The TB burden in the Americas is concentrated in ten countries in Latin America: Haiti, the Dominican Republic, Mexico, Honduras, Ecuador, Bolivia, Brazil, Nicaragua and Peru. The combined estimated number of cases in these countries in 2005 was more than 220,000, of which men constituted 58 percent. The impact of HIV and multidrug resistance on TB control has been enormous. The prevalence of TB/HIV co-infection is generalized in Haiti, Guyana, Honduras and Panama. Multidrug-resistant TB is highest in the Dominican Republic with 6 percent, Ecuador with 5 percent and Guatemala and Peru with 3 percent.1
Treatment drop-out rates contribute to the high prevalence of multidrug-resistant TB in the Americas. But community-based programs have been effective in increasing treatment adherence even in poor settings, as has been demonstrated by a number of studies carried out in the region.
DOTS — the internationally recommended strategy for treating TB — is at the heart of international programs led by the Stop TB Partnership to control the epidemic, and efforts are underway in the region to increase DOTS access in rural and remote areas and among vulnerable populations.
Several of the Global Fund’s TB grants focus on increas- ing detection rates for new smear-positive cases and increaing success rates for treatment as well as DOTS- Plus for multidrug-resistant TB. Global Fund-financed strategies include decentralization of health care services via the creation or strengthening of diagnosis and treatment services in regional and isolated communities.
Currently, Global Fund grants support TB programs in Bolivia, Brazil, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Nicaragua, Paraguay and Peru.