Brazil

Brazil has a population of more than 184 million people, and the country accounts for 35 percent of TB cases reported annually in the WHO Region of the Americas. Brazil ranks sixteenth among the 22 high-burden TB countries. The estimated TB prevalence is 77 cases per 100,000, with approximately 110,000 new cases and 14,000 TB-related deaths per year. The highest prevalence rates occur among the poorer members of the population and at the most productive time of life. TB is the ninth leading cause of hospital admission and fourth leading cause of death by infectious disease in Brazil.

TBCTA Project 1 (2000-2006)

Objectives

• Accelerate implementation and expansion of the DOTS strategy in Brazil.
• Develop institutional and technical capacity for TB control at federal, state and municipal levels.
• Integrate TB control efforts within primary health care services more effectively; develop or strengthen linkages between the TB control program and HIV/AIDS prevention and treatment programs and MDR-TB efforts.

Rio Project

Initial TBCTA assistance was focused on Rio de Janeiro State. The objective was to strengthen the Rio de Janeiro State Tuberculosis Control Program by implementing the DOTS strategy. The components of the Rio Project are listed below.

• Implement DOTS in 11 priority municipalities of Rio de Janeiro State.
• Promote the participation of health professionals in national and international courses, to facilitate knowledge exchange of successful experiences in TB control.
• Support monitoring, supervision and evaluation activities in municipal TB control programs integrated with the Family Health and Community Health Worker Programs.
• Provide specialized technical consultancies, as needed.
• Support and carry out operational research.
• Support IEC activities.
• Technical assistance for epidemiology.
• WHO/PAHO technical assistance visit to Brazil.

Federal Project

Additional support was given to assist with the reorganization of primary health care services for DOTS implementation and effective TB treatment, specifically effective and continuous supervision from the state to the municipal level. The objectives were 1) to improve the central NTP, and 2) to help the NTP reach the goals outlined in the new TB program. The Federal Project’s components are listed below.

• Supervision and training for health service reorganization and DOTS expansion in the 315 priority municipalities.
• BBC media campaign for public awareness.
• Completion of drug resistance and HIV infection prevalence studies.
• Conclusion of laboratory work related to drug resistance, HIV prevalence and re-treatment drug regimen studies.

Major TBCTA Accomplishments

• Increased DOTS coverage from 3% in 1998 to 68% in 2005, and implementation in all 315 priority municipalities.
• Prioritization of DOTS by the Brazilian Ministry of Health with an increase in funding for the DOTS National TB Action Plan 2004-2007.
• Establishment of a Task Force Training Group in 2004 to monitor and assist states and prioritized municipalities with DOTS expansion and implementation, as well as a state-level monitoring and evaluation plan.
• Increased human resource capacity: 4,639 university-level professionals, 1,822 intermediate-level health personnel, and 6,455 community health workers trained in DOTS. Also, 33 professionals received training in public laboratory management and 400 professionals from the laboratory network received training on how to perform sputum-smear analyses.
• Protocol is in place for a quality assurance system for smear microscopy based on WHO/partner-recommended guidelines with coverage of 40 percent. In addition, 86 laboratory workers and 28 state coordinators received training in management, diagnosis and laboratory information systems.
• TBCTA also assisted the NTP in the launching of a successful national media TB campaign to increase community education and awareness of TB control and prevention.
• The NTP and National AIDS Program are now integrated. HIV testing is available to all TB patients, and TB control strategies are applied in 388 basic health units for people with HIV. There is now active search for TB cases among HIV-positive patients in 240 basic health units, and 950 basic health units participate in a network of health care services that systematically refer patients to either TB or HIV services, as required. Chemoprophylaxis with isoniazid in 420 units are available for people living with HIV.
• Brazil’s operational research plan was revised and now includes the evaluation and interpretation of TB-related epidemiological indicators, treatment outcomes, and morbidity and mortality indicators. The plan also includes an evaluation of factors associated with treatment default; prevalence of TB/HIV co-infection in Brazil; national TB laboratory quality control; and evaluation of the National Epidemiological Information System.
  

TB CAP PROJECT PERIOD (2005-2010)

Expected output(s)

Improve and assist NTP to reach goals outlined in the new tuberculosis program.

Current status

TB CAP hired a full-time resident consultant to assist Brazil’s NTP in reaching the goals outlined in the new tuberculosis strategy. During APA1(October 2005-September 2006) the consultant assisted Brazilian NTP to implement Drug Resistance and HIV Prevalence Surveys in 3 additional Brazilian states. The consultant also helped to develop and distribute a software program for data entry, train health care workers for data entry and enroll over 1,000 patients in the survey.