Democratic Republic of the Congo
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The Democratic Republic of the Congo (DRC) ranks 10th on the list of 22 high-burden tuberculosis (TB) countries in the world. TB is one of the leading causes of death in the country, particularly affecting individuals in their economically productive years. According to the World Health Organization’s (WHO’s) Global Tuberculosis Control Report 2008, the DRC had an estimated 237,473 TB cases in 2006, with an estimated incidence rate of 392 cases per 100,000 population. For the first time since 1997, case notifications fell between 2005 and 2006, although reasons for this are not clear. The DOTS (directly observed treatment, short course) treatment success rate for sputum smear-positive (SS+) patients has met the WHO target of 85 percent; however, the decreased notification rate, as well as a low percentage of smear-negative cases, suggests there may be problems in timely access and diagnosis. By the end of 2005, 100 percent of the population theoretically had access to DOTS, but civil conflict has presented some barriers to seeking and receiving care.
Since 1981, TB control in the DRC has been integrated into the primary health care system. With international assistance, the National Tuberculosis and Leprosy Program (NTLP) directs the TB program at the provincial level. Due to the vastness of the country and the weak national health system, program coordination is difficult, and the supply system for TB drugs is almost entirely dependent on air transport.
The TB-HIV co infection rate was 9.2 percent in 2007. Coordination with HIV/AIDS activities needs to be enhanced, as less than 2 percent of TB patients were tested for HIV in 2006. The growing TB-HIV/AIDS epidemic and the presence of well-documented patients with multidrug-resistant (MDR) TB pose serious threats to the achievements of NTLP.
USAID Approach and Key Activities
At the national and health zone levels, USAID provides support for the NTLP as well as for the basic primary health care package that includes family planning, nutrition, policy development, immunization, HIV/AIDS, and disease surveillance and response activities. USAID’s overall goal is to help the NTLP expand access to TB services while achieving WHO targets for improved case detection and treatment success rates. To achieve this goal, USAID supports TB activities undertaken by the Tuberculosis Control Assistance Program (TB CAP) and the AXxes project. USAID-supported activities focus on provinces that have a high need for assistance. In 2008, USAID funds for TB programming in the DRC totaled almost $4.3 million. USAID assistance includes the following:
- Providing technical assistance to the NTLP for coordination and supervision of TB activities in more than 107 health zones in South-Kivu, Kasai Occidental, Kasai Oriental, Equateur Est , Maniema, and Katanga provinces
- Assisting monitoring and data quality control and improvement
- Assisting the NTLP to improve linkages between TB and HIV/AIDS control activities, including training of health workers and provincial coordinators
- Improving NTLP strategies for expanding DOTS and developing new policies to address drug resistance and co-infection
- Improving TB drug management logistics and distribution
- Supporting national TB evaluations
- Strengthening the laboratory network and laboratory capacity, including decentralization of culture capacity to two regional laboratories and improving the microscopic diagnosis of TB
- Integrating the counseling and testing (CT) centers into TB detection and treatment centers in 25 USAID-assisted health centers
- Improving TB drug management logistics and distribution
- Supporting national TB evaluations
- Training nurses in TB case management (detection, treatment, and reporting)
USAID Program Achievements
With assistance from implementing partners, USAID’s achievements include the following:
- Provided technical assistance to the NTLP and partners, which resulted in an increase in case detection from 51 percent in 2001 to 61 percent in 2006; treatment success increased from 77 percent in 2001 to 85 percent in 2006
- Expanded TB control activities to 115 health zones in fiscal year 2008
- Continued to provide technical assistance to integrate a pilot project on the management of patients into TB-HIV co-infection activities in two health zones in Kinshasa, covering approximately 400,000 inhabitants
- Integrated TB-HIV/AIDS co-infection activities into three existing USAID-supported CT centers
- Improved the referral system between TB-HIV services with other support health services (opportunistic infections and psychosocial support)
- Rehabilitated and upgraded the National Reference Laboratory and training of lab technicians on fluorescence microscopy
- Provided technical assistance to the NTLP to improve financial management, procurement planning, and monitoring and evaluation in order to assist the NTLP in becoming the future primary recipient of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria
- Completing the DOTS Implementation Progress Evaluation and the Sputum Sample Quality Control Evaluation
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment sucess rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008.
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Partnerships
International partnerships are critical to TB control in the DRC. USAID’s main partner for strengthening the capacity of the NTLP is the Tuberculosis Coalition for Technical Assistance project, which is implementing TB CAP. TB CAP members are the KNCV Tuberculosis Foundation, WHO, the U.S. CDC, the International Union Against Tuberculosis and Lung Disease, the American Thoracic Society, Family Health International, the Japan Anti-Tuberculosis Association, and Management Sciences for Health. The DRC was awarded $7.9 million for TB control activities from the Global Fund during Round 2, $14.6 million in Round 5, and $8.5 million in Round 6.
February 2009
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