Zimbabwe
Tuberculosis (TB) is a major public heath problem in Zimbabwe. Zimbabwe is ranked
17th on the list of 22 high-burden TB countries in the world. According to the World
Health Organization’s (WHO’s) Global Tuberculosis Control Report 2009, Zimbabwe had
an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539
cases per 100,000 population. The number of new reported TB cases in Zimbabwe
declined 2.6 percent between 2006 and 2007. However, the DOTS (the internationally
recommended strategy for TB control) case detection rate declined from 46 percent in
2002 to 27 percent in 2007. The treatment success rate also declined from 71 percent
in 2001 to 60 percent in 2006. These declines reflect the deteriorating sociopolitical
context, which has a direct impact on health service delivery in Zimbabwe.
Zimbabwe has the second highest TB mortality rate in the world. The
TB-HIV/AIDS co-infection rate is high. According to WHO, nearly 69 percent of new
adult TB patients tested HIV positive. National data suggest the actual estimate is
slightly higher, around 80 percent, and there is increasing HIV surveillance in TB
patients. Multidrug-resistant (MDR) TB remains low, and extensively drug-resistant
(XDR) TB has not been found; however, they are still threats because neighboring
countries have higher levels of MDR-TB as well as XDR-TB.
Health services for TB control and prevention in Zimbabwe are inadequate in terms of
coverage, access, and quality of care, mainly due to the lack of infrastructure and
limited human capacity. The National TB Control Program (NTCP), which is part of
one HIV/AIDS/STI and TB unit, has a manager and a national TB coordinator. Recently,
the NTCP, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria,
gained new staff. The NTCP does have a policy of testing TB patients for HIV and
providing antiretroviral treatment and counseling to HIV-positive patients, yet no data
are available on the number of patients tested or treated.
USAID’s Approach and Key Activities
USAID support for TB control in Zimbabwe began in fiscal year (FY) 2008, with $1.6
million in funding. Through the Tuberculosis Control Assistance Program (TB CAP),
USAID will be working closely with the Ministry of Health and Child Welfare
(MOHCW), WHO’s National and Regional Offices, and the U.S. CDC to provide
technical assistance at the central level and to promote the implementation of
expanded DOTS for TB and TB-HIV/AIDS collaborative activities. USAID has built a
strong foundation of successful HIV/AIDS activities and will be building its TB activities
in coordination with these successful programs and partners to implement TBHIV/
AIDS activities. While strengthening central-level management and technical skills,
USAID’s plan will expand TB activities from one province level to the others in a
phased manner. USAID’s three-year plan for TB assistance supports the following
activities and interventions:
- Supporting DOTS expansion through management training for central-level
senior staff as well as provincial-level staff
- Determining where technical gaps in human resources are and training
personnel in a targeted manner
- Promoting the use of guidelines developed by the WHO and the International
Union Against Tuberculosis and Lung Disease (The Union) for TB diagnosis
and treatment in order to standardize treatment
- Ensuring adequate and appropriate district- and provincial-level TB and TBHIV/
AIDS service delivery
- Supporting achievement of TB targets and indicators at the provincial and district levels
• Improving case detection by increasing diagnostic capacity and encouraging active case finding at the community level
- Decreasing the risk for MDR-TB and XDR-TB through an enhanced DOTS package of services
- Supporting basic infection control measures in clinics, where service delivery takes place, as well as in laboratories that
handle sputum specimens
- Improving provincial managerial, logistics, and information systems for TB and TB-HIV/AIDS and increasing availability of
drugs for the treatment of TB
- Implementing TB-HIV/AIDS collaborative activities to combat high co-infection rates by increasing TB screening of HIVpositive
patients, allowing for earlier detection and initiation of treatment, and improving coordination of TB and HIV
referral systems
- Supporting the development of a national advocacy, communication, social mobilization strategy
USAID Program Achievements
As this is the first year of USAID support for TB control and prevention activities, future reports will document achievements.
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 Zimbabwe. TB CAP and one of its partners, The Union,
will collaborate with others to strengthen TB control in the country. The Union has been working in Zimbabwe on integrated
HIV care for people living with HIV/AIDS and TB. The other partners include John Snow Inc. and Population Services
International. The WHO is supporting DOTS expansion and enhancement, TB-HIV/AIDS integration, MDR-TB and XDR-TB
surveillance, and is building the capacities of laboratories. The U.S. CDC has worked with the MOHCW, focusing on laboratory
strengthening. The U.K. Department for International Development is assisting in procurement of commodities and TB drugs.
The European Union and European Commission are supporting development of logistics systems and human resource
development. In December 2006, the Global Fund approved a $9.2 million grant to the Zimbabwe Association of Church-Related
Hospitals for strengthening program management and laboratory diagnostic capacity, and for improving treatment outcomes and
coordination between TB and HIV/AIDS services. Zimbabwe received a Round 8 grant for $86.8 million for HIV, which will
support TB-HIV/AIDS collaborative activities, increased TB case-finding among people living with HIV/AIDS, and provision of
treatments with cotrimoxazole preventative therapy and antiretroviral therapy for eligible, dually infected patients.
May 2009
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