DTBE in Haiti
Capital City: Port-Au-Prince
Area*: 27,750 sq km. (17,243 sq. mi.)
Population (est.), 2010*:9.8 million
Estimated TB Incidence, 2010**: 230/100,000
Estimated TB Prevalence, 2010**: 314/100,000
Adult HIV Prevalence Rate, 2009***: 1.9%
Number of people living with HIV (PLHIV), 2009***: 120,000
Percent of tested TB patients who were HIV-positive, 2010**: 20%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
Haiti has the highest burden of tuberculosis (TB) in the Americas, however, it is estimated that nearly 40% of people with TB disease remain undiagnosed. There is also concern of growing TB drug resistance, estimated by the World Health Organization (WHO) to consist of 2% of new and 12% of retreatment TB cases. The Centers for Disease Control and Prevention (CDC) has supported TB and HIV activities since 2005 in collaboration with the President’s Emergency Plan for AIDS Relief (PEPFAR). CDC’s Division of Tuberculosis Elimination (DTBE) has been working closely with other international and U.S. government (USG) partners and the national TB program since 2010. The earthquake in January 2010 affected the national TB program, interrupting service and care delivery, damaging laboratories, and disrupting supply chains for needed drugs. In the aftermath of the earthquake, CDC/DTBE has worked with USG partners, the Pan-American Health Organization (PAHO), in-country partners, and non-governmental organizations (NGO) to provide technical support, capacity building activities, and logistical and commodity support. A significant focus of this work is on improving TB case detection and treatment success, and rebuilding and strengthening laboratory systems.
Recent Accomplishments & Ongoing Collaborations
Program Strengthening & Epidemiology
Immediate aftermath of the earthquake:CDC/DTBE staff provided technical support in Haiti on one month rotations for four months following the 2010 earthquake. Since August 2011, a CDC/DTBE TB advisor has been assigned to Haiti to provide in-country technical assistance. CDC supports what are now routine partner meetings among USG, NGO, and government partners that are providing TB services to share activities and jointly plan interventions. CDC/DTBE worked with communities, internally displaced person camps, and clinics to provide educational materials about TB transmission, treatment, and other guidelines. CDC/DTBE also encouraged identification and tracing of suspected or current TB patients to ensure they could be properly diagnosed and started or restarted on treatment.
Laboratory Strengthening: Since 2007, CDC has supported an external quality assurance (EQA) program for microscopy in collaboration with other partners. Recently, CDC worked with the Foundation for Innovative New Diagnostics (FIND) and the American Society for Microbiology (ASM) to purchase light emitting diode (LED) fluorescent microscopes and train laboratory technicians in Haiti on their use in 10 health facilities with the greatest need for diagnostic equipment. These facilities process about one-third of all specimens in the country. WHO is encouraging the use of LED microscopes over conventional microscopes because LED microscopes save laboratory technicians significant time and offer superior accuracy compared to conventional microscopes.
Building Laboratory Capacity: A new TB laboratory opened in October 2011. CDC/DTBE is working with in-country partners to develop procedures for handling TB specimens and reporting results, as well as establishing TB culture and drug susceptibility testing (DST) at the laboratory. Six laboratory technicians have been trained in culture and DST. A permanent Bio Safety Level (BSL) 3 Laboratory will be completed by late 2012.
New Rapid Diagnostics: CDC/DTBE collaborated with many partners in Haiti to coordinate the purchase and rollout of the new rapid diagnostic technology, GeneXpert MTB/RIF. This test allows for the diagnosis of TB in a matter of hours and also identifies resistance to rifampicin, one of the most effective first-line drugs for TB. CDC/DTBE is helping to develop guidelines for use of GeneXpert, including when to use GeneXpert instead of traditional technologies and how to appropriately refer specimens. CDC/DTBE plans to place two GeneXpert machines at the national laboratory and at an NGO-supported TB diagnosis and treatment site.
Multidrug-resistant (MDR) TB, TB/HIV, and Other At-Risk Populations
Drug Resistance Survey: CDC/DTBE is currently helping the ministry of health and other partners to implement routine surveillance for drug resistance in people being retreated for TB and to develop a national drug resistance survey to provide reliable, current data on the level of TB drug resistance in the country.
Development of National Guidelines and Capacity Building: CDC/DTBE is working with in-country partners to begin development of national guidelines for MDR TB care and management and infection control assessments at health facilities. Further guidelines and standards of practice are in development for the use of TB culture and new, rapid diagnostic technology (GeneXpert) for diagnosis of TB. In addition, CDC/DTBE is working to identify partners to assist in clinical and pharmacological consultation, training in management of MDR TB, and providing support and training to regional laboratory staff. CDC/DTBE is working with staff from CDC’s Division of Global HIV/AIDS and others to develop guidelines and tools related to TB infection control.