Mexico
Tuberculosis (TB) is a public health problem in Mexico and remains of great interest to
the United States, given the shared borders and immigration flow between the two
countries. According to the World Health Organization’s (WHO’s) Global TB Report
2008, Mexico had an estimated 22,473 TB cases in 2006, with an estimated incidence
rate of 21 cases per 100,000 population. The National TB Control Program (NTCP)
began implementing DOTS (directly observed treatment, short course) in selected
demonstration areas in 1996, and, according to WHO estimates, DOTS population
coverage reached 100 percent in 2005. Multidrug-resistant (MDR) TB is a concern,
with 2.4 percent of new cases being drug resistant. Mexico received approval from the
Green Light Committee (GLC) to expand access to second-line TB drugs. Extensively
drug-resistant TB also was confirmed in Mexico in February 2007.
USAID Approach and Key Activities
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More than 25 percent of TB patients reported in the United States originate from
Mexico, which make the control, prevention, and treatment of this highly infectious
disease a question of important to U.S. national interest and policy. In 2000, USAID
and the Mexican Secretariat of Health signed a $16 million bilateral grant agreement to
strengthen TB prevention efforts. In fiscal year (FY) 2007, USAID funds for TB
programming in Mexico totaled $1.5 million per year. USAID has a solid relationship
with its NTCP counterparts, and all technical areas and projects are coordinated
closely. Together, USAID and the NTCP have developed a plan, focusing on 13 target
states (Baja California, Chiapas, Chihuahua, Coahuila, Guerrero, Jalisco, Michoacán,
Nuevo León, Oaxaca, Zacatecas, Sonora, Tamaulipas, and Veracruz). These states
include those along the U.S.-Mexico border and those with the highest TB rates and
largest concentrations of migrants. More recently, USAID has begun working with
local and binational nongovernmental organizations to further support control efforts
and to mitigate the effects of TB in vulnerable populations.
USAID’s TB strategy is to collaborate with public and private entities in priority regions
in Mexico, where 70 percent of the country’s reported TB cases occur. USAID focuses
on the following objectives: expanded and strengthened quality DOTS activities at the
national and state levels; expanded TB research; and improved advocacy,
communication, and social mobilization. USAID’s strategy includes the following:
- Promoting collaboration and augmenting capacity and coordination among
governmental and nongovernmental stakeholders
- Promoting TB health education as part of a national awareness campaign and
emphasizing community-based social mobilization
- Strengthening TB diagnostic and treatment practices among health workers
through training and capacity building
- Strengthening the national network of TB laboratories by building a systematic
quality assurance program to improve capabilities in smear microscopy and
drug resistance testing, and purchasing laboratory equipment
- Improving DOTS services for migrants by strengthening national and
international referral systems and organizing community activities
- Expanding DOTS coverage and treatment success rates by augmenting
community health worker networks and capacities
- Supporting operations research projects as well as a national TB drug
resistance survey
- Developing performance indicators for project monitoring and evaluation (M&E) and developing information
management systems for program evaluation, data management, and analysis
- Enhancing public-private mix (PPM) coordination through training on the International Standards for Tuberculosis Care and
establishment of a PPM Work Group under the STOP TB Partnership initiative
- Strengthening, reorganizing, and updating the programmatic and clinical management of MDR-TB and supporting the
GLC application and operation
USAID Program Achievements
Although implementation of many aspects of the USAID TB program were initially delayed, full implementation of a wide variety of technical components are now contributing to substantial improvements in TB control and prevention in Mexico. Achievements to date include the following:
- Implemented a model community-based TB program through Project Concern International
- Trained more than 5,500 health professionals in DOTS in 2008
- Supported seven small grants that demonstrated important results in TB control in high-risk populations in the border
area, which include community awareness programs and a model program for treatment of drug-resistant patients
- Assisted two university partnerships in TB research and control – the first between the University of Texas, El Paso and
the Autonomous University of Ciudad Juárez and the second between the University of Texas Health Science Center in
San Antonio and the Autonomous University of Tamaulipas
- Distributed country-crucial laboratory equipment for diagnostics throughout the country, as well as computers and
equipment for management and training, and vehicles to support TB supervision and M&E activities
- Adapted, printed, and distributed the International Standards for Tuberculosis Care throughout the country
- Revised and updated the clinical guidelines for case management of drug-resistant TB and supported Mexico in the
approval and preparations for GLC access to second-line drugs
- Created an information, education, communication strategy and public awareness campaign with printed and multimedia
materials, including brochures, radio spots, and public service announcements for television
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: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
Within the Mexican Secretariat of Health, USAID collaborates with the Division of Prevention and Control of Microbacteria, the National Center for Epidemiology, Surveillance and Health Promotion, the National Institute of Epidemiological Diagnosis and Reference, and the National Institute of Respiratory Diseases. USAID also collaborates with state health secretariats, the U.S. CDC on cross-border migration issues, the Pan American Health Organization on TB research, and Project Concern International on community-based TB activities. Other technical partners and consultants include members of the Tuberculosis Control Assistance Program coalition.
January 2009
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