approaches to program implementation. In drug development, USAID’s long-standing commitment to supporting research for improved drugs and drug regimens for the treatment of TB resulted in significant progress.
Public-Private Approaches
For improving program approaches, public-private mix (PPM) is a promising innovation for increasing case detection and treatment success in DOTS programs. PPM aims to expand the involvement of all public and private providers in DOTS. USAID has been a leader in advancing PPM approaches through support for pilot activities; monitoring and evaluation of PPM; data analysis and synthesis; and documentation of lessons learned. More than 40 PPM pilot projects are under way in 14 countries; 24 of these projects have undergone process or outcome evaluations. At most pilot sites, treatment success rates have met or exceeded the global target of 85 percent. Increases ranging from 14 to 61 percent have also been achieved in detecting new smear-positive cases through private sector referrals to DOTS programs or diagnosis and reporting of cases. USAID supported the publication of a cross-site analysis and report on PPM cost-effectiveness and is assisting with the development of guidelines for implementing PPM DOTS activities.
Research
USAID supports critical
research for accelerating global expansion of the DOTS approach to TB control and improving program performance.
Working with its partners,
USAID focuses its support on developing,
evaluating, and introducing tools
and approaches that are appropriate for
low-resource countries; have the potential
for significant public health impact;
and have traditionally been underfunded
by the public and private sectors.
TB-HIV/AIDS Collaboration
USAID has
advanced the adoption of approaches to
involving communities in DOTS and collaborative TB-HIV/AIDS activities.
With USAID support, Côte d’Ivoire,
the Democratic Republic of the Congo,
Ethiopia, Kenya, Tanzania, and
Cambodia are scaling up collaborative
activities, while Mozambique, Rwanda,
Senegal, and Chad have finalized
collaboration plans.
Related Links
|
