Transcript Infectious Diseases in the LAC Region

BOLIVIA
BOLIVIA
1.098.581 Km2 de Superficie
8.137.113 Habitantes, 57.5% Urbano
9 Departamentos
112 Provincias
314 Secciones Municipales
USAID/Bolivia
USAID Infectious Diseases Strategy

Understand, contain and respond to the
development and spread of AMR (antimicrobial
resistance)

Reduce the incidence of tuberculosis among key
populations

Reduce deaths due to malaria

Improve the capacity to obtain and use good quality
data for surveillance and effective response
USAID/Bolivia
USAID/Bolivia
Infectious Diseases Initiative
FY1998 - 2002

Goal: To support decentralized and participatory
health care systems; improved quality and
increased coverage of community health care by
local governments and PVOs/NGOs; and
improved child survival, reproductive and sexual
health practices.
USAID/Bolivia
Objective I.

To develop capacity for implementing innovative and
sustainable community-based prevention and control
programs for priority infectious diseases (Chagas
disease, tuberculosis, & malaria) in highly endemic
areas of Bolivia, via local governments and NGOs.
USAID/Bolivia
Objective II.

To strengthen the Epidemiological Surveillance System
for Infectious Diseases to increase Quality and
Coverage of Local Health Services via:

enabling the MOH to develop and strengthen a
decentralized epidemiological surveillance system for
infectious diseases in coordination with regional
centers for vectorborne/infectious diseases.

support MOH in developing intra-regional, crossborder linkages for addressing long-term prevention
and control of priority infectious diseases.
USAID/Bolivia
Objective III.

To strengthen capacity of National Laboratory
Network for improved diagnosis, prevention, control,
and epidemiological surveillance of priority IDs via:

developing decentralized capacity of MOH/regional
centers for infectious diseases to provide technical
guidance and training on infectious disease prevention
and control, and epidemiological surveillance.

assisting MOH/regional centers to develop and field
test new approaches and technologies for diagnosis,
surveillance, AMR assessment, and the prevention/
USAID/Bolivia
control of priority infectious
diseases.
Collaborating Partners:
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Ministry of Health/Bolivia:
(Bilateral Agreements:PROSIN)
National Laboratory Network
NGO Network: PROCOSI
Pan American Health Organization (PAHO-WHO)
Donor Agencies: Belgium, DIFID, France/IRD, InterAmerican Development Bank, World Bank
Cooperating Agencies/Institutions: CDC, NAMRID,
EHP, QAP, IUATLD, MSH, NIH/Peru, UTMB,
USAID/Peru, USAID/Brazil
USAID/Bolivia
Interventions by Sector:
Tuberculosis

Development of intensive DOTS initiative in 2 periurban
areas of high endemicity (Santa Cruz/El Alto) – joint effort
between public and private NGO sectors

Development of TB initiative in rural areas thru NGO
network

Development/Consolidation of national IEC program via
Bolivian IEC Institution.

Development of Spanish version of interactive training
program on tuberculosis case management (DOTS).
USAID/Bolivia
% T B C a s e s in L A C
P re s e n c e C o u n trie s *
H A
E C
N I
D R
G T E S
B O
M X
B R
P E
* N o d a ta a v a ila b le fo r J a & H o
Tuberculosis
Ca ses/100, 000
200
150
100
50
0
PE
BO
HA
DR
NI
BR
EC
GT
ES
MX
No data avail for JA or HO
USAID/Bolivia
Notified cases of Tuberculosis in LAC Region, 1994
Argentina (3)
Number of
cases
13,683
40.0
new smear+/
all cases(%)
43.0
Bolivia (5)
9,431
130.3
73
Brazil (1)
87,280
54.8
51
Colombia
8,901
25.8
73.4
Chile
Ecuador (4)
Guyana
2,199
9,685
266
15.9
86.3
32.2
57*
69
23
Paraguay
1,850
38.3
47
Peru (2)
48,601
208.3
66
Suriname
53
12.7
n.a.
Uruguay
Venezuela
TOTAL (LAC)
666
4,877
222,596
21.0
22.8
-
57
56
-
Country
Rate/100,000
* figures from 1993, + only new smear + cases notified
Sources: PAHO - Reports from the Ministries of Health
USAID/Bolivia
MAPA DE RIESGO
TASA DE INCIDENCIA BAAR(+)
> 80 RIESGO MUY SEVERO
60-80 RIESGO SEVERO
< 60 RIESGO MODERADO
USAID/Bolivia
USAID/Bolivia
Malaria

