The tuberculosis (TB) burden in Haiti is significant, with an estimated 29,333 new cases in 2007, representing a TB incidence of 306 cases per 100,000 population. Haiti has the highest per capita TB burden in the Latin America and Caribbean region, and TB is the country’s second leading cause of infectious mortality after HIV/AIDS. The Pan American Health Organization has identified Haiti as one of eight priority countries for TB control in the region.
The World Health Organization’s (WHO) 2009 Global Tuberculosis Control Report indicates that Haiti’s DOTS (the internationally recommended strategy for TB control) case detection rate rose from 37 percent to 49 percent between 2003 and 2007. However, the country falls short of the WHO targets of 70 percent case detection and 85 percent treatment success rates. The DOTS treatment success rate was 82 percent in 2006, a slight increase from 78 percent in 2003. DOTS coverage fell to 70 percent in 2007 compared with 91 percent in 2006, though it was still above the 2005 level of 55 percent.
The Ministry of Health (MOH) has supported the DOTS strategy since 1998 to strengthen the national TB program, the Programme National de Lutte contre la Tuberculose (PNLT). However, the program lacks political and financial support from the government, and there is a lack of skilled technical human resources at the central level of the PNLT. Co-infection with HIV can run as high as 30 percent in some urban areas, and strong stigma and cultural barriers attached to TB interfere with case detection and adherence to treatment. Multidrug-resistant (MDR) TB has increased from 1.4 percent in 2004 to 1.8 percent in 2007.
USAID has provided $1.3 million to Haiti for TB programming in fiscal year 2008. The USAID approach in Haiti complements the priorities of the PNLT, focusing on TB-HIV/AIDS program building within the national DOTS program and establishing links between TB and HIV services to increase case detection and improve treatment completion rates. Through the Santé pour le Développement et la Stabilité d’Haïti Project, USAID provides a continuum of care for co-infected patients based on national norms. Three Haitian non-governmental organizations (NGOs) receive support through this project: International Child Care/Anti-Tuberculosis Crusade (ICC/CAT); Center for Health Development (CDS); and CARE.
USAID assistance includes strengthening TB program leadership, management, and technical capacities at the central level of the PNLT, developing and implementing “DOTS Model Areas” in the capital city to accelerate quality DOTS expansion, building TB-HIV/AIDS testing, referral, and care systems, and ensuring that protocols for TB-HIV/AIDS are fully integrated into HIV training curricula and updating guidelines for infection control. USAID has also fostered alliances with private doctors treating TB patients to provide them with continued training on DOTS protocols, integrated TB screening and prophylaxis into all HIV care services through the different HIV care and treatment networks, and improved laboratory capacity and reinforced quality assurance for TB testing and initiated the monitoring of drug resistance at the National Tuberculosis Reference Laboratory.