Namibia
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In 2007, Namibia’s estimated tuberculosis (TB) incidence rate of 767 cases per 100,000 population was the fourth highest in Africa, and more than twice the African regional average. The TB prevalence of 532 cases per 100,000 population and TB mortality of 102 cases per 100,000 population are also above average for the region. About 67 percent of newly registered TB patients are HIV positive. The case notification rate has averaged around 736 cases per 100,000 population for the last five years, nearly eight times higher than the rate in 1996 (and 10 times higher than the global average), an increase fueled by the spread of HIV/AIDS. According to UNAIDS, Namibia’s HIV prevalence is 15.6 percent, and this high prevalence poses serious problems for the successful treatment of TB.1 Multidrug-resistant (MDR) TB is prevalent in 1.6 percent of new cases. Extensively-drug resistant (XDR) TB has also been found in Namibia. Since 1996, Namibia has sustained DOTS (the internationally recommended strategy for TB control), achieving a case detection rate above the global target of 84 percent. The DOTS treatment success rate continues to improve, but at 76 percent, it is still below the global target of 85 percent.
The National TB Control Program (NTCP) was established in 1991. Until 2002, the national government provided the sole support for the program. From 2002 onwards, the KNCV Tuberculosis Foundation provided external technical assistance (TA), and since 2005, expanded support from one full-time staff to three resident technical staff. Although there have been impressive gains in TB control and prevention, much remains to be done to expand access to DOTS programs and improve the treatment success rate of new patients. Sustained support to improve management of patients with drug-resistant TB using second-line TB drugs is also still needed.
USAID Approach and Key Activities
USAID launched its program for TB control and surveillance in Namibia in 2005, expanding since then and providing $1.9 million in fiscal year (FY) 2008. USAID supports the NTCP and the Ministry of Health and Social Services (MOHSS) with TA through the Tuberculosis Control Assistance Program, which is managed by the KNCV Tuberculosis Foundation. By strengthening the capacity of the NTCP, USAID efforts will enable Namibia to improve the management of drug-resistant TB patients and TBHIV/AIDS patients, and expand community-based DOTS (C-DOTS) into other regions. USAID assistance includes support for the following activities:
- Strengthening management capacity of the NTCP
- Expanding C-DOTS in target zones
- Increasing the knowledge and skills of clinicians and nurses for basic TB control, diagnosis, and treatment for MDR-TB and TB-HIVAIDS
- Improving management and coordination among TB and HIV/AIDS partners in prevention, care, and support, including drug supply management for dually infected individuals
- Developing infection control (IC) measures for TB and MDR-TB in health facilities and training health workers on IC guidelines
- Developing and implementing sector-specific TB control strategies
- Improving community knowledge, attitudes, and practices on TB and TB-HIV
- Supporting the establishment of a formal MOHSS/private sector collaboration and engaging private sector professionals in the NTCP technical guidelines and the International Standards for Tuberculosis Care, including on MDR-TB and XDR-TB
USAID Program Achievements
USAID’s assistance and support have helped address TB prevention and control through the following activities:
- Trained 98 health care providers in the National TB Control Guidelines in their respective regions in FY 2007
- Trained and mobilized 323 nurses to become part of a future cadre of trainers on decentralized detection, management, and treatment of TB in FY 2007
- Coordinated with the International Union Against Tuberculosis and Lung Disease to train the first-ever cadre of health care providers in Namibia on clinical management of MDR-TB and continued to support staff training on MDR-TB
- Ensured follow-up on training through quarterly performance review meetings, support, and on-site supervision of 100 health care providers across the country in FY 2007
- Provided palliative care and TB treatment and care to 14,300 HIV-infected individuals, trained 1,500 individuals to provide TB palliative care, and supported 300 service outlets
- Introduced a monitoring and evaluation system that captures TB-HIV/AIDS data in all reporting health facilities in Namibia
- Supported the development of a MDR-TB survey, in collaboration with staff from the National Institute of Pathology, MOHSS, and U.S. Government (USG) partners
- Assisted the NTCP with its application to the Green Light Committee and supported 340 patients on second-line drugs
- Facilitated the monitoring of 21 XDR-TB patients by a clinical review committee
- Introduced, expanded, and improved the performance of C-DOTS
- Provided training to clinicians and nurses on IC and improved facilities to accommodate IC guidelines
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
USAID’s partners in helping Namibia implement DOTS include the national government, the KNCV Tuberculosis Foundation, the Tuberculosis Coalition for Technical Assistance, the U.S. CDC, and other USG partners. Namibia received funding for TB activities from the Global Fund to Fight AIDS, Tuberculosis and Malaria in Round 2 for $1.5 million and in Round 5 Phase One for $7.2 million and Phase Two for $9.9 million.
1 Epidemiological Fact Sheet on HIV and AIDS. UNAIDS, September 2008
May 2009
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