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</td> </tr> <tr align="right"> <td align="right" valign="bottom"> </td> </tr> </tbody></table> Haiti has the highest per capita tuberculosis (TB) burden in the Latin America and Caribbean region. After HIV/AIDS, TB is the country?s greatest infectious cause of mortality in both youth and adults (6,814 deaths in 2007). Haiti is among the eight priority countries identified by the Pan American Health Organization for TB control in the region. According to the World Health Organization?s (WHO?s) 2009 Global Tuberculosis Control Report, Haiti had and estimated 29,333 new TB cases in 2007. Of these, 53 percent were new pulmonary sputum smear-positive (SS+) cases. Although Haiti falls short of the WHO targets of 70 percent case detection and 85 percent treatment success rates, the DOTS (the internationally recommended strategy for TB control) case detection rate rose from 37 percent to 49 percent between 2003 and 2007. The DOTS treatment success rate was 82 percent in 2006, a slight increase from 78 percent in 2003. DOTS coverage fell to 70 percent in 2007 compared with 91 percent in 2006, though it was still above the 2005 level of 55 percent. However, in some highly dense metropolitan settings, such as areas in Port-au-Prince, coverage can be as low as 13 percent. The most populated department in Haiti, Ouest (West), has 34 percent of the country?s population but only 25 percent coverage.
Since 1998, the Ministry of Health (MOH) has supported the DOTS strategy in order to strengthen the national TB program, the Programme National de Lutte contre la Tuberculose (PNLT), and approved national guidelines and norms for TB control in 2002. However, the program lacks political and financial support from the government, and there is a lack of skilled technical human resources at the central level of the PNLT. A major problem in combating TB is that co-infection with HIV can run as high as 30 percent in some urban areas. Strong stigma and cultural barriers attached to TB also interfere with case detection and adherence to treatment.
Multidrug-resistant (MDR) TB has increased from 1.4 percent in 2004 to 1.8 percent in 2007. In partnership with three USAID-supported nongovernmental organizations, the MOH has taken steps to implement DOTS clinics in all 10 geographical departments in Haiti.
USAID Approach and Key Activities
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</td> </tr> </tbody></table> USAID provided $1.3 million to Haiti for TB programming in fiscal year (FY) 2008. USAID?s approach in Haiti complements the priorities of the PNLT. The major areas of USAID activities reinforce TB-HIV/AIDS program building within the national DOTS program and establish links between TB and HIV services in order to continue to increase case detection and improve treatment completion rates. Through the Sant? pour le D?veloppement et la Stabilit? d?Ha?ti Project, USAID provides a continuum of care for co-infected patients based on the national norms. Three Haitian nongovernmental organizations (NGOs) receive support through this project: International Child Care/ Anti-Tuberculosis Crusade (ICC/CAT); Center for Health Development (CDS); and CARE. This new integrated community care and support project supports the provision of TB detection and limited DOTS treatment services in clinics and communities nationwide, serving approximately 50 percent of the Haitian population. In the past, the Tuberculosis Coalition for Technical Assistance had also supported the PNLT with technical assistance.
USAID assistance includes the following interventions:
USAID Program Achievements
In the face of political turmoil and socioeconomic instability, TB control in Haiti has progressed in recent years. USAID support has led to improvements in TB control through the following achievements:
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Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009</td> </tr> </tbody></table> Partnerships
The international community provides significant support for TB control in Haiti. Other partners include the Haitian Study Group on Kaposi?s Sarcoma and Opportunistic Infections (GHESKIO), Partners in Health, Management Sciences for Health, and the U.S. CDC. In 2003, the Global Fund awarded Haiti $14.6 million for TB control and prevention.
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</td> </tr> <tr align="right"> <td align="right" valign="bottom"> </td> </tr> </tbody></table> Haiti has the highest per capita tuberculosis (TB) burden in the Latin America and Caribbean region. After HIV/AIDS, TB is the country?s greatest infectious cause of mortality in both youth and adults (6,814 deaths in 2007). Haiti is among the eight priority countries identified by the Pan American Health Organization for TB control in the region. According to the World Health Organization?s (WHO?s) 2009 Global Tuberculosis Control Report, Haiti had and estimated 29,333 new TB cases in 2007. Of these, 53 percent were new pulmonary sputum smear-positive (SS+) cases. Although Haiti falls short of the WHO targets of 70 percent case detection and 85 percent treatment success rates, the DOTS (the internationally recommended strategy for TB control) case detection rate rose from 37 percent to 49 percent between 2003 and 2007. The DOTS treatment success rate was 82 percent in 2006, a slight increase from 78 percent in 2003. DOTS coverage fell to 70 percent in 2007 compared with 91 percent in 2006, though it was still above the 2005 level of 55 percent. However, in some highly dense metropolitan settings, such as areas in Port-au-Prince, coverage can be as low as 13 percent. The most populated department in Haiti, Ouest (West), has 34 percent of the country?s population but only 25 percent coverage.
