Zambia
|
| |
Tuberculosis (TB) continues to be a major health threat in Zambia and is ranked among
the 10 top causes of morbidity and mortality. Zambia has one of the highest incidence
rates of TB per capita in the world. The sputum-smear positive (SS+) case notification
rate in Zambia is 193 cases per 100,000 population, more than three times the global
average of 61 cases per 100,000 population. It also has the 10th highest incidence rate in
the world. With strong government commitment and an assured supply of anti-TB
drugs through the Global TB Drug Facility, Zambia has achieved 100 percent DOTS
(the internationally recommended strategy for TB control) coverage and about 74
percent case detection for all forms of TB. The treatment success rate has also
continued to rise since 2003 and is at the World Health Organization (WHO) target of
85 percent. Unfortunately, the TB-HIV/AIDS co-infection rate is high in the country,
and HIV is a major contributor to increasing numbers of TB cases. The DOTS case
detection of SS+ TB was only 58 percent in 2007, still below WHO’s target of 70
percent.
Zambia’s National TB Strategic Plan for 2006–2010 identified the treatment of TB as a
specific objective for the reduction of the socioeconomic impact of HIV/AIDS in the
country. Seventy percent of all new TB patients in Zambia are co-infected with HIV,
and Zambia has the seventh highest rate for prevalence of co-infection rate in the
world. The estimated HIV prevalence rate of 14.3 percent in the adult population has
made TB treatment difficult and has strained already limited financial and human
resources.1 Multidrug-resistant (MDR) TB seems to be a minor problem so far, as
there were an estimated 577 new MDR-TB among SS+ cases, although only 26 cases
were confirmed in 2007. , As of March 2009, there are no reports of extensively drugresistant
(XDR) TB. However, the upsurge of MDR-TB and XDR-TB in the sub-
Saharan African region and the lack of compliance to treatment by 3 percent of the TB
patients on treatment may lead to a higher incidence of drug-resistant TB.2
USAID Approach and Key Activities
The USAID TB program in Zambia began in fiscal year (FY) 2005, with a budget of $1
million, which supported the initial assessment of Zambia’s National TB Control
Program (NTCP). In FY 2008, USAID funding for TB programs was $3.1 million, and
USAID has continued to support the NTCP in the implementation of the National TB
Strategic Plan. USAID, through the Tuberculosis Control Assistance Program (TB
CAP), currently supports TB control activities in Northern, Central, Copperbelt,
North-Western, and Luapula provinces, covering five of the nine Zambian provinces. In
line with the Stop TB Strategy, the National Health Strategic Plan, and the National TB
Strategic Plan, TB CAP aims to ensure that these provinces meet global targets for case
detection and treatment success rates. USAID supports activities in the following
areas:
- Strengthening and expanding quality DOTS services through improved
laboratory case detection and treatment, and monitoring and evaluation of
DOTS programs
- Standardizing case management training of health care workers with WHOapproved
training manuals, supporting supervision, and revising manuals and
guidelines
- Improving collaboration between TB and HIV/AIDS programs at the provincial and district levels
- Expanding laboratory external quality assurance (EQA) activities to strengthen the laboratory system and identify and
support laboratory needs
- Supporting the Ministry of Health (MOH) to achieve optimal community participation in TB control
- Increasing community mobilization and involvement in TB and TB-HIV/AIDS care and developing information, education,
and communication activities and materials for TB and TB-HIV/AIDS
- Expanding the involvement of all providers in TB control to include TB-HIV/AIDS in workplace programs and publicprivate
mix DOTS
- Developing policies and guidelines for managing MDR-TB, building capacity to conduct drug susceptibility testing, and
conducting drug resistance surveys to find out the actual burden of MDR-TB
USAID Program Achievements
Through TB CAP, USAID has made the following contributions to TB control:
- Trained 314 health care workers in various TB control concepts, including provider-initiated HIV counseling and testing
and community-based TB support concepts
- Trained and employed seven microscopists for Luapula province and eight microscopists for North-Western province
(areas most in need of laboratory support), which contributed to improvements in the percentage of correct diagnoses
of SS+ TB in Luapula province (an increase from 81.2 percent in 2007 to 98 percent in 2008) and in North-Western
province (an increase from 73.5 percent in 2007 to 92 percent in 2008)
- Procured laboratory supplies and supported laboratory personnel to increase laboratory capacity, aiding in 94 percent of
U.S. Government (USG)-supported laboratories were able to report correct results for TB microscopy more than 95
percent of the time in FY 2008
- Supported EQA visits conducted by the provincial laboratory staff to identify and support laboratory needs
- Provided technical and financial support for TB-HIV/AIDS activities, enabling 45 percent of all TB patients in the USGsupported
treatment centers to be tested for HIV
- In collaboration with other USG partners, trained an additional 4,681 health care workers in TB-HIV/AIDS and procured
needed commodities, such as protective equipment, microscopes, and laboratory reagents
Case Detection and Treatment Success Rates Under DOTS
 |
Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
USAID support to the NTCP is provided through TB CAP, under the direction of the KNCV Tuberculosis Foundation. TB
CAP partners include the Japan Anti-Tuberculosis Association, Family Health International, WHO, and Management Sciences
for Health. Other partners include CARE and JHPIEGO. The U.S. CDC provides support with laboratory capacity building.
The Global Fund to Fight AIDS, Tuberculosis and Malaria awarded three principal recipients (the MOH, the Church Health
Association of Zambia, and Zambia National AIDS Network) a total of $47.3 million in 2003 in Round 1 and $3.9 million in
2008 in Round 7 to implement TB control activities.
1 Preliminary 2007 Demographic and Health Survey
2 USAID data on default rate
May 2009
Related Links
|
