DTBE in Peru
Capital City: Lima
Area*:1,280,000 sq. km. (496,225 sq. mi.)
Population (est.), 2011*: 29.8 million (30% in Lima/Callao metro)
Estimated TB Incidence, 2010**: 106/100,000
Estimated TB Prevalence, 2010**: 118/100,000
Adult HIV Prevalence Rate, 2009***: <0.1%
Number of people living with HIV (PLHIV), 2009***:75,000
Percent of tested TB patients who were HIV+, 2010**: 9%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
The Centers for Disease Control and Prevention’s Division of TB Elimination (CDC/DTBE) collaborates with U.S. Agency for International Development (USAID) and Peru’s National Tuberculosis Program (NTP) and Ministry of Health to address TB control and prevention. CDC/DTBE’s technical assistance includes: conducting operations research (OR) trainings, improving Multidrug-resistant TB (MDR TB) control, implementing infection control (IC) activities and providing communication and educational materials about MDR TB. Since 2009, CDC/DTBE has had a regional TB technical advisor (Medical Officer) providing assistance to Latin America.
CDC/DTBE serves as an implementing partner of the South American Infectious Disease Initiative (SAIDI). SAIDI is a U.S. Agency for International Development/Latin American and the Caribbean (LAC) initiated sub regional strategy for Ecuador, Bolivia, Peru and Paraguay. CDC/DTBE is thus responsible for designing, implementing, and evaluating capacity building and human resource training in the region.
Recent Accomplishments & Ongoing Collaborations
Program Strengthening and Epidemiology
TB IC Trainings: CDC/DTBE has been conducting IC trainings in Peru since 2005. In 2007, CDC/DTBE partnered with SAIDI to solicit and select proposals for TB IC plans and building modifications for implementation in Peru. In 2010, after years of supported training, three trainees became TB IC experts and now provide technical assistance in the Americas. In 2011, the selected IC control proposals were put into action, funded by the NTP, and jointly monitored by Peruvian experts and CDC/DTBE.
Laboratory Strengthening: CDC/DTBE built two district mycobacteriology reference laboratories and installed equipment needed for TB culture and drug susceptibility testing. The National Reference Laboratory received equipment and support for conducting rapid culture and rapid second-line drug resistance testing. CDC/DTBE and partners also streamlined specimen transportation from health centers to reference laboratories, reducing time from specimen processing to reporting results.
Multidrug-Resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations
MDR TB Training Modules: Since 2000, Peru has served as a nexus for the development of evidence-based practices and policies on drug-resistant TB, including its participation on the Stop TB Partnership Green Light Committee. In 2003, nine training modules were developed on diagnosis, treatment, and case management of MDR TB.The content from the modules has been synchronized with the new World Health Organization (WHO) recording and reporting system, and will ultimately be adapted for a broader Latin American audience. CDC/DTBE has also designed and produced communication and educational materials about MDR TB.
Preserving Effective TB Treatment Study (PETTS): In collaboration with the Ministry of Health (MOH) and local partners in nine countries (including Peru), CDC/DTBE spearheaded the Preserving Effective TB Treatment Study (PETTS). PETTS, a large multi-year, multi-country study compared programs approved by the Green Light Committee (GLC) to programs that were not GLC approved; this was done to determine the incidence and consequences of acquired resistance to second-line drugs (SLD) among MDR TB patients. Preliminary results suggest that acquired resistance to these drugs was lower in GLC approved programs. GLC approved projects also demonstrated higher cure rates, lower mortality, and lower treatment failure rates when compared with non-GLC approved projects. PETTS has informed the new framework for WHO and international partners that support countries in achieving universal access to the diagnosis, treatment, and care of MDR TB.
Rapid Diagnosis of Drug-Resistant TB: CDC/DTBE is partnering with Harvard/Partners in Health (PIH), Socios en Salud, the MOH, the National TB Reference Laboratory, and two district reference laboratories to assess the costs and impact of rapid drug susceptibility testing (DST) in terms of a quicker treatment response among patients with MDR TB. The study will compare the time to culture conversion among patients with MDR TB receiving therapy based on rapid methods of DST compared with those receiving therapy based on conventional DST. Demonstrating clinical impact from the application of rapid diagnostic methods will aid in setting a standard of care for using rapid DST in MDR TB treatment programs in both resource-poor and resource-endowed settings. Analysis is complete and publications on this study will be released in late 2012.