Ethiopia
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Ethiopia ranks seventh among the world’s 22 high-burden tuberculosis (TB) countries.
According to the World Health Organization’s (WHO’s) Global TB Report 2009, the
country had an estimated 314,267 TB cases in 2007, with an estimated incidence rate
of 378 cases per 100,000 population. Ethiopia’s National Tuberculosis and Leprosy
Control Program (NTLCP) began to implement DOTS (the internationally
recommended strategy for TB control) in two zones in 1991; in 2007, WHO reported
that DOTS coverage reached 95 percent of the population. However, while treatment
is integrated into general health services and DOTS geographical coverage is 95
percent, due to the limited health infrastructure in the country, only approximately 60
to 70 percent of the population has access to DOTS services.1 The DOTS detection
rate remains low, at 28 percent, compared with WHO’s target of 70 percent
detection. The limited diagnostic capacity for TB in the country remains a challenge to
improving case detection rates. The treatment success rate is close to the 85 percent
target set by WHO; after falling from 80 percent in 2000 to 70 percent in 2003, it rose
to 84 percent in 2007.
The number of TB cases is likely to increase as Ethiopia’s HIV/AIDS epidemic expands;
while 16 percent of notified TB patients tested for HIV, 40 percent are HIV positive.
The level of multidrug-resistant (MDR) TB among new TB cases is estimated at 20
percent; 5,979 cases of MDR-TB were reported in 2007. In response to the problem
of MDR-TB, Ethiopia received a grant from the Global Fund to Fight AIDS,
Tuberculosis and Malaria for drug resistance surveillance and MDR-TB control and
received funding from the Green Light Committee for second-line TB treatment for 45
patients in 2008.
USAID Approach and Key Activities
USAID began working on TB control in Ethiopia in 2001 in collaboration with the
Disease Prevention and Control Department of the Ministry of Health and regional
health bureaus. The major TB and TB-HIV/AIDS prevention and control activities
supported by USAID are implemented through the Tuberculosis Control Assistance
Program (TB CAP) at the public health center level and in workplace clinics and
hospitals. In fiscal year (FY) 2008, USAID funds for TB programming in Ethiopia totaled
$3.4 million. Program activities focus on the following areas:
- Improving the capabilities of the NTLCP and regional TB programs for
leadership and treatment success
- Scaling up and strengthening TB-HIV/AIDS collaborative activities
- Improving quality assurance in laboratory and supply chain systems and drug
management systems
- Improving TB care in primary health care units
- Expanding access to TB care through public-private partnerships (PPP) for
DOTS
- Supporting the development of public-private mix (PPM) DOTS
implementation guidelines
- Strengthening the TB microscopic diagnosis at primary microscopic sites,
selected regional labs, and hospitals
- Improving MDR-TB diagnosis and management
- Scaling up infection control (IC), including designing a strategy and formulating national IC guidelines
USAID Program Achievements
USAID’s assistance and support have helped address TB prevention and control in Ethiopia. USAID’s program achievements
include the following:
- Supported the NTLCP, TB-HIV/AIDS Technical Working Group, and the TB-HIV/AIDS Advisory Committee in
prioritizing assistance for leadership and coordination of TB and TB-HIV/AIDS activities
- Increased case detection rate by 26 percent in USAID-supported areas
- Strengthened TB-HIV/AIDS collaborative activities, resulting in an increased number of TB patients who are tested for
HIV and, where positive, placed on preventive therapies
- Established external quality assurance and surveillance of drug-resistant TB
- Revised and standardized TB-HIV/AIDS clinical, programmatic, and training tools and provided training to general health
workers, laboratory technicians, counselors, and program managers in all regions
- Reformed the federal PPM DOTS guidelines
- Expanded PPP services in 56 workplace clinics and 21 for-profit clinics in Addis Ababa and Oromia Region
- Produced lessons learned from pilot PPP sites that will inform the national expansion of PPP
- Exceeded targets for PPP DOTS case notification: PPP DOTS, operating in 11 private for-profit clinics in Addis Ababa,
accounted for 14 percent of regional TB case notification
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
Partnerships are one of the most important elements in combating TB in Ethiopia. Through TB CAP, USAID collaborates with
eight partners to implement WHO’s Stop TB Strategy. Management Sciences for Health, a member of the TB CAP consortium, is
strengthening TB microscopic diagnostic capacity in 80 health centers, six hospitals, and three regional labs. WHO and Italy’s
University of Brescia are supporting laboratory skills training. The Dutch Government is providing funds for TB drugs, while the
German Leprosy and Tuberculosis Relief Association is funding overall program support. USAID also partners with Abt
Associates and IntraHealth for TB and TB-HIV/AIDS interventions in the private sector and John Snow, Inc./DELIVER for drug
logistics. The Global Fund approved around $27.0 million in Round 1 funding in 2003 and $11.8 million in Round 6 funding in
2007 for TB activities in Ethiopia.
1 TB CAP data 2008
May 2009
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