One-third of the world’s population is infected with Mycobacterium tuberculosis, the pathogen responsible for causing tuberculosis (TB). In 2011, there were an estimated 8.7 million incident cases of TB globally. Despite the fact that diagnostic and treatment services for TB are integrated with primary health care in most countries, the number of deaths due to TB remains high—1.4 million in 2011.1
Of the 15 countries with the highest incidence of TB, 14 are in Africa. This is largely due to HIV—40% to 50% of people with HIV will develop TB disease in their lifetime. In fact, nearly one-quarter of the estimated 1.8 million HIV-related deaths in 2009 were due to TB.2
What Jhpiego Is Doing
Jhpiego, an international health organization affiliated with The Johns Hopkins University, is recognized as a global leader in strengthening health systems in limited-resource settings. Using innovative approaches, Jhpiego puts research into practice to improve the health of women and families in the technical areas of maternal and newborn health, family planning and reproductive health, and prevention and treatment of HIV/AIDS and other infectious diseases. As part of its efforts in prevention and treatment of infectious diseases, Jhpiego works toward the global goal of eliminating TB.
HIV prevalence among people with TB is as high as 80% in some countries. Jhpiego is committed to integrating TB with all of its HIV programs in order to improve the lives of women and their families through TB prevention, care and treatment. As a key implementing partner in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR),3 Jhpiego works with ministries of health, national TB & HIV programs, educational institutions and nongovernmental organizations to implement TB & HIV initiatives. In 2008, Jhpiego joined the Stop TB Partnership, whose goal is to eliminate TB as a public health problem. Jhpiego is also a member of the USAID-funded TB Care II consortium, providing technical leadership in TB/HIV integration.
Jhpiego is working to integrate TB with maternal health in order to improve case detection and get clients with TB onto treatment earlier to save lives and decrease transmission. For example, in collaboration with TB Care II partners and the World Health Organization (WHO), Jhpiego developed the “measuring for impact” tape measure as well as the Focused Antenatal Care Plus (FANC+) job aid. In 2011, these tools were launched at a TB Care II-hosted workshop, at the International Confederation of Midwives (ICM) Congress in Durban. These tools have been, and continue to be, disseminated through maternal health networks in a number of countries. Pilot projects in Malawi and Ethiopia and pre-service programs in Ghana and Liberia are using these tools. The measuring tape is used to measure fundal height to monitor a mother’s progress through pregnancy; clinical reminders, found on either side of the "measuring for impact" tape, include minimum standards of care in FANC, as well as specific information related to HIV and TB.
Jhpiego has provided technical assistance to nursing education institutions in several countries including Zambia, Botswana, Lesotho, Ghana, Liberia and South Africa to ensure that new graduates are able to provide high-quality, integrated TB & HIV services.
Innovations to Combat MDR-TB
Globally, more than 3.7% of new cases of TB and 20% of previously treated cases are estimated to have multiple drug resistant-TB (MDR-TB).4 In 2011, only 60,000 of the estimated 310,000 MDR-TB cases were diagnosed, and even fewer had access to treatment. Through its innovations unit, Jhpiego, with The Johns Hopkins University Center for Bioengineering Innovation and Design (CBID), is supporting a group of master’s students who are working on a TB diagnostic to increase access to culture and drug/sensitivity testing in an era with ever-increasing MDR-TB.
The highlights below illustrate Jhpiego’s experience in implementing TB projects in selected countries.
- Pregnancy increases the risk of developing TB, and TB in pregnancy may result in negative health outcomes for the mother and fetus. As prime partner for the USAID-funded AIDS, Population and Health Integrated Assistance (APHIA II) Eastern Program, Jhpiego has incorporated TB screening and referral into the Focused Antenatal Care training package.
- Jhpiego supports advocacy, communication and social mobilization through training of providers and communities on TB prevention, diagnosis and control. For example, Jhpiego supports service delivery in prisons by training peers to support treatment, sensitizing prison officers and inmates, increasing laboratory capacity, providing clinical support and integrating TB & HIV services.
- Under Support for Service Delivery Integration (SSDI), Jhpiego is supporting pilot implementation of TB screening in antenatal care.
- With funding from CDC, Jhpiego provided technical assistance to the Ministry of Health to develop and implement a TB infection control plan. Implementation of the plan, including training of providers and managers, continues under this project.
- Since 2008, Jhpiego has supported the government in expanding access to community-based HIV counseling and testing, health education, and screening for tuberculosis. In 2012, more than 200,000 people were screened for symptoms of TB and 1,000 referred to a facility for further assessment.
- Jhpiego has developed an on-the-job, competency-based training package for the diagnosis and management of opportunistic infections in adults and children, including TB.
- To improve the quality of services, Jhpiego is working with the Zambian Defense Force to implement a quality improvement program in HIV & TB prevention, care, treatment and support.
- 1 World Health Organization (WHO). 2012. Global Tuberculosis Report 2012. Geneva: WHO. http://www.who.int/tb/publications/global_report/gtbr12_main.pdf.
- 2 Joint United Nations Programme on HIV/AIDS (UNAIDS). 2010. Global Report: UNAIDS Report on the Global AIDS Epidemic, 2010. Geneva: UNAIDS. http://www.unaids.org/globalreport/Global_report.htm
- 3 With funding from and in collaboration with major international health organizations, such as the U.S. Agency for International Development (USAID), the U.S. Centers for Disease Control and Prevention (CDC), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the United Nations Children’s Fund (UNICEF), UNAIDS and WHO.
- 4WHO. 2012. Global Tuberculosis Report 2012. Geneva: WHO.