Development of national malaria strategy based on Global Malaria
Strategy and Roll Back Malaria Program.
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Development of national treatment protocols based on results of
scientifically sound malaria drug efficacy trials.
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Field-testing of rapid diagnostic assays with plans for integration with
local diagnostic services in areas of Bolivian amazon.
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Training/IEC for health care providers / communities to improve prompt
case management of malaria via IMCI and pathway to survival.
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Develop integrated prevention and control program in Bolivian Amazon
among local public health sector, NGOs, and communities.
USAID/Bolivia
USAID/Bolivia
Chagas Disease
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Development of household improvement via local
materials/technologies
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Development of BCC /IEC modules for community-based
prevention interventions
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Integration of efforts among NGO network, Min. of Housing
and Min. of Health
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Integration of Chagas disease into IMCI.
USAID/Bolivia
USAID/Bolivia
USAID/Bolivia
USAID/Bolivia
USAID/Bolivia
USAID/Bolivia
Leishmaniasis

Provide support and technical assistance for diagnosis and
treatment of cutaneous/muco-cutaneous leishmaniasis in
endemic areas.
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Develop a referral center for leishmaniasis via an integrated
USAID initiative for the Yungas.
USAID/Bolivia
USAID/Bolivia
USAID/Bolivia
Yellow Fever, Dengue, Emerging Diseases
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Development of long term national strategies on prevention and control of
yellow fever and dengue
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Initiation of research to determine susceptibility of Bolivian strains of
Aedes egypti to YF virus (genotype 2), and transmissibility to animal
model.
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Adaptation of protocols for syndromic management of YF.
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Integration of hemorrhagic fevers into IMCI.
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Support to MOH for outbreak investigations for emerging infectious
diseases
USAID/Bolivia
USAID/Bolivia
USAID/Bolivia
STDs/HIV-AIDS
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Technical assistance to strengthen national
epidemiological surveillance for STDs/HIV-AIDS.
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Strengthening of coordination of prevention efforts
in border towns.
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Consolidation of national IEC program via local
NGO.
USAID/Bolivia
National Immunization Program (PAI)
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Support regional program for elimination of measles in the
Americas.
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Integration of pentavalent vaccine into PAI2.
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Integration of PAI and IMCI programs to increase coverage
opportunities.
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Strengthened coordination between public sector and private
sector NGOs to increase vaccination rates in low-coverage
rural areas.
USAID/Bolivia
Epidemiological Surveillance

To develop capacity of MOH/regional centers for infectious diseases to
provide technical guidance and training on infectious diseases prevention,
control, diagnosis and epidemiological surveillance.
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Strengthening of laboratory network at district level in priority areas and
national capacity to determine levels of antimicrobial resistance.
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Strengthening of capacity at local level to implement the national
epidemiological surveillance system.
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Technical assistance to MOH (by CDC) to assess the integration of the
epidemiological surveillance system with the NHIS
USAID/Bolivia
Highlights:
Epidemiologic Shield Program
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Promoted formation of Inter-Agency Committee in September 2000.
Led to strengthened coordination among donors and GOB on
immunization, malaria, tuberculosis, Chagas and other infectious
diseases, and epidemiological surveillance.
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Strengthening of regional (and South-South) cooperation among
Boliva, Brazil, and Peru (over 15 significant regional activities
executed since 1999 – to be described in separate presentation).
USAID/Bolivia
Highlights: Immunization
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Support for successful elimination of measles outbreak in 1999
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Evaluation of national program led to improved management of
cold chain, integration with IMCI program
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Successful integration of pentavalent vaccine into national
program in 2000.
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Strengthened coordination between public sector and private
sector NGOs.
USAID/Bolivia
Highlights: Tuberculosis
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Consolidation of national IEC program via local NGO (in progress)
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Development of inter-agency committee on tuberculosis (in progress)
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Development of interactive training program on DOTS (tuberculosis case
management) (done - to be demonstrated in separate presentation)
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Development of intensive DOTS initiative in 2 periurban areas of high
endemicity (Santa Cruz/El Alto) – joint effort between public and private
NGO sectors (underway)
Development of TB initiative in rural areas thru NGO network (underway)
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USAID/Bolivia
Economic impact and mortality studies
on tuberculosis (planned via PAHO)
Highlights: Malaria
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Development of national malaria strategy based on WHO Global Malaria
Strategy and Roll Back Malaria Program (monograph). July 2000.
Development of capacity to conduct malaria drug efficacy trials (in order to
establish appropriate treatment protocols and national norms) 2000/2001.
Field-testing of rapid diagnostic assays with plans for integration with local
diagnostic services in areas of Bolivian amazon. (2000/2001) To be published
in peer review literature.
Integration of malaria into IMCI (planned)
Integration of private and public sector programs in Bolivian amazon (model
chosen to be presented at World Bank/WHO Global conference on
strengthening Roll Back Malaria).
Economic impact study on malaria (planned).
Support via LAC AMR initiative for resident PAHO malariologist/advisor
assigned to national malaria program.
USAID/Bolivia
Highlights:Yellow Fever

