USAID's Key Achievements

Providing Guidance to Global Fund Countries.

An enormous proportion of Global Fund resources will be for procurement of essential HIV/AIDS, TB, and malaria drugs. To contain drug resistance, recipient countries must be concerned with building systems to manage and use these drugs appropriately and with monitoring the emergence of drug resistance. USAID’s Bureau for Global Health has helped WHO develop comprehensive guidance for countries receiving Fund support to be published in 2004.

Tracking Resistance Patterns.

Better information is needed on the epidemiology of vaccine-preventable bacterial infections, particularly those caused by S. pneumoniae and H. influenzae, which are leading agents of mortality among children in developing countries. From 1993 to 2003 in India, the Indian Clinical Epidemiology Network tracked patterns of antimicrobial resistance and serotype distributions of these isolates in six hospital surveillance sites across the country. The resulting information has provided the Indian government and neighboring countries with good evidence of high levels of resistance to cotrimoxazole in pneumococcal and H. influenzae infections. This evidence has influenced the management of patients, particularly children who have meningitis, pneumonia, or septicemia. Information on serotype distributions will be important in designing future vaccine programs to reduce acute respiratory infections and meningitis in children.

Improving Treatment Regiments.

In the Philippines, USAID partners are supporting an initiative to promote “rapid-cycle quality improvement for infection control.” Treatment guidelines, a structured approval process, provider education, standardized admitting forms, and an audit process are being fieldtested in Manila. In one hospital, use of the correct antimicrobial regimen for surgical prophylaxis increased from 50 to 89 percent of patients. Discussions have been initiated with the Philippines Department of Health about disseminating these infection control methods to other hospitals.

Identifying Drug Resistance.

Improper prescribing by pharmacists, self-prescribing by individuals, and counterfeit or poor-quality medications contribute to malaria drug resistance in Cambodia. In an effort to improve prescription practices and ensure that effective medications reach consumers, USAID supported two research studies to determine the extent of poor medication practices. The studies found that only 11 percent of people with symptoms of malaria received the nationally recommended first-line therapy; that 41 percent of people receiving treatment for malaria did not take the full course of medication; and that 50 percent were self-prescribing with medications obtained in the private market. In addition, many malaria drugs for sale were of poor quality and not registered in the country. The research results have been shared with neighboring countries to warn them of these poor-quality products.

Advocacy on Global Initiatives.

USAID continued its advocacy in support of strategies for minimizing the development and spread of drug resistance. This is especially critical as new initiatives such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria begin to supply large amounts of pharmaceuticals to countries that may not have systems to manage and use them appropriately. USAID's advocacy and technical assistance has helped ensure that Global Fund proposals reflect the importance of containing antimicrobial resistance and assessing the capacity of health systems to manage pharmaceuticals.

Improving Use of Medicines.

Through support to the Joint Research Initiative for Improving the Use of Medicines, USAID has been building research capacity around the globe to discover effective interventions for improving drug use by consumers and drug prescribing and dispensing by health providers. Research has demonstrated that targeted, behaviorally focused interventions can achieve large impacts on prescribing practices. A study involving Vietnamese district hospital physicians brought about an increase in appropriate prescribing for acute respiratory infections (ARI) from 35 to 57 percent and a one-third reduction in unnecessary prescribing for non-ARI conditions.

Latin America and Caribbean Antimicrobial Resistance Initiative.

This initiative is introducing approaches to improving antimicrobial drug use in nine countries in Latin America and the Caribbean. It is also providing training and reference materials to improve laboratory capacity for monitoring antimicrobial resistance. As of 2002, seven countries had established national networks to monitor antimicrobial resistance, with six of them already achieving the laboratory quality control target of 95 percent. Regional treatment guidelines to promote rational use of antibiotics were launched in 2002, and national adaptation activities are ongoing.