Mozambique
Mozambique ranks 17th on the list 22 high-burden tuberculosis (TB) countries in the world in 2008. According to the World Health Organization’s (WHO) Global TB Report 2008, Mozambique had more than 92,000 TB cases in 2006, with an estimated sputum smear-positive (SS+) incidence rate of 186 cases per 100,000 people. The number of TB cases in Mozambique is likely to increase further over the next few years due to HIV/AIDS. The TB-HIV co-infection rate is high, with 30 percent of new TB patients testing HIV positive. Multidrug-resistant (MDR) TB, largely caused by non-adherence to drug regimens or inappropriate drug regimens, is further exacerbating Mozambique’s TB epidemic. In 2008, 3.5 percent, or more than 3,200, of TB cases were MDR-TB. Extensively drug-resistant TB was confirmed in Mozambique by September 2007.
Health services for TB control and prevention in Mozambique are inadequate in terms of coverage, access, and quality of care, mainly due to the lack of infrastructure and a shortage of human resources. While all districts are implementing DOTS (directly observed treatment, short course), access to primary health care is still limited, and only 40 percent of the population has access to DOTS. This results in low case detection rates and high death rates among patients in treatment. TB and HIV/AIDS are among the government’s health priorities and collaborative TB-HIV/AIDS activities are now in place throughout the country. The government launched the National TB and Leprosy Program (NTLP) in 1977, and by 2003, the NTLP had developed a comprehensive plan for expanding the use of DOTS.
USAID Approach and Key Activities
USAID support for the NTLP began in 2001. USAID funding for TB activities in Mozambique has risen from $150,000 in 2002 to $1 million in 2006 and 2007. With rising co-infection rates, the increased support will help strengthen TB-HIV/AIDS collaborative activities. USAID provides support to the KNCV Tuberculosis Foundation, which manages the Tuberculosis Control Assistance Program, (TB CAP). TB CAP activities are closely coordinated with the NTLP, the National HIV/AIDS Program, and nongovernmental organizations. The main components of the USAID program are TB-HIV/AIDS collaborative activities, community-based DOTS (CB-DOTS) expansion, and laboratory strengthening. Activities include:
- Expanding quality DOTS by increasing awareness of TB among health workers and improving diagnosis
- Organizing and conducting stakeholder meetings and workshops and developing guidelines for CB-DOTS
- Increasing community involvement and awareness of TB
- Improving laboratory systems with activities such as supply and specimen management and strengthening the microscopy network for improved diagnostic services
- Training staff, updating equipment, and establishing quality assurance guidelines at the National Reference Laboratory
- Strengthening HIV counseling and testing in TB patients and TB testing in HIV/AIDS patients
- Improving collaboration between TB and HIV/AIDS programs at the provincial and district levels
- Improving TB drug resistance surveillance and support systems for the treatment of drug resistant TB
- Strengthening and improving the management capacity of the NTLP and supporting NTLP monitoring and evaluation (M&E) activities at central and provincial levels
USAID Program Achievements
USAID’s assistance has contributed substantially to the prevention and control of TB. In fiscal year (FY) 2007, TB CAP supported the successful implementation of CB-DOTS in three provinces. With full support from the Ministry of Health, CB-DOTS will be expanded in these provinces and to two additional priority provinces. Other program achievements include the following:
- Increased DOTS coverage by 82 percent in six selected targeted districts in FY 2007
- Expanded CB-DOTS, resulting in close to 1,000 volunteers in targeted districts referring approximately 5,000 TB suspects to the health centers for clinical examination and diagnosis in FY 2007
- Created the National TB-HIV Task Force and revised and updated the national TB and TB-HIV guidelines
- Provided technical assistance in the development of the National Strategic Plan for TB, 2008–2012 as well as in the development of the TB component of the Round 7 proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria
- Developed the Community Based DOTS National strategy including training modules and TB-HIV leaflets for people living with AIDS, TB patients and health workers
- Supported the development of referral systems for suspected TB and co-infected TB-HIV/AIDS cases
- Supported supervision at all levels and developed a Standard Operational Procedures for laboratories
- Distributed 25 microscopes for sputum smear examination and developed a training curricula to train nurses in sputum fixation
- Strengthened the National TB Reference Laboratory capacity in Maputo with in-service training laboratory staff on bio-safety and quality assurance
- Supported the National TB meeting and provincial TB meetings, and supported the National meeting on infection control in December 2008
- Developed the construction specifications and project documents for Beira laboratory renovation and refurbishment to decentralize TB culture and drug-sensitivity testing to the central region
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
Partnerships are one of the most important elements in combating TB in Mozambique. USAID-funded TB CAP is implemented by the Tuberculosis Coalition for Technical Assistance and led by the KNCV Tuberculosis Foundation. Other partners in TB CAP include WHO, the U.S. Centers for Disease Control and Prevention (CDC), Management Sciences for Health, and Family Health International. USAID also works closely with partners from the U.S. President’s Emergency Plan for AIDS Relief to implement TB-HIV/AIDS activities. In 2004, the Global awarded Mozambique $14.2 million in Round 2 for DOTS expansion. In 2007, Mozambique received a total of $21 million in Round 7 from the Global Fund to strengthen the NTLP at all levels.
March 2009
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