Coordinated international conference on yellow fever in 2000 toward
development of long term national strategy on prevention and control of
yellow fever (monograph of scientific/technical articles published).
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Supported emergency procurement of YF vaccines in response to outbreak in
2000.
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Initiation of research to determine susceptibility of Bolivian strains of Aedes
egypti to YF virus (genotype 2), and transmissibility to animal model.
Results could enhance sustainability of national program.
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Adaptation of protocols on syndromic management of YF.
USAID/Bolivia
Highlights:
Dengue and Emerging Diseases
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Provided technical assistance to assess the national dengue
program in 2000.
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Supported source reduction campaign during periurban
outbreaks in 2000.
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Support to MOH for outbreak investigations for emerging
infectious diseases (on-going)
USAID/Bolivia
Highlights:
Leishmaniasis

Provide support and technical assistance for
diagnosis and treatment of cutaneous/mucocutaneous leishmaniasis in endemic areas (in
progess).

Development of a referral center for leishmaniasis via
an integrated USAID initiative for the Yungas
(planned).
USAID/Bolivia
Highlights:
STDs/HIV-AIDS

Technical assistance to strengthen national
epidemiological surveillance for STDs/HIV-AIDS.

Strengthening of coordination of prevention efforts in
border towns (in progress).

Consolidation of national IEC program via local NGO (in
progress)
USAID/Bolivia
Highlights:
Epidemiological Surveillance
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Strengthening of laboratory network at district level in
priority areas (Beni, Pando, La Paz departments (in
progress)
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Feasibility study undertaken in 2000 for development
of a vector-borne diseases center in Bolivian Amazon to
strengthen the laboratory network, epidemiological
surveillance, and local capacity in medical entomology.
(Completed – final report under review with MOH).
USAID/Bolivia
Highlights:
Laboratory Network/Medical
Entomology
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Supported development of national model for epidemiological
surveillance (in coordination with PAHO and IDB) in 2000.
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Supported evaluation of epidemiological training course for
district-level personnel in coordination with CDC, PAHO, and
IDB. (In progress).
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Technical assistance for computerization of epidemiological
surveillance data and development of website for the
Epidemiological Shield Program (planned).
USAID/Bolivia
Highlights:
National Health Information
System
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Technical assistance to MOH (by CDC) to assess the integration of the
epidemiological surveillance system with the NHIS (planned)

Supported the first evaluation of the NHIS in 2000 in coordination with
MOH, PAHO and cooperating agencies. Recommendations (if followed)
should enable successful deployment of revised system, enhance training and
supervision, thus also improving overall data quality.
USAID/Bolivia
Challenges

Lack of leadership and consensus within MOH towards shaping and
implementing a rational and consistent strategic agenda (e.g. health sector
reform (municipalization/decentralization), RRHH, quality of services, etc.)
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Politicization of national health services.
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National elections in 2002 may distract from achieving program goals and
objectives.
USAID/Bolivia
Challenges