Since 1998, the Ministry of Health (MOH) has supported the DOTS strategy in order to strengthen the national TB program, the Programme National de Lutte contre la Tuberculose (PNLT), and approved national guidelines and norms for TB control in 2002. However, the program lacks political and financial support from the government, and there is a lack of skilled technical human resources at the central level of the PNLT. A major problem in combating TB is that co-infection with HIV can run as high as 30 percent in some urban areas. Strong stigma and cultural barriers attached to TB also interfere with case detection and adherence to treatment.
Multidrug-resistant (MDR) TB has increased from 1.4 percent in 2004 to 1.8 percent in 2007. In partnership with three USAID-supported nongovernmental organizations, the MOH has taken steps to implement DOTS clinics in all 10 geographical departments in Haiti.
USAID Approach and Key Activities
<table align="right" border="0" cellpadding="0" cellspacing="0" width="260"> <tbody><tr> <td>
</td> </tr> <tr> <td height="10"></td> </tr> </tbody></table> USAID provided $1.3 million to Haiti for TB programming in fiscal year (FY) 2008. USAID?s approach in Haiti complements the priorities of the PNLT. The major areas of USAID activities reinforce TB-HIV/AIDS program building within the national DOTS program and establish links between TB and HIV services in order to continue to increase case detection and improve treatment completion rates. Through the Sant? pour le D?veloppement et la Stabilit? d?Ha?ti Project, USAID provides a continuum of care for co-infected patients based on the national norms. Three Haitian nongovernmental organizations (NGOs) receive support through this project: International Child Care/ Anti-Tuberculosis Crusade (ICC/CAT); Center for Health Development (CDS); and CARE. This new integrated community care and support project supports the provision of TB detection and limited DOTS treatment services in clinics and communities nationwide, serving approximately 50 percent of the Haitian population. In the past, the Tuberculosis Coalition for Technical Assistance had also supported the PNLT with technical assistance.
USAID assistance includes the following interventions:
- Strengthening TB program leadership, management, and technical capacities at the central level of the PNLT
- Developing and implementing ?DOTS Model Areas? in the capital city in order to accelerate quality DOTS expansion
- Building TB-HIV/AIDS testing, referral, and care systems
- Ensuring that protocols for TB-HIV/AIDS are fully integrated into HIV training curricula and updating guidelines for infection control
- Fostering alliances with private doctors treating TB patients to provide them with continued training on DOTS protocols
- Integrating TB screening and prophylaxis into all HIV care services through the different HIV care and treatment networks
- Improving laboratory capacity and reinforcing quality assurance for TB testing and initiating the monitoring of drug resistance at the National Tuberculosis Reference Laboratory
- Ensuring that staff trained by the MOH know how to assess drug management problems and improve the drug management systems
USAID Program Achievements
In the face of political turmoil and socioeconomic instability, TB control in Haiti has progressed in recent years. USAID support has led to improvements in TB control through the following achievements:
- Equipped the National Tuberculosis Reference Laboratory
- Trained 30 health care providers in the integration of TB treatment into HIV care and treatment services in FY 2007
- Trained more than 800 health care providers in DOTS in FY 2007
- Established national pediatric TB guidelines and developed algorithms for TB-HIV co-infection and pediatric TB
- Increased the TB treatment success rate in USAID-supported areas from 73 percent in 2000 to 81 percent in 2006, approaching the WHO target of 85 percent
- Conducted a survey of knowledge, attitude, and practices, where results formed the basis for the development of evidence-based communication methods, tools, and materials needed for outreach
- Provided essential assistance to the TB drug supply management and laboratory services, including warehousing and logistical support, quality control, training, and preparation of laboratory reagents
- Provided technical support for proposals to the Global TB Drug Facility and to the Global Fund to Fight AIDS, Tuberculosis and Malaria
- Provided technical and administrative support for the launch of a cross-border TB program with the Dominican Republic
- Established a Working Group to address TB-HIV/AIDS co-infection and conducted a workshop with the National AIDS Program on integrating aspects of HIV/AIDS surveillance, care, and treatment into TB control activities
Case Detection and Treatment Success Rates Under DOTS
<table align="center" border="0" cellpadding="0" cellspacing="0" width="450"> <tbody><tr> <td></td> </tr> <tr> <td class="smalltext">Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009</td> </tr> </tbody></table> Partnerships
The international community provides significant support for TB control in Haiti. Other partners include the Haitian Study Group on Kaposi?s Sarcoma and Opportunistic Infections (GHESKIO), Partners in Health, Management Sciences for Health, and the U.S. CDC. In 2003, the Global Fund awarded Haiti $14.6 million for TB control and prevention.
June 2009
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