Mozambique
Mozambique ranks 19th on the list 22 high-burden tuberculosis (TB) countries in the
world. According to the World Health Organization’s (WHO’s) Global TB Report
2009, there were more than 92,000 estimated new TB cases in Mozambique in 2007,
with a sputum smear-positive (SS+) incidence rate of 174 cases per 100,000 population.
The number of TB cases in Mozambique is likely to increase further over the next few
years due to HIV/AIDS. The TB-HIV co-infection rate is high, with an estimated 47.3
percent of new TB patients testing HIV positive. Multidrug-resistant (MDR) TB, largely
caused by non-adherence to drug regimens or inappropriate drug regimens, is further
exacerbating Mozambique’s TB epidemic. In 2007, there were an estimated 1,464
cases of MDR-TB. Extensively drug-resistant TB was also confirmed in Mozambique in
September 2007.
Health services for TB control and prevention in Mozambique are inadequate in terms
of coverage, access, and quality of care, mainly due to the lack of infrastructure and a
shortage of human resources. While all districts are implementing DOTS (the
internationally recommended strategy for TB control), access to primary health care is
still limited, and only 40 percent of the population have access to DOTS. This results
in low case detection rates and high death rates among patients in treatment. TB and
HIV/AIDS are among the government’s health priorities and collaborative TB-HIV/AIDS
activities are now in place throughout the country. The government launched the
National TB and Leprosy Program (NTLP) in 1977, and by 2003, the NTLP had
developed a comprehensive plan for expanding the use of DOTS.
USAID Approach and Key Activities
USAID support for the NTLP began in 2001. USAID funding for TB activities in
Mozambique totaled $3.0 million in fiscal year (FY) 2008. With rising
co-infection rates, the increased support will help strengthen TB-HIV/AIDS
collaborative activities. USAID provides support to the KNCV Tuberculosis
Foundation, which manages the Tuberculosis Control Assistance Program (TB CAP).
TB CAP activities are closely coordinated with the NTLP, the National HIV/AIDS
Program, and nongovernmental organizations. The main components of the USAID
program are TB-HIV/AIDS collaborative activities, community-based DOTS (C-DOTS)
expansion, and laboratory strengthening. Activities include the following:
USAID Approach and Key Activities
USAID support for the NTLP began in 2001. USAID funding for TB activities in
Mozambique totaled $3.0 million in fiscal year (FY) 2008. With rising
co-infection rates, the increased support will help strengthen TB-HIV/AIDS
collaborative activities. USAID provides support to the KNCV Tuberculosis
Foundation, which manages the Tuberculosis Control Assistance Program (TB CAP).
TB CAP activities are closely coordinated with the NTLP, the National HIV/AIDS
Program, and nongovernmental organizations. The main components of the USAID
program are TB-HIV/AIDS collaborative activities, community-based DOTS (C-DOTS)
expansion, and laboratory strengthening. Activities include the following:
- Expanding quality DOTS by increasing awareness of TB among health workers
and improving diagnosis
- Organizing and conducting stakeholder meetings and workshops and
developing guidelines for C-DOTS
- Increasing community involvement and awareness of TB
- Improving laboratory systems with activities such as supply and specimen
management and strengthening the microscopy network for improved
diagnostic services
- Training staff, updating equipment, and establishing quality assurance
guidelines at the National Reference Laboratory
- Strengthening HIV counseling and testing in TB patients and TB testing in
HIV/AIDS patients
- Improving collaboration between TB and HIV/AIDS programs at the provincial
and district levels
- Improving TB drug resistance surveillance and support systems for the
treatment of drug-resistant TB
- Strengthening and improving the management capacity of the NTLP and supporting NTLP monitoring and evaluation
activities at the central and provincial levels
USAID Program Achievements
USAID’s assistance has contributed substantially to the prevention and control of TB. In FY 2007, TB CAP supported the
successful implementation of CB-DOTS in three provinces. With full support from the Ministry of Health, C-DOTS will be
expanded in these provinces and to two additional priority provinces. Other program achievements include the following:
- Increased DOTS coverage by 82 percent in six selected targeted districts in FY 2007
- Expanded C-DOTS, resulting in close to 1,000 volunteers in targeted districts referring approximately 5,000 TB suspects
to the health centers for clinical examination and diagnosis in FY 2007
- Created the National TB-HIV Task Force and revised and updated the national TB and TB-HIV guidelines
- Provided technical assistance in the development of the National Strategic Plan for TB, 2008–2012 as well as in the
development of the TB component of the Round 7 proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria
- Developed the Community Based DOTS National strategy, including training modules and TB-HIV leaflets for people
living with AIDS, TB patients, and health workers
- Supported the development of referral systems for suspected TB and co-infected TB-HIV/AIDS cases
- Supported supervision at all levels and developed Standard Operational Procedures for laboratories
- Distributed 25 microscopes for sputum smear examination and developed a training curricula to train nurses in sputum
fixation
- Strengthened the National TB Reference Laboratory capacity in Maputo with in-service training for laboratory staff on
bio-safety and quality assurance
- Supported the national TB meeting and provincial TB meetings, and supported the national meeting on infection control
in December 2008
- Developed the construction specifications and project documents for Beira laboratory renovation and refurbishment to
decentralize TB culture and drug-sensitivity testing to the central region
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 Mozambique. USAID-funded TB CAP is implemented by
the Tuberculosis Coalition for Technical Assistance and led by the KNCV Tuberculosis Foundation. Other partners in TB CAP
include WHO, the U.S. CDC, Management Sciences for Health, and Family Health International. USAID also works closely with
partners from the U.S. President’s Emergency Plan for AIDS Relief to implement TB-HIV/AIDS activities. In 2004, the Global Fund
awarded Mozambique $14.2 million in Round 2 for DOTS expansion. In 2007, Mozambique received $21 million in Round 7 to
strengthen the NTLP at all levels.
May 2009
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