Status of TB Operations . . Status of TB Operations (Region of the Americas, 2004) Regional Program on Tuberculosis Status of TB Operations (Region of the Americas, 2004)

Status of TB Operations (Region of the Americas, 2004) Elements of the DOTS Strategy Political commitment Bacteriological diagnostic capacity Regular supply of medications and supplies Directly Observed Treatment Strategy Information system Registries Training, Supervision, IEC, Evaluation Status of TB Operations (Region of the Americas, 2004)

Trend of DOTS Coverage (% pop., 1999–2003) Status of TB Operations (Region of the Americas, 2004)

Current Status of the DOTS Strategy (Americas, 2002) DOTS Coverage: 73% of the population < 10% coverage < 10% -<49% >50-90% Total coverage No DOTS Status of TB Operations (Region of the Americas, 2004)

Coverage of the DOTS/TAES Strategy (by country, Americas, 2002) >90% >50<89% >10<49% <10% No DOTS Argentina Belize Chile Cuba El Salvador Guatemala Honduras Peru Puerto Rico Nicaragua Uruguay USA Bolivia Costa Rica Mexico Panama Venezuela Brazil Colombia Dominican Republic Ecuador Guyana Haiti Paraguay English-speaking Caribbean Suriname Countries in the same category without changes Countries that have improved their coverage within the same category Countries whose category has gone up Status of TB Operations (Region of the Americas, 2004)

Success in Treating TB BAAR+ Cases (Region of the Americas, 2002) OR= 2.21 (IC:2.15 – 2.28) 17% 83% 41% Con esta lamina pretendemos mostrar que los pacientes manejados con DOTS/TAES, tienen 2,21 veces mayor probabilidad de curar que los no DOTS, y en términos de porcentaje el resultados de pacientes tratados con DOTS es mayor en un 24% que los no DOTS. 59% Status of TB Operations (Region of the Americas, 2004)

Current Limitations for Controlling TB, Region of the Americas Political support for National TB Programs. Health-sector reform process. Irregular drug supply. High staff turnover, need to improve training (management/supervision). Organization of laboratory network, insufficient quality control. Inconsistent registry system and delay in reporting. Insufficient monitoring and cohort analysis. Estas limitaciones son generales para la región por lo que sugerimos, enfatizar en las que apliquen para su país. Status of TB Operations (Region of the Americas, 2004)

Status of TB Operations (Region of the Americas, 2004) Main Challenges Expand DOTS Strategy in the remaining countries, so as to achieve total DOTS coverage in 2005. Strengthen laboratory capacity. Strengthen regional capacity for country monitoring. Maintain and/or reinforce resistance surveillance. Status of TB Operations (Region of the Americas, 2004)

Status of TB Operations (Region of the Americas, 2004) Main Challenges Coordinate joint strategies for HIV/AIDS-TB Programs. Increase access to and application of strategies for groups at high risk for TB. Minimize possible negative effects of the health-sector reform process.. Maintain high levels of training and supervision at the country level. Status of TB Operations (Region of the Americas, 2004)

Millennium Development Objectives (2015) Goal 6 Fight HIV/AIDS, Malaria, and other illnesses (TB). Objective 8 Stop and begin to reduce the spread of HIV/AIDS. Stop and begin to reduce the incidence of malaria and other serious illnesses (TB). Indicators 23. Prevalence and mortality rates associated with tuberculosis. 24. Proportion of tuberculosis cases detected and cured under DOTS. Status of TB Operations (Region of the Americas, 2004)

Regional Action Plan (PAHO Regional Program on TB, 2004–2005) The Plan of Action for the biennium will be structured on the basis of the magnitude of the TB problem in the countries and the challenges for implementing/expanding the DOTS/TAES Strategy. Objective To assist the countries of the Region of the Americas in the implementation and expansion of the DOTS/TAES Strategy, so as to achieve millennium objectives. Status of TB Operations (Region of the Americas, 2004)

Status of TB Operations (Region of the Americas, 2004) Strategy and Goals Strategy Support to countries in the extension of the DOTS Strategy, via training, monitoring, and evaluation. Support to countries for surveillance of resistance of anti-tubercular drugs (MDR). Advocacy in the search for technical and financial partners. Goals For all countries of the Region to have implemented/expanded the DOTS/TAES Strategy on a national scale by the end of 2005. Status of TB Operations (Region of the Americas, 2004)

Status of TB Operations (Region of the Americas, 2004) World TB Day 24 March 2004 Status of TB Operations (Region of the Americas, 2004)