Malawi
Tuberculosis (TB) continues to be a public health problem in Malawi. According to the
World Health Organization’s (WHO’s) Global TB 2008, there were an estimated
51,172 new cases of TB, but Malawi’s National TB Control Program (NTCP) estimates
are around half that. The NTCP has been implementing DOTS (directly observed
treatment, short course) for two decades, achieving nationwide coverage. The NTCP
also provides for home-based care using community “guardians” to observe and follow
up with TB patients. Despite these advances, the high HIV/AIDS prevalence has had an
impact on the success of the TB program. Case detection has averaged 41 percent
during the past five years, well below the WHO target of 70 percent. The treatment
success rate has remained steady at about 72 percent over the past five years, which is
below the WHO target of 85 percent.
In 2004, Malawi had an HIV/AIDS prevalence rate of 14 percent, and more recently, a
2007 HIV sero-survey of antenatal clinics estimated a national prevalence of 12 percent,
for a total of roughly 900,000 Malawians living with HIV/AIDS. An independent,
countrywide survey indicated that 72 percent of all TB patients were HIV positive, a
much higher percentage than previous estimates. This finding is similar to the 2008
WHO estimate that 70 percent of new TB patients have HIV. In 2008, 3.5 percent of
new TB cases were multidrug-resistant drug (MDR) TB; extensively drug-resistant
(XDR)TB has not been reported in Malawi. In 2002, the Malawi TB-HIV/AIDS
Technical Working Group began implementing a three-year plan for joint TB and
HIV/AIDS services, consistent with the WHO/UNAIDS recommendations for policies
and TB-HIV/AIDS collaborative activities.
USAID Approach and Key Activities
Through the Tuberculosis Control Assistance Program (TB CAP) and its partners,
USAID is helping the NTCP combat TB in Malawi by providing key national-level needs
for equipment and transport, increasing case detection and treatment success, and
supporting prevention and control of MDR-TB and TB-HIV/AIDS co-infection.
USAID is also supporting community-level TB treatment services. In fiscal year 2007,
USAID funds for TB programming in Malawi totaled $1.4 million. USAID is supporting
the following key activities:
- Strengthening national-level TB surveillance
- Supporting the goal of universal access to TB diagnosis through expansion of
laboratory networks (TB microscopy centers) at the health center level and
sputum collection points at the community level
- Providing technical assistance to the NTCP to develop standards for TB
laboratory services, survey protocols, and implementation of the XDR-TB
survey
- Refurbishing the National Reference Laboratory
- Supporting community-based TB care and TB-HIV/AIDS co-infection activities
- Providing support to the NTCP’s efforts to increase cross-referrals of TB
cases for CT and to provide cotrimoxazole prophylaxis for HIV-positive TB
patients
- Evaluating, through operations research, active TB case finding at CT sites
USAID Program Achievements
USAID assistance and support of partners have contributed to significant improvements in TB control in Malawi. Achievements
include the following:
- Supported activities in two districts to intensify TB case-finding activities at CT sites
- Provided assistance to counsel and test 2,806 TB patients for HIV and provided cotrimoxazole treatment to 2,300
patients from July 2007 to September 2008, in accordance with the Ministry of Health’s TB-HIV/AIDS policy of routine
testing of TB patients and pregnant women; and enabled three districts to provide HIV testing to 100 percent of TB
patients and two others to reach 94 and 88 percent of patients
- Assisted in auditing TB deaths in two districts, which resulted in increased staff in TB wards, improved provision of care
among TB patients, and a reduction in the death rate among TB patients
- Increased active case finding by training 48 facility managers and 237 health workers on techniques to identify unreported
cases
- Continued to provide support for training and placement of lay counselors in eight districts to respond to the CT
workload
- Held community sensitization meetings for 600 community leaders and provided seminars to support community-based
TB care and involvement of traditional healers
- Supported TB-HIV/AIDS activities, including provision of isoniazid preventive therapy (IPT) to CT centers; registers for
IPT; information, education, and communication; and nutritional support for patients
- Strengthened systems to improve DOTS program performance and implemented the revised recording and reporting
systems
- Developed a comprehensive human resource development plan to increase service capacity
Case Detection and Treatment Success Rates Under DOTS
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Note: DOS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
International donor assistance is an important element in combating TB in Malawi. Donors include the Norwegian Agency for
Development Cooperation and the U.K. Department for International Development. Partners include the KNCV Tuberculosis
Foundation, which manages TB CAP, and the U.S. CDC. In 2008, Malawi received $7.8 million in Round 7 funding from the
Global Fund to Fight AIDS, Tuberculosis and Malaria for Phase One of TB control activities.
January 2009
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