Peru
Although tuberculosis (TB) remains a serious public health threat in Peru, the country
is no longer included in the World Health Organization’s (WHO’s) list of countries
with a high TB burden. Peru was the first high-burden TB country to successfully
implement DOTS (directly observed treatment, short course) which resulted in a sharp
decline in TB incidence from 1991 to 1999. By also pioneering new DOTS approaches
to combat multidrug-resistant (MDR) TB, the country has developed a highly capable
specialized health research community. Although Peru accounts for only 3 percent of
the population of the Americas, it has 14 percent of the region’s TB cases. According
to the WHO Global TB Report 2008, Peru had more than 44,000 reported TB cases in
2006, and the reported incidence rate was 162 cases per 100,000 people. MDR-TB
represents 5.6 percent of all new TB cases and extensively drug-resistant (XDR) TB
has been confirmed in Peru since February 2007.
In the past few years, Peru’s National TB Program (NTP) has been hindered by serious
administrative and funding problems in the Ministry of Health (MOH). These problems
led to a deterioration of the TB situation, and in 2004, a reorganization of the MOH
created the National Sanitary Strategy for the Prevention and Control of Tuberculosis
(ESNTBC) to replace the NTP.
USAID Approach and Key Activities
USAID and the ESNTBC are working together to further strengthen both Peru’s DOTS
program and its capacity to address MDR-TB. In fiscal year 2007, USAID funds for TB
programming in Peru totaled $600,000. USAID’s assistance includes support for:
- Building capacity for diagnostic laboratory capabilities (including MDR-TB
diagnostics)
- Providing technical assistance and training to ESNTBC staff
- Supporting information, education, and communication activities
- Strengthening surveillance
- Supporting operational research
USAID Program Achievements
In 2005, USAID supported a study of the TB situation in Peru that is helping the MOH to solve institutional weaknesses in its system. USAID also supported efforts to strengthen the control and management of TB cases through technical assistance to the DOTS program in five target regions and to the MOH for upgrading national TB guidelines. USAID’s achievements have included the following:
- Trained over 1100 clinicians and health workers in fiscal year 2007 in updated protocols for TB treatment, DOTS and MDR-TB infections. USAID also trained 148 health workers in monitoring and evaluating TB programs, in order to improve service quality
- Provided technical assistance for a nation-wide communication strategy to mobilize the public for TB prevention and control
- Supported ESNTBC in the creation of a Stop TB committee
- Funded the revision of technical norms for TB control in accordance with current protocol from the World Health Organization
- Held workshops for health care personnel to reduce stigma and discrimination toward TB patients
- Supported regional health authorities to develop regionally-based TB control plans that include staffing analyses, upgraded information systems, and expanded community outreach plans
- Strengthened infection control and trained clinical laboratory staffs in early diagnosis of MDR- TB
- Supported training and implementation of DOTS and of MDR-TB treatment at the subnational level
- Supported the implementation of USAID’s regional South American Infectious Diseases Initiative, which has included sampling of anti-TB drugs in Callao and Lima for quality
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 have been an important component of combating TB in Peru. Stakeholders, such as the Pan American Health Organization and Partners in Health and USAID, are collaborating with the ESNTBC on TB prevention and control activities. Partners in Health will continue to focus on treatment and control of MDR-TB. Other partners include the CDC, the Johns Hopkins Bloomberg School of Public Health, the University of Alabama, and Universidad Peruana Cayetano Heredia. Peru received grants from the Global Fund to Fight AIDS Tuberculosis and Malaria in Round 2 ($20.2 million), Round 5 (13.6 million) and Round 8 ($14.7 million).
February 2009
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