WHO ranks Brazil among the 22 highest burden countries for tuberculosis (TB) in the world. It is estimated that there are approximately 86,000 cases annually with 5,000 TB patients dying each year.
In 1998, Brazil adopted the WHO recommended public health initiative for TB case management called DOTS while also embracing the WHO targets for high burden countries by identifying at least 70 percent of cases and successfully treating at least 85 percent of those detected to break the transmission of TB.
USAID/Brazil has supported the National Tuberculosis Program's (NTP) efforts through its partners since 2001. This includes strengthening state and municipal TB and HIV/AIDS-TB co-infection control programs and expanding DOTS in many areas of the country. USAID extended its support in 2003 when it provided funding to the Rational Pharmaceutical Management (RPM) Plus Program to collaborate with the NTP, Helio Fraga National TB Reference Center, the Oswaldo Cruz Foundation (National Institute of Quality and Control, Public Drugs Producer Complex of Farmanguinhos) and several agencies of the government (Pharmacy Department, Anvisa/Brazilian FDA) in four different streams of activities related to improving pharmaceutical management, strengthening MDR-TB control and DOTS expansion.
Partners created effective working groups (WG) coordinated by RPM Plus to develop and implement common workplans for -
- Improving the management information system (MIS) for treating MDR-TB patients and managing 2nd line drugs
- Modifying drug treatment scheme for TB failures to avoid adverse reactions
- Developing Fixed Dose Combinations (FDCs) to promote patient compliance
- Investigating the quality of TB drug products and implementing a scheme to continually monitor quality
Main results and outcomes obtained so far are -
- Validation and implementation of a decentralized model for MDR-TB case surveillance in 27 states, including a new MIS developed for 2nd line drugs management application
- Training of 450 health professional in 61 MDR-TB Reference Centers, thus increasing case detection by 20% with a 12% increase in cure rate
- Development of a protocol to study TB failure population to determine a suitable regimen replacement; on-going discussions for starting clinical trial and recommendations to change the national TB program and Ministry of Health
- Development of new formulations of three-drug combined products which are expected to decrease dosage from 9-10 tablets to 4-6 tablets in one dose and improve patient adherence
- Establishment of a sustainable system with government agencies for a quality testing program for all 1st and 2nd line TB drugs
RPM Plus continues to act as a critical catalyst for mobilizing cross cutting agencies in a complex process where stakeholders collaborate on various views according to their specific mandates (i.e. production, procurement, distribution, quality control, rational use). Agencies interact more with producers for improving drug quality and defining concerted legal actions without risk of creating shortages.
Related Information
» Previous RPM Plus activities
» More on RPM Plus' work in TB
» More on RPM Plus' work in HIV/AIDS
