USAID's Expanded Response to Tuberculosis

Brief Background

USAID began working in TB in 1998. The Agency’s TB funding increased from $8 million in 1998, to approximately $77 million in 2003 (all accounts), and assistance to countries has expanded from handful of countries in 1998, to over 32 countries in 2003. In addition, USAID plays a global leadership role as a member of the STOP TB partnership and STOP TB working groups, and is making important contributions to global advocacy, research and tools development for TB.

Summary of USAID Funded Country Level TB Programs

The World Health Organization has identified 22 countries that contribute 80 percent of the global TB burden. These countries are known as the high-burden countries or HBCs. The DOTS Strategy has five components: political commitment; passive case detection among patients seeking care at health facilities and diagnosis using sputum smear microscopy; standardized short-course treatment with direct observation of therapy at least in the initial phase; assurance of an uninterrupted supply of high-quality drugs; and standardized recording/reporting with systematic evaluation of treatment outcomes.

• USAID supports country-level programs funded through USAID country missions in 34 countries, including 16 of the 22 high-burden countries
  


• All USAID country-level programs support the expansion and strengthening of DOTS . The specific assistance provided varies according to local needs, and can include training of health personnel, laboratory strengthening, technical assistance, monitoring and evaluation, communications and advocacy, drug management strengthening, support for planning and management of programs.
  


• USAID is supporting community approaches to strengthen and expand DOTS in at least 10 countries, including partnerships with local NGOs in countries such as Afghanistan, Kenya, Brazil, Uganda, Cambodia, Pakistan, Bolivia, Haiti, and Georgia.
  


• USAID supports operations research on TB-HIV/AIDS and activities to strengthen the coordination and referral between TB and HIV/AIDS programs in Cambodia, El Salvador, Ethiopia, Kenya, Malawi, Mozambique, Peru, South Africa, Uganda and Vietnam.
  


• To address the challenge of Multi-Drug resistant TB (MDR TB), USAID supports country-level surveys to measure the magnitude of TB drug resistance. USAID has supported surveys in 14 countries or sites to date - Kazakhstan, Honduras, El Salvador, Ecuador, Guatemala, Lithuania, Peru, Egypt, Algeria, Turkmenistan, Uzbekistan, Paraguay, Russia, and South Africa. TB drug resistance studies are ongoing in 10 more countries - Bolivia, the Dominican Republic, Brazil, Ethiopia, India, Lebanon, Jordan, Romania, and Peru, and are planned in 6 countries - Mexico, Egypt, Morocco, Kyrgysztan, Indonesia, Democratic Republic of Congo.
  


• USAID also supports DOTS Plus for MDR TB pilot projects in Russia (Orel and Ivanovo oblasts), The Baltics (Latvia, Estonia, and Lithuania), and India.