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DTBE in Mozambique

map of Mozambique

Capital City: Maputo
Area*:799,380 sq km. (496,712 sq. mi.)
Population (est.), 2011*: 22.9 million
Estimated TB Incidence, 2010**: 544/100,000
Estimated TB Prevalence, 2010**: 491/100,000
Adult HIV Prevalence Rate, 2009***: 11.5%
Number of people living with HIV (PLHIV), 2009***:1,400,000
Percent of tested TB patients who were HIV+, 2010**: 61%

*Source: www.state.gov
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010

Background

Mozambique has one of the highest HIV prevalence rates in the world and is among the 22 high-burden tuberculosis (TB) countries, with growing TB drug resistance.  Most patients with TB in Mozambique also have HIV, making TB more difficult to diagnose and treat.  The Centers for Disease Control and Prevention’s Division of TB Elimination (CDC/DTBE) has been providing direct technical assistance to the national TB program and supporting program activities in Mozambique for nearly 10 years, focusing on integration of TB/HIV services, strengthening of surveillance systems, and diagnosis and treatment of drug-resistant TB.

Recent Accomplishments & Ongoing Collaborations

Program Strengthening and Epidemiology

TB Program Review:  In 2011, the government of Mozambique requested an external mid-term program review of the Mozambique TB Control Program Strategic Plan.  The World Health Organization (WHO) led this review in which many CDC/DTBE and U.S. Agency for International Development (USAID) TB experts participated.  This review informed the program of strengths and weaknesses in all program areas, and provided concrete action steps and recommendations for improvement. 

Laboratory Strengthening:  CDC/DTBE has been collaborating with CDC/Global AIDS Program (GAP)-Mozambique, United States Government partners, and the government of Mozambique to improve the quality assurance and quality management systems at the two functioning regional reference laboratories for monitoring culture and drug-susceptibility testing. 

Multidrug-Resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations

Pediatric TB Contact Tracing:  Available diagnostic methods often miss TB in children.  Most common tests (smear microscopy) are also not very good at diagnosing TB among people with HIV.  Children with HIV are at much higher risk of developing TB disease but are the most difficult patients to diagnose.   In March 2008, CDC/DTBE and CDC/GAP-Mozambique worked with the national TB program to conduct a study to describe the current burden of TB infection and disease among children living with HIV, and develop simple tools to screen for TB among children and treat children with TB infection with isoniazid preventive therapy (IPT) to prevent TB disease.

Strengthening MDR TB Management: CDC/DTBE is working with the National TB Program to strengthen the MDR TB program by streamlining recording and reporting systems, assisting the revision of guidelines and standardized forms, facilitating access to second-line drugs, and training clinicians on MDR TB management. 

Assessment of Diagnosis and Treatment of MDR TB: In 2012, CDC/DTBE is conducting a study with in-country partners to describe the management of MDR TB in Mozambique from 2007-2010, including burden of MDR TB and patient treatment outcomes.  This study aims also to identify barriers to accurate diagnosis, referral, treatment completion, and recording and reporting to inform improved management practices.

 
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