Haiti
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Haiti has the highest per capita tuberculosis (TB) burden in the Latin America and
Caribbean region. After HIV/AIDS, TB is the country’s greatest infectious cause of
mortality in both youth and adults (5,400 deaths in 2006). Haiti is among the eight
priority countries identified by the Pan American Health Organization for TB control in
the region. According to the World Health Organization’s (WHO’s) 2008 Global
Tuberculosis Control Report, Haiti had and estimated 28,290 new TB cases in 2006. Of
these, 44 percent were new pulmonary sputum smear-positive (SS+) cases. Although
Haiti falls short of the WHO targets of 70 percent case detection and 85 percent
treatment success rates, the DOTS (directly observed treatment, short course) case
detection rate is 55 percent, up from 22 percent in 1998. The DOTS treatment
success rate is 81 percent and has remained stable at an average of 78 percent over the
last five years. DOTS coverage is estimated at 91 percent, up from 55 percent in 2004,
but in some highly dense metropolitan settings, such as areas in Port-au-Prince,
coverage can be as low as 13 percent. The most populated department in Haiti, Ouest
(West), has 34 percent of the country’s population but only 25 percent coverage.
Since 1998, the Ministry of Health (MOH) has supported the DOTS strategy in order
to strengthen the national TB program, the Programme National de Lutte contre la
Tuberculose (PNLT), and approved national guidelines and norms for TB control in
2002. However, the program lacks political and financial support from the government,
and there is a lack of skilled technical human resources at the central level of the
PNLT. A major problem in combating TB is that co-infection with HIV can run as high
as 30 percent in some urban areas. Conversely, 20 percent of HIV-positive adults in
Haiti are infected with TB. Strong stigma and cultural barriers attached to TB also
interfere with case detection and adherence to treatment. Multidrug-resistant (MDR)
TB has increased from 1.4 percent in 2004 to 1.9 percent in 2006. In partnership with
three USAID-supported nongovernmental organizations, the MOH has taken steps to
implement DOTS clinics in all 10 geographical departments in Haiti.
USAID Approach and Key Activities
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Between 2003 and 2005, USAID funds for TB programming in Haiti averaged $1.8
million per year. USAID’s approach in Haiti complements the priorities of the PNLT.
The major areas of USAID activities reinforce TB-HIV/AIDS program building within
the national DOTS program and establish links between TB and HIV services in order
to continue to increase case detection and improve treatment completion rates.
Through the Santé pour le Développement et la Stabilité d’Haïti Project, USAID provides a
continuum of care for co-infected patients based on the national norms. Three Haitian
non-governmental organizations (NGOs) receive support through this project:
International Child Care/ Anti-Tuberculosis Crusade (ICC/CAT); Center for Health
Development (CDS); and CARE. This new integrated community care and support
project supports the provision of TB detection and limited DOTS treatment services in
clinics and communities nationwide, serving approximately 50 percent of the Haitian
population. In the past, the Tuberculosis Coalition for Technical Assistance had also
supported the PNLT with technical assistance. USAID assistance includes the following
interventions:
- Strengthening TB program leadership, management, and technical capacities at
the central level of the PNLT
- Developing and implementing “DOTS Model Areas” in the capital city in
order to accelerate quality DOTS expansion
- Building TB-HIV/AIDS testing, referral, and care systems
- Ensuring that protocols for TB-HIV/AIDS are fully integrated into HIV training curricula and updating guidelines for
infection control
- Fostering alliances with private doctors treating TB patients to provide them with continued training on DOTS protocols
- Integrating TB screening and prophylaxis into all HIV care services through the different HIV care and treatment
networks
- Improving laboratory capacity and reinforcing quality assurance for TB testing and initiating the monitoring of drug
resistance at the National Tuberculosis Reference Laboratory
- Ensuring that staff trained by the MOH know how to assess drug management problems and improve the drug
management systems
USAID Program Achievements
In the face of political turmoil and socioeconomic instability, TB control in Haiti has progressed in recent years. USAID support has led to improvements in TB control through the following achievements:
- Equipped the National Tuberculosis Reference Laboratory
- Trained 30 health care providers in the integration of TB treatment into HIV care and treatment services in fiscal year
(FY) 2007
- Trained more than 800 health care providers in DOTS in FY 2007
- Established national pediatric TB guidelines and developed algorithms for TB-HIV co-infection and pediatric TB
- Increased the TB treatment success rate in USAID-supported areas from 73 percent in 2000 to 81 percent in 2006,
approaching the WHO target of 85 percent
- Conducted a survey of knowledge, attitude, and practices, where results formed the basis for the development of
evidence-based communication methods, tools, and materials needed for outreach
- Provided essential assistance to the TB drug supply management and laboratory services, including warehousing and
logistical support, quality control, training, and preparation of laboratory reagents
- Provided technical support for proposals to the Global TB Drug Facility and to the Global Fund to Fight AIDS,
Tuberculosis and Malaria
- Provided technical and administrative support for the launch of a cross-border TB program with the
Dominican Republic
- Established a Working Group to address TB-HIV/AIDS co-infection and conducted a workshop with the National AIDS
Program on integrating aspects of HIV/AIDS surveillance, care, and treatment into TB control activities
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
The international community provides significant support for TB control in Haiti. Other partners include the Haitian Study Group
on Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Partners in Health, Management Sciences for Health, and the U.S.
CDC. In 2003, the Global Fund awarded Haiti $14.6 million for TB control and prevention.
January 2009
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