Namibia
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In 2006, Namibia’s estimated tuberculosis (TB) incidence rate of 767 cases per 100,000
population (national data for 2007 show a rate of 722) was more than twice as high as
the African regional average. The TB prevalence of 658 cases per 100,000 population
and TB mortality of 96 cases per 100,000 population are also above average for the
region. About 38 percent of newly registered TB patients are HIV positive; national
data show that nearly 60 percent of all TB patients tested for HIV were HIV positive.
The number of new sputum-smear positive (SS+) cases notified has averaged around
5,300 for the last four years, almost twice the number notified in 1996, an increase
fueled by the spread of HIV/AIDS. According to UNAIDS, Namibia’s HIV prevalence is
15.6 percent, and this high prevalence poses serious problems for the successful
treatment of TB1. Multidrug-resistant (MDR) TB is prevalent in 1.5 percent of new
cases. Namibia has so far identified 21 extensively-drug resistant (XDR) cases. Since
1996, Namibia has sustained DOTS (directly observed treatment, short course),
achieving a case detection rate above the global target of 70 percent. The DOTS
treatment success rate continues to improve, but at 75 percent, it is still below the
global target of 85 percent.
The National TB Control Program (NTCP) was established in 1991. Until 2002, the
national government provided the sole support for the program. From 2002 onwards,
the KNCV Tuberculosis Foundation provided external technical assistance (TA), and
since 2005, expanded support from one full-time staff to three resident technical staff.
Although there have been impressive gains in TB control and prevention, much remains
to be done to expand access to DOTS programs and improve the treatment success
rate of new patients. Sustained support to improve management of patients with drug-resistant
TB using second-line TB drugs is also still needed.
USAID Approach and Key Activities
USAID launched its TB program in Namibia in 2005, expanding since then to a $1.4
million per year program for TB control and surveillance efforts. USAID supports the
NTCP and the Ministry of Health and Social Services (MOHSS) with TA through the
Tuberculosis Control Assistance Program (TB CAP), which is managed by the KNCV
Tuberculosis Foundation. By strengthening the capacity of the NTCP, USAID efforts
will enable Namibia to improve the management of drug-resistant TB patients and TBHIV/
AIDS patients, and expand community-based DOTS (C-DOTS) into other regions.
USAID assistance includes support for the following activities:
- Strengthening management capacity of the NTCP
- Expanding C-DOTS in target zones
- Increasing the knowledge and skills of clinicians and nurses for basic TB
control, diagnosis, and treatment for MDR-TB and TB-HIVAIDS
- Improving management and coordination between TB and HIV/AIDS partners
in prevention, care, and support, including drug supply management for dually
infected individuals
- Developing infection control (IC) measures for TB and MDR-TB in health
facilities and training health workers on IC guidelines
- Developing and implementing sector-specific TB control strategies
- Improving community knowledge, attitudes, and practices on TB and TB-HIV
- Supporting the establishment of a formal MOHSS/private sector collaboration and engaging private sector professionals
in the NTCP technical guidelines and the International Standards of Tuberculosis Care, including on MDR-TB and XDR-TB
USAID Program Achievements
USAID’s assistance and support have helped address TB prevention and control through the following activities:
- Trained 98 health care providers in the National TB Control Guidelines in their respective regions in fiscal year (FY) 2007
- Trained and mobilized 323 nurses to become part of a future cadre of trainers on decentralized detection, management,
and treatment of TB in FY 2007
- Coordinated with the International Union Against Tuberculosis and Lung Disease to train the first-ever cadre of health
care providers in Namibia on clinical management of MDR-TB and continued to support staff training on MDR-TB
- Ensured follow-up on training through quarterly performance review meetings, support, and on-site supervision of 100
health care providers across the country in FY 2007
- Provided palliative care and TB treatment and care to 14,300 HIV-infected individuals, trained 1,500 individuals to
provide TB palliative care, and supported 300 service outlets
- Introduced a monitoring and evaluation system that captures TB-HIV/AIDS data in all reporting health facilities in
Namibia
- Supported the development of a MDR-TB survey in collaboration with staff from the National Institute of Pathology,
MOHSS, and U.S. Government (USG) partners
- Assisted the NTCP with its application to the Green Light Committee and supported 340 patients on second-line drugs
- Facilitated the monitoring of 21 XDR-TB patients by a clinical review committee
- Introduced, expanded, and improved the performance of C-DOTS
- Provided training to clinicians and nurses on IC and improved facilities to accommodate IC guidelines
Case Detection and Treatment Success Rates Under DOTS
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Note: DOS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
USAID’s partners in helping Namibia implement DOTS include the national government, the KNCV Tuberculosis Foundation, the Tuberculosis Coalition for Technical Assistance, the U.S. CDC, and other USG partners. Namibia received funding for TB activities from the Global Fund to Fight AIDS, Tuberculosis and Malaria in Round 2 for $1.5 million and in Round 5 Phase One for $7.2 million and Phase Two for $9.9 million.
1 Epidemiological Fact Sheet on HIV and AIDS. UNAIDS, September 2008
February 2009
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