Baltics
Tuberculosis has been a serious public health problem in the Baltic countries (Estonia, Latvia, and Lithuania) since their independence from the Soviet Union in 1991. According to the World Health Organization’s Global Tuberculosis Control: WHO Report 2004, Lithuania had more than 2,300 new TB cases in 2002; Latvia, more than 1,800; and Estonia, nearly 750. Although the total case numbers are low, they represent a high incidence rate (66 cases per 100,000 people, on average) despite strong political commitment to TB control in all three countries. The Baltics have some of the highest incidence rates of multidrug-resistant TB (MDR-TB) in the world (up to 14 percent of cases annually), which dramatically increases the costs and decreases the chances of TB treatment success.
These TB indicators reflect the deterioration of the health care system in the Baltic countries since the breakup of the Soviet Union in the early 1990s. This deterioration facilitated the spread of infectious diseases, including TB and MDR-TB, throughout the region. As a result, the TB infrastructure became unsustainable, and governments needed new solutions to combat the growing TB problem.
USAID Approach and Key Activities
In response to the TB crisis, USAID began supporting TB control in the Baltics in 1999. Along with the U.S. Centers for Disease Control and Prevention (CDC) and Latvia’s State Agency of Tuberculosis and Lung Diseases, USAID helped establish the regional Center of Excellence for the Treatment and Management of MDR-TB in Latvia. The Center’s four primary objectives are to:
1) Build the expertise of Latvian physicians
2) Strengthen clinical practice and patient management
3) Improve infection control practices in health care facilities
4) Provide MDR-TB training for health professionals throughout the region
The Center has developed an international MDR-TB surveillance system and undertaken feasibility and cost-effectiveness studies of rapid TB diagnostic technologies.
Between 2001 and 2003, USAID funds for TB programming in the Baltics averaged $450,000 per year. USAID assistance focuses on building capacity essential to TB control strategies. Activities include:
- Establishing national TB control policies and training programs consistent with WHO’s Directly Observed Therapy, Short-Course (DOTS) strategy
- Strengthening infection control
- Strengthening laboratory capacity for case detection through sputum smear microscopy
- Strengthening recording and reporting systems that allow assessment of treatment results for each patient and for the TB program as a whole
- Strengthening clinical practice and patient management
- Developing appropriate TB supervision and monitoring systems
- Implementing MDR-TB training and treatment programs regionwide
- Developing TB-HIV co-infection referral networks and training programs
USAID Program Achievements
In partnership with the Baltic governments and donors, USAID has achieved significant progress in TB control. Achievements include:
- Reduced the proportion of MDR-TB in notified cases from 14.4 percent in 1996 to less than nine percent in 2003
- Provided more than 20 training sessions for physicians, TB program managers, nurses, social workers, laboratory staff, outreach workers, and engineers from Latvia, Lithuania, Estonia, Russia, Romania, Moldova, Ukraine, the Central Asian Republics, Egypt, the Philippines, and Nepal
- Gained recognition for Latvia’s regional Center of Excellence as a WHO Collaborating Center for Research and Training in the Management of MDR-TB
- Developed a regional MDR-TB surveillance system
- Implemented a regional computerized information system to improve patient case management, treatment delivery, and
cost analyses
- Implemented a partnership program at the Latvia Center of Excellence incorporating business training to ensure financial
sustainability
- Developed modules for Estonia’s TB nurse training program, followed by training of all TB nurses in Estonia and initiation of recurrent training cycles
- Developed a national TB infection control strategy in Estonia, accompanied by training of 50 health care workers on controlling TB transmission in congregate settings such as schools, arenas, and other public places
- Implemented Lithuania’s first national TB drug resistance survey to conform to international standards
Partnerships
USAID and its partners have provided critical leadership in implementing the DOTS strategy in the Baltics. These partners include the governments of Estonia, Latvia, and Lithuania; CDC; WHO; the Stop TB initiative; and the American International Health Alliance.
December 2004
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