Bolivia
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Bolivia ranks third in the Western hemisphere in tuberculosis (TB) cases, with
approximately 8,344 new sputum smear-positive (SS+) cases, or 89 per 100,000
population, according to the World Health Organization’s (WHO’s) Global TB report
2008. DOTS (directly observed treatment, short course) was first implemented in
Bolivia in 1999, and progress has been uneven to date; while DOTS coverage reached
100 in 1999, 2001, and 2003, it fell to 47 percent in 2006. Where implemented, DOTS
has been effective. The current DOTS case detection rate, at 69 percent, is close to
the WHO target of 70 percent, although this represents a decline from a high of 79
percent in 2002. One of Bolivia’s major goals is, with U.S. Government (USG) support,
to meet the WHO target of 85 percent treatment success rate. After reaching 84
percent in 2002, the TB cure rate declined to 78 percent in 2006. A lack of
registration and follow-up of patients following treatment due to limited national
financial resources and trained staff have contributed to the decline in DOTS case
detection and treatment. Multidrug-resistant (MDR) TB is a small but growing threat;
among new TB cases, 1.2 percent are MDR-TB.
The Prevention and Control of Communicable Diseases Unit of the Ministry of Health
(MOH) operates Bolivia’s National TB Control Program (NTCP). The NTCP’s
objectives are to increase case detection and treatment success rates. To meet these
objectives, the NTCP needs to maintain its TB training program for nursing and
medical university students; continue TB diagnosis and treatment training for health
care workers; increase the number of locally-trained personnel; increase public TB
awareness through mass media campaigns; and engage the private sector and
nongovernmental organizations (NGOs) in delivering DOTS services.
USAID Approach and Key Activities
For the past few years, USAID has assisted the NTCP through the Gestion y Calidad en
Salud project (implemented by John Snow, Inc.), the Programa de Coordinacion en Salud
Integral project (implemented by PROCOSI), and the Asociacion Proteccion a la Salud
(implemented by PROSALUD). Continued USAID/Bolivia assistance has included the
following activities and interventions:
- Establishing a community-based DOTS (C-DOTS) program to reach TB
patients in rural and isolated regions
- Improving the TB laboratory network
- Providing technical assistance and equipment to strengthen laboratory
services, quality control, and the drug logistics system
- Supporting the MOH in changing policy for treatment from an eight-month
treatment scheme to a six-month treatment scheme
- Assisting 35 priority municipalities in four of Bolivia’s nine departments in
2008 to expand DOTS and strengthen the NTCP
- Training health providers and community health workers (CHWs), improving
the TB drug logistics system, and (with MOH collaboration) strengthening TB
laboratories
- Training health providers in case detection to extend service coverage
- Assuring complete treatment regimens for each patient by upgrading the
logistics system
- Monitoring and evaluation of TB program activities in targeted municipalities
USAID Program Achievements
USAID’s assistance and support have led to improvements in TB prevention and control activities, including the following
achievements in 2008:
- Supported 24 TB reference laboratories in four major cities to assess and improve their diagnostic capabilities
- Trained 1,681 rural CHWs and NGO health technicians with C-DOTS training kits developed in collaboration with the
MOH, resulting in 332 pulmonary patients being referred to health centers for evaluation and treatment
- Supported the MOH in training 330 municipal and departmental public sector health workers from 133 health facilities
on new treatment norms, guidelines, and protocols, as well as quality of care
- Supported participation of 16 targeted municipalities in a collaborative TB intervention to increase coverage and improve
quality of care, TB surveillance, and data management
- Trained 67 health professionals in 27 USG-supported private health clinics in urban areas around the country on the new
MOH norms, guidelines, and TB protocols to allow them to continue providing free and comprehensive TB patient care
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS 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 Bolivia. Partners of USAID/Bolivia include the Pan
American Health Organization and the International Union Against Tuberculosis and Lung Disease, who provide technical support
to Bolivia’s TB control effort. In 2006, the Global Fund to Fight AIDS, Tuberculosis and Malaria awarded $4.2 million in Round 3
funding for TB activities in Bolivia, the second phase of which will end in early 2010.
January 2009
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