Dominican Republic
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According to the World Health Organization’s (WHO’s) Global TB Report 2009, the
Dominican Republic had an estimated 6,764 tuberculosis (TB) cases in 2007, with an
estimated incidence rate of 69 cases per 100,000 population. Between 2003 and 2005,
the case detection rate for sputum smear-positive (SS+) cases increased from 63 to 73
percent per 100,000 population, above the WHO global target of 70 percent, but it fell
to 66 percent in 2007. The National TB Control Program (NTCP) began implementing
DOTS (the internationally recommended strategy for TB control) in 1998, and has
recently made progress in expanding it throughout the country. By the end of 2007,
DOTS coverage reached 85 percent of the population compared with 40 percent in
2002, and DOTS coverage is available at more than 900 service points. The Dominican
Republic has one of the highest rates of TB drug resistance in the Western Hemisphere
and multidrug-resistant (MDR)-TB has remained a persistent challenge to TB control
over time. The prevalence of MDR-TB may have fallen according to preliminary results
of a recent drug resistance survey. A survey conducted in 1995 reported a prevalence
of 8.2 percent while a survey in 2008 reported 6.3 percent.1 However, further analysis
will be performed in the near future to determine whether these are new or previously
treated cases. WHO estimates 6.6 percent of all new TB cases were MDR-TB in 2007.
The Dominican Republic also has a serious HIV/AIDS problem, with an adult HIV
seroprevalence rate of 1.1 percent. In 2007, an estimated 15.2 percent of new TB
patients had HIV/AIDS. As access to counseling and testing services for HIV/AIDS
increases and better data become available, the detection rate of TB-HIV/AIDS coinfection
will likely increase.
USAID Approach and Key Activities
USAID assistance to the Dominican Republic’s NTCP began in 2001. In fiscal year
2008, USAID provided $1.3 million for TB programs. In coordination with the Pan
American Health Organization (PAHO) and the NTCP, USAID is supporting DOTS
programs in seven provinces and expanding services to five more provinces. USAID’s
program focuses on strengthening DOTS through decentralization and better
integration into primary health care services and by improving the diagnosis and
treatment for MDR-TB, increasing coordination of TB-HIV/AIDS activities, and
expanding private sector involvement in TB control. USAID assistance includes
support for the following activities:
- Increasing political commitment for DOTS implementation using evidencebased
approaches
- Increasing public and private sector participation in DOTS implementation
- Increasing and strengthening TB and HIV/AIDS coordinated and collaborative
activities
- Performing external evaluations of the NTCP
- Training health personnel, including doctors, nurses, laboratory
technicians, and health promoters, in the DOTS approach
- Developing community education and social mobilization strategies
- Expanding MDR-TB services to reduce the number of patients not yet on
treatment
- Further integrating DOTS into primary care
USAID Program Achievements
USAID’s assistance has contributed to improvement in human resources and infrastructure through the following activities:
- Reached the WHO target of 85 percent for treatment success rate for the 2005 cohort
- Implemented a pharmaceutical procurement and logistics system that resulted in saving the NTCP an estimated $800,000
per year
- Supported the annual external and internal evaluations of all the TB program components of the NTCP and provided the
Ministry of Health with recommendations for program improvement
- Supported treatment for MDR-TB in two public hospitals in coordination with the Global Fund to Fight AIDS,
Tuberculosis and Malaria
• Strengthened quality control and laboratory services in order to process cultures for a TB network of eight regional labs
and approximately 164 provincial and local laboratories
- Developed a national manual for recording and reporting systems that has innovative components on identification of
suspected TB cases, TB-HIV/AIDS collaboration, and contact tracing
- Established drug resistance surveillance systems
- Conducted courses on quality control for 72 laboratory specialists, enabling the introduction of quality control into the
laboratory network
- Supported nine nongovernmental organizations to provide social mobilization support for the NTCP in 145 communities
and 80 towns and trained more than 220 health providers, 233 community organizations, and 1,443 community
volunteers on TB control
- Participated in a strong collaborative effort among partners, resulting in a coordinated program implementation
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 partners in TB control in the Dominican Republic include the NTCP, the PAHO, the Tuberculosis Coalition for Technical
Assistance, the Royal Netherlands Tuberculosis Association, PROFAMILIA, and Management Sciences for Health’s Rational
Pharmaceutical Management Plus Program. The Global Fund approved $4.6 million in Round 3 funding and $10.3 million in Round
7 funding for TB control in the Dominican Republic.
1 Survey results reported by USAID/Dominican Republic
June 2009
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