Need for more continuous coordination both within the MOH, but also
among donors. Still no rational plan by MOH for strengthening coordination
with NGOs.
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Scarcity of human resources in MOH in such critical areas as medical
entomology, epidemiology, malaria and other infectious diseases, strategic
planning, health economics, etc.
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Lack of progressive national policies on importation of essential drugs,
mosquito nets, insecticides, and review processes related to medical research.
USAID/Bolivia
Why we are here ...
USAID/Bolivia
Useful WEBLinks on Infectious Diseases
in the Americas
I. general background info:

World Health Organization, Division for Control of Tropical Disease:
http://www.who.int/ctd/
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Pan American Health Organization (Organización Panamericana de la
Salud) (PAHO/OPS): http://www.paho.org/
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USAID’s Environmental Health Project (EHP):
http://www.access.digex.net/~ehp/webliog.html
CDC, Health Information for International Travelers:
http://www.cdc.gov/travel/blusheet.htm
USAID/Bolivia
II. Specific Diseases
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Acute Respiratiory Infections (Spanish):
http://www.paho.org/spanish/hcp/hctari01.htm#informacion
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AIDS/STDs: http://www.paho.org/english/aid/aidprog.htm
http://lucas.funsalud.org.mx/sidalac/english.htm
http://www.paho.org/english/aid/aidw0497.htm
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Chagas Disease: http://www.who.int/ctd/html/chag.html
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Cholera: http://www.paho.org/english/hcp/hctcho02.htm ;
http://www.cdc.gov/travel/cholera.htm ;
http://www.who.int/chd/pub/cholera/cholemer.htm
Basic facts for travelers:
http://www.who.int/chd/pub/cholera/chobfact.htm
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USAID/Bolivia
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Malaria: http://www.who.int/ctd/html/malaria.html ;
http://www.who.int/ctd/html/malariaburtre.html ;
http://www.azer.com/AIWeb/Categories/Magazinehtml/52.folder/
52.articles/52.malaria.html
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Malaria Risk/Treatment Regimen by Country: (CDC):
http://www.cdc.gov/ncidod/dpd/malaria/tropsam.htm ;
http://www.who.int/ctd/html/malariageo.html
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Leishmaniasis: http://www.who.int/ctd/html/leisburtre.html
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Arboviruses: Dengue & Yellow Fever
http://www.who.int/ctd/html/dengueburtre.html ;
http://www.cdc.gov/travel/yfever.htm
USAID/Bolivia
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Tuberculosis:http://www.paho.org/english/hcp/hcttb02.htm#burden
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Antimicrobial Resistance:
http://www.cdc.gov/ncidod/dbmd/antibioticresistance/Default.htm
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Regional Emerging Infectious Diseases:
http://www.paho.org/english/hcp/hcteme02.htm#americas
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Other insect-borne diseases: http://www.cdc.gov/travel/insctdis.htm
USAID/Bolivia
III. Selected Readings on Emerging Diseases
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http://www.cdc.gov/ncidod/publications/slides/index042.htm
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Dr. Robert S. Desowitz. Who Gave Pinta to the Santa Maria? Tracking
the Devastating Spread of Lethal Tropical Disease in the Americas, W. W.
Norton, 1997.
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Dr. Robert S. Desowitz. New Guinea Tapeworms and Jewish
Grandmothers, Tales of Parasites and People, W. W. Norton, 1981.
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Dr. Robert S. Desowitz The Malaria Capers, Parasites and People,
Research and Reality, W. W. Norton, 1991.
USAID/Bolivia
IV. Prevention
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Integrated Management of Childhood Illnesses (IMCI/AEPI):
http://www.paho.org/english/hcp/imci/index.htm
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CDC Travel Information: http://www.cdc.gov/travel/index.htm
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Mexico & Central America: http://www.cdc.gov/travel/camerica.htm
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Caribbean: http://www.cdc.gov/travel/caribean.htm
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Tropical South America: http://www.cdc.gov/travel/tropsam.htm
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Temperate South America: http://www.cdc.gov/travel/temsam.htm
USