In partnership with the Ministry of Public Health (MOPH), the REACH Program is battling an age-old disease that still kills one person on Earth every 15 seconds: tuberculosis.

One of the 22 highest TB-burdened countries in the world, Afghanistan has an estimated 76,000 new, active TB cases annually. The rate of infection among Afghan women is especially high, accounting for 2/3's of the active cases reported. Although 85% of all Afghans treated for TB overcome the disease, only 26% of the TB cases in Afghanistan are being detected. Untreated, approximately 50% of people with active cases of TB die within two to four years after onset; after five years, nearly 75% are dead. These are needless, preventable deaths.

Detected and properly diagnosed, TB can almost always be successfully treated—but only when patients follow and fully complete a treatment regimen in which drugs tailored to fight their particular type of TB are taken at specific times in dosages based on the patient's weight. Thus, the best way to cure TB and control its spread is through the DOTS strategy (the global standard for tuberculosis diagnosis, treatment, and monitoring).

Health providers administering the six-month DOTS regimen closely monitor patient compliance. They watch patients swallow their medicine, making sure the dosage is correct and taken at the right time. They also identify patient contacts to screen them for the disease. Children asymptomatic for TB but who live in the patient's household are given preventive medication. DOTS is 99% effective in curing TB and controlling its spread, but in Afghanistan, DOTS is available to only 38% of the population.

REACH is actively working with the Afghan MOPH's National Tuberculosis Control Program to expand DOTS coverage to the entire country. National data gathered through the Ministry's health management information system (HMIS), designed and recently installed by REACH, shows that between June 2004 and June 2005, the percentage of health facilities providing DOTS nearly doubled nationally. Early results for the year 2005 indicate a 20% increase in the number of TB patients detected and treated nationally compared to 2004.

REACH NGO grantees are now integrating TB control and treatment into the Basic Package of Health Services (BPHS) they deliver in health centers throughout the 13 provinces they serve. Currently, patients in 50% of the health facilities operated by REACH NGO grantees are regularly receiving DOTS.

One such NGO grantee is Medair, recipient of a $1.6 million USAID-funded REACH grant to deliver the BPHS in two mountainous districts of Badakhshan Province. Medair's Yawah Comprehensive Health Center (CHC) in Ragh District is a five-hour drive from Faizabad, the provincial capital, over steep, narrow roads that wind their way up and through the mountains. In the winter, when snow and freezing rain close the road, the same trip takes two days on horseback. Due to the rigors of travel in the area, the Yawah CHC runs a TB hostel, where up to 12 TB patients can stay with their families while receiving DOTS treatment.

On a recent visit, Malika, a clinic midwife trained in DOTS, was filling in for the clinic's TB officer, a male nurse away receiving refresher training. At Yawah CHC, 28 people are now receiving DOTS. Clinic doctors diagnose TB through microscopic examination of a series of sputum smears, determine medications to be used, and calculate the proper dosage, but nurses administer DOTS treatment, weighing the patient monthly, keeping accurate patient records, and coordinating with the doctor when additional sputum smears are necessary.

Nurses also monitor DOTS treatment. They must be alert to any sign that a TB patient may abandon the prescribed regimen. Should a patient fail to keep an appointment, the nurse pays a home visit to make sure treatment resumes. If a TB patient is unable to visit the clinic, a community health worker (CHW), under the nurse's supervision, will schedule treatment in the home, provide medications, and observe the patient taking them. All CHWs attached to the Yawah CHC recently completed training enabling them to spot and refer those with TB symptoms to the clinic for treatment, as well as to educate family members and the community on the importance of supervised treatment in curing the disease.

Nurses play an especially critical role in controlling the spread of TB; in patient interviews, they learn—and regularly update—the names of the patient's contacts and family members, who can then be screened for the disease and begin treatment if needed. Children and adults living in the patient's household but exhibiting no TB symptoms are administered antibiotics as a preventive measure.

REACH continues to provide expert assistance to Afghanistan's National Tuberculosis Control Program to rapidly scale up TB case detection and DOTS expansion, including helping the MOPH to review policies and procedures to be followed in diagnosing TB with sputum microscopy and to establish national quality assurance programs for TB labs.

<<< Back to News Room