Haiti has the highest per capita tuberculosis burden in the Latin America and Caribbean region. The country’s TB burden is exacerbated by a high HIV/AIDS prevalence, with TB being the second leading cause of mortality after HIV/AIDS, resulting in approximately 6,000 deaths annually. Haiti is among the eight priority countries identified by the Pan American Health Organization (PAHO) for TB control in the region.
According to the WHO Global TB Report 2006, Haiti had more than 25,000 new TB cases in 2004, with 11,140 being new pulmonary sputum smear-positive (SS+) cases. The Directly Observed Therapy Short-Course (DOTS) case detection rate is 49 percent, up from 12 percent in 1998, while the treatment success rate has remained fairly stable around 78 percent. However, DOTS coverage is estimated at 55 percent, with significant disparities in coverage across different regions, including areas of Port-au-Prince where coverage can be as low as 13 percent.
The national TB program, Programme National de Lutte contre la Tuberculose (PNLT), which officially began in 1988, lacks political and financial support from the government. The official adoption of DOTS in 1997, coupled with approval in 2002 of national guidelines and norms for TB control, strengthened and formalized the approach to TB control. A major challenge in combating TB in Haiti is the high prevalence of co-infection with HIV among TB cases, which can run as high as 30 percent in some urban areas. Conversely, 20 percent of HIV-positive adults in Haiti are infected with TB.
Strong stigma and cultural barriers attached to TB also interfere with case detection and adherence to treatment. The country’s TB profile is characterized by a high incidence of TB, with an estimated 306 cases per 100,000 population in 2004. The rate of new sputum smear-positive (SS+) cases is 84 per 100,000 population, while the DOTS case detection rate is 49 percent. The DOTS treatment success rate in 2003 was 78 percent, and the estimated adult TB cases HIV+ rate is 29.0 percent. New multidrug-resistant TB cases account for 1.4 percent of all cases.
Between 2003 and 2005, USAID funds for TB programming in Haiti averaged $1.8 million per year. USAID’s approach in Haiti complements the priorities of the PNLT, focusing on increasing case detection, improving treatment completion rates, and strengthening coordination between HIV/AIDS and TB programs. USAID assistance includes strengthening DOTS implementation, assessing and guiding protocol design, supporting social mobilization, improving coordination and reinforcement of capacity-building activities, stimulating operational research studies, building TB-HIV/AIDS testing, referral, and care systems, and ensuring that staff trained by the Ministry of Public Health and Population know how to assess drug management problems and improve the drug management systems.
In the face of political turmoil and socioeconomic instability, TB control in Haiti has progressed in recent years, thanks in part to USAID support. Key achievements include the addition of 19 new TB-DOTS service providers throughout the country in 2004, an increase in TB case treatment success rate from 73 percent in 2000 to 78 percent in 2004, facilitation of the operation of 41 of 71 voluntary counseling and treatment sites, and provision of essential assistance to TB drug supply management and laboratory services. USAID also provided technical support for proposals to the Global TB Drug Facility and to the Global Fund for AIDS, Tuberculosis and Malaria, developed tools to improve supervision, recording and reporting, and home visits, and established a working group to address TB-HIV co-infection.