Democratic Republic of the Congo
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The Democratic Republic of the Congo (DRC) ranks 10th on the list of 22 high-burden
tuberculosis (TB) countries in the world. TB is one of the leading causes of death in the
country, particularly affecting individuals in their economically productive years.
According to the World Health Organization’s (WHO’s) Global Tuberculosis Control
Report 2009, the DRC had an estimated 245,333 TB cases in 2007, with an estimated
incidence rate of 392 cases per 100,000 population. Case notifications remained at high
levels, with little change between 2006 and 2007, which reflects intensive case finding
efforts. The DOTS (the internationally recommended strategy for TB control)
treatment success rate for sputum smear-positive (SS+) patients passed WHO’s target
of 85 percent in 2007; however, a low percentage of smear-negative cases suggests
there may be problems in timely access and diagnosis. By the end of 2005, 100 percent
of the population theoretically had access to DOTS, but civil conflict has presented
some barriers to seeking and receiving care.
Since 1981, TB control in the DRC has been integrated into the primary health care
system. With international assistance, the National Tuberculosis and Leprosy Program
(NTLP) directs the TB program at the provincial level. Due to the vastness of the
country and the weak national health system, program coordination is difficult, and the
supply system for TB drugs is almost entirely dependent on air transport.
The TB-HIV co-infection rate for new cases was an estimated 5.9 percent in 2007.
Coordination with HIV/AIDS activities improved, and there has been a steady increase
in the number of TB patients tested for HIV, from 2 percent in 2006 to 14 percent in
2007. The growing TB-HIV/AIDS epidemic and the presence of well-documented
patients with multidrug-resistant (MDR) TB pose serious threats to the achievements
of the NTLP.
USAID Approach and Key Activities
At the national and health zone levels, USAID provides support for the NTLP as well as
for the basic primary health care package that includes family planning, nutrition, policy
development, immunization, HIV/AIDS, and disease surveillance and response activities.
USAID’s overall goal is to help the NTLP expand access to TB services while achieving
WHO targets for improved case detection and treatment success rates. To achieve
this goal, USAID supports TB activities undertaken by the Tuberculosis Control
Assistance Program (TB CAP) and the AXxes project. USAID-supported activities
focus on provinces that have a high need for assistance. In fiscal year (FY) 2008, USAID
funds for TB programming in the DRC totaled almost $4.3 million. USAID assistance
includes the following:
- Providing technical assistance (TA) to the NTLP for coordination and
supervision of TB activities in more than 107 health zones in South,
Kasai Occidental, Kasai Oriental, Equateur Est, Maniema, and Katanga
provinces
- Assisting monitoring and data quality control and improvement
- Assisting the NTLP to improve linkages between TB and HIV/AIDS control
activities, including training of health workers and provincial coordinators
- Improving NTLP strategies for expanding DOTS and developing new policies
to address drug resistance and co-infection
- Improving TB drug management logistics and distribution
- Supporting national TB evaluations
- Strengthening the laboratory network and laboratory capacity, including decentralization of culture capacity to two
regional laboratories, and improving the microscopic diagnosis of TB
- Integrating the counseling and testing (CT) centers into TB detection and treatment centers in 25 USAID-assisted health
centers
- Improving TB drug management logistics and distribution
- Supporting national TB evaluations
- Training nurses in TB case management (detection, treatment, and reporting)
USAID Program Achievements
With assistance from implementing partners, USAID’s achievements include the following:
- Provided TA to the NTLP and partners, which resulted in an increase in case detection, from 51 percent in 2001 to 61
percent in 2006; treatment success increased from 77 percent in 2001 to 85 percent in 2006
- Expanded TB control activities to 115 health zones in FY 2008
- Continued to provide TA to integrate a pilot project on the management of patients into TB-HIV co-infection activities
in two health zones in Kinshasa, covering approximately 400,000 inhabitants
- Integrated TB-HIV/AIDS co-infection activities into three existing USAID-supported CT centers
- Improved the referral system between TB-HIV services with other support health services (opportunistic infections and
psychosocial support)
- Rehabilitated and upgraded the National Reference Laboratory and training of lab technicians on fluorescence
microscopy
- Provided TA to the NTLP to improve financial management, procurement planning, and monitoring and evaluation in
order to assist the NTLP in becoming the future primary recipient of grants from the Global Fund to Fight AIDS,
Tuberculosis and Malaria
- Completing the DOTS Implementation Progress Evaluation and the Sputum Sample Quality Control Evaluation
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
International partnerships are critical to TB control in the DRC. USAID’s main partner for strengthening the capacity of the
NTLP is the Tuberculosis Coalition for Technical Assistance project, which is implementing TB CAP. TB CAP members are the
KNCV Tuberculosis Foundation, WHO, the U.S. CDC, the International Union Against Tuberculosis and Lung Disease, the
American Thoracic Society, Family Health International, the Japan Anti-Tuberculosis Association, and Management Sciences for
Health. The Global Fund awarded the DRC $7.9 million in Round 2 for TB control activities, $14.6 million in Round 5, and $8.5
million in Round 6.
May 2009
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