Regional Development Mission for Asia
The USAID Regional Development Mission for Asia (RDMA) manages regional
programs that benefit all of East Asia and much of South Asia and the Pacific. RDMA
supports tuberculosis (TB) activities in nine high-burden countries (HBCs) (Bangladesh,
Burma, Cambodia, China, India, Indonesia, Philippines, Thailand, and Vietnam) but
focuses particularly on five countries in the Greater Mekong subregion: Burma, China,
Laos, Thailand, and Vietnam.
Together, the five focus countries accounted for 17.7 percent of the global total new
TB cases in 2007, with 14.1 percent in China alone. There were almost 1.64 million
estimated new sputum smear positive TB cases in 2007 and an estimated 242,600 deaths
in these countries, despite tremendous progress in the implementation of the DOTS
(the internationally recommended strategy for TB control) strategy. All five countries
have achieved global targets for case detection (70 percent) and three of the five have
met the target for treatment success rate (85 percent), except for Thailand and Burma
(see chart at left).
The presence of multidrug-resistant (MDR) TB in the focus countries ranges from 1.7
percent in Laos to 5.0 percent in China. In 2007, these five countries accounted for
24.7 percent of the new MDR-TB cases globally, 89 percent of which occurred in
China. Extensively drug-resistant (XDR) TB has been confirmed in China (Hong Kong),
Vietnam, and Thailand. Treatment of MDR-TB is limited throughout the region. For
example, in China, only 388 cases of the 112,348 cases were expected to be treated in
2008, or about 0.3 percent of MDR-TB patients.1 Challenges to TB control include a
lack of quality assured laboratories for culture and drug susceptibility testing (DST),
which are essential for diagnosis and treatment of MDR-TB. The lack of laboratory
capabilities also hinders efforts to conduct surveillance for drug resistance in the
region. Expanding laboratory capacity for DST for both first- and second-line drugs in
the region and training more staff are urgent priorities in most countries.
USAID Approach and Key Activities
USAID/Asia’s TB goal is to contribute significantly to the regional reduction of
morbidity and mortality associated with TB. The approach to achieve this goal lies in
six key strategic areas: expanding and enhancing DOTS, increasing access to highquality
and affordable medications, improving management of MDR-TB and XDR-TB,
addressing the TB-HIV/AIDS “syndemic,” developing new tools and approaches, and
strengthening information systems and data use. USAID funding to RDMA for TB
programs was $5.8 million in fiscal year 2008. USAID works in partnership with the
World Health Organization (WHO), U.S. CDC, Management Sciences for Health,
United States Pharmacopeia (USP), and Population Services International to implement
strategic priority interventions in the following ways:
- Supporting laboratory quality assurance in HBCs
- Expanding culture and DST services in areas with high MDR-TB and TB-HIV
co-infection
- Involving private health providers in DOTS scale up
- Increasing availability of high-quality drugs for the treatment of TB
- Strengthening collaboration between TB and HIV national programs
- Supporting operational research studies to develop new tools
and approaches
- Providing technical assistance (TA) to strengthen pharmaceutical management of TB drugs to reduce stockouts (absence
of drugs) at facilities and expanding drug management training
- Supporting the establishment of a Model Center focused on MDR-TB and XDR-TB for the training of national and
nongovernmental TB staff from the Asia region
- Providing TA for development and implementation of MDR-TB program strategies, including expanding public-private
partnerships for TB control and implementing funds from the Global Fund to Fight AIDS, Tuberculosis and Malaria
- Supporting supranational reference laboratories in Thailand and India to provide external quality assurance activities and
TA for TB laboratories throughout Asia
- Collecting population-based TB data to strengthen national programs’ capacities to analyze the data and use them for
priority setting, decision-making, and planning purposes
USAID Program Achievements
USAID support has contributed to the following achievements:
- Sustained case detection rate at 78 percent and treatment success at 91 percent, both above WHO’s targets in the
WHO Western Pacific Region, making it the first and only WHO Region to have achieved the global TB control targets
- Engaged a wide range of health providers in TB control and strengthened capacities of countries to develop locally based
advocacy, communications, and social mobilization strategies
- Established the Thailand TB Active Surveillance Network, which has strengthened capacity for mycobacterial culture,
identification, and DST throughout the region
- Developed a new algorithm, which will be incorporated into regional and global WHO guidelines, using a combination of
symptoms to identify about 90 percent of HIV-infected patients with TB
- Strengthened collaboration between national TB and HIV/AIDS programs by finalizing regional-specific TB and HIV
training modules, conducting situational analysis of ongoing TB-HIV activities in five countries, and providing technical
support for TB-HIV program implementation to four countries.
- Assisted with revising the regional TB-HIV Framework, which will guide countries on accelerating implementation of TBHIV
collaborative activities
- Assisted the National TB Control Programs of Cambodia, Mongolia, and Vietnam in reviewing public-private mix (PPM)
DOTS pilot projects and expanded the PPM-DOTS approach based on lessons learned from the Philippines
- Introduced and disseminated the International Standards for Tuberculosis Care
- Provided TA with the establishment of Green Light Committee-approved MDR-TB management in Vietnam, Mongolia,
the Philippines, and Cambodia and supported Samoa and Federated States of Micronesia for fast-track application
approval
- Promoted rational medicine use by training 198 participants in the Drug and Therapeutics Committee (DTC) training
course to improve the selection and use of medicines and instructed 40 participants in the “Monitoring, Training, and
Planning” methodology that assists in the implementation of DTC-related activities
- Provided laboratory infrastructure and training and strengthened capacity for TB diagnosis and DST in Thailand, which
enabled the performing of TB cultures on 3,226 patients and the diagnosing of 83 patients with MDR-TB
- Tested 85 percent of registered TB patients in U.S. Government-supported programs for HIV, surpassing the target of
80 percent
- Provided assistance to four national TB prevalence surveys in the Philippines, Cambodia, Vietnam, and Laos; two
operational research studies; and one surveillance activity in Thailand
- Supported the Technical Advisory Group meeting of WHO’s Western Pacific Regional Office, which addressed issues of
MDR-TB, XDR-TB, TB-HIV, and the strengthening of regional laboratory capacity
Partnerships
Host-country governments collaborate with USAID and provide resources for DOTS implementation to various degrees. WHO
and the U.S. CDC are the two primary partners in USAID assistance. Through the USP, USAID is developing the Asian Network
of Excellence in Quality Assurance of Medicines, which provides a permanent regional source of TA for all stakeholders supplying
essential medicines. The supranational reference laboratories in Thailand and India provide laboratory support and coordination
in the region. In China, USAID is also supporting WHO to provide TA to a World Bank TB project and a Bill & Melinda Gates
Foundation TB project. In Rounds 1 through 8, the Global Fund has approved a total of $260 million to the five focus countries
for TB programs.
1 WHO Global Report 2009.
May 2009
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