Dominican Republic

The Dominican Republic covers the eastern two thirds of the island of Hispaniola and had 9,100,183 inhabitants in 2005. Sixty-three percent of the population lives in urban areas and the annual population increase is 1.6 percent. Gross domestic product per capita was estimated to be US$7,000 in 2005, but 25 percent of the population lives below the poverty line and the unemployment rate is 17 percent. The Dominican Republic is one of the Latin American countries with the highest TB burden and is one of eight priority countries identified by WHO/PAHO for TB control. The estimated burden of TB is 118/100,000 population for all cases and 52/100,000 population for new smear-positive cases. Many of these cases are among high-risk populations such as the poor, migrants from Haiti, workers at sugar factories and prisoners. There is also increasing HIV prevalence among these population groups. The TB/HIV co-infection rate is estimated to be 8.6 percent.

TBCTA Project 1 (2000-2006)

Objectives

Support to the implementation of the NTP Dominican Republic by the provision of technical assistance to the NTP, especially in relation to ‘Strengthening of the PNTC and reducing the impact of the associated HIV-AIDS in the Dominican Republic, 2004-2006’ and the National Strategic Plan PNCT Dominican Republic, 2005 – 2010.

Major TBCTA Accomplishments

• DOTS coverage increased from 10% in 2001 to 80% in 2005. The case detection rate for new smear-positive cases increased from 7% in 2001 to 81% in 2005, exceeding the global target of 70 percent. Treatment success for new smear positive patients was 82.3 % for the 2004 cohort, which is an increase from 77.6 % for the 2001 cohort.
• The NTCP received assistance from a TBCTA consultant in 2005 with a Green Light Committee application, which was accepted and an MDR-TB treatment program was launched in 2006.
• A national manual was developed and officially adopted by the national health secretary. The manual ’ s recording and reporting system includes innovative components on identification of TB suspects, TB/HIV collaboration and contact tracing.
• The NTP was strengthened with an increased capacity on management issues through participation of staff members in several trainings on TB Management, supervision and use of data as a management tool for national and provincial staff. As a result, the new supervision guidelines were reviewed and now include additional items on general health services and TB/HIV activities.
• Following training courses on the management of the electronic epidemiological and operational database, software was installed in all provinces. From the beginning of the project, the NTCP organized annual evaluations in which all provinces presented progress achieved during the previous year, problems encountered and major challenges for the future. The Central Unit used these evaluation meetings to introduce new developments in international TB control to scale-up activities.  
• Following the development of training modules for health staff at facility level 26 trainings over a period of three years. Provincial and health facility staff from both the 18 provinces included in the GFATM project and the five USAID-supported provinces received training. Furthermore, training and retraining of staff in other provinces was also initiatedin. These activities have enabled the NTP to continuously improve capacity of its staff, as well as strengthen its program as a whole.
• With TBCTA assistance norms for the use of bacteriology in TB was established and published as a manual. Courses on quality control were conducted for 72 laboratory specialists; quality control was subsequently introduced into the laboratory network.
• Following extensive reconstruction, financed by the European Union, the National TB Reference Laboratory is functional.   TBCTA provided technical assistance on the proper functioning of the National Reference Laboratory and the five regional laboratories. Following the summary and analysis of the first results of the quality control assessment, a second round of supervisory visits to the 48 laboratories took place. As a result, the postponed drug resistance survey began in 2006 with results expected in 2007.
• With TBCTA support the first joint workshop of the NTCP and the HIV/AIDS project on TB/HIV co-infection was organized. TB/HIV activities are now included in the regular recording and reporting system and HIV testing is possible in all laboratories. In 2006, the Dominican Republic finalized its TB/HIV survey. The survey showed that 8.6 percent of adult TB patients were HIV-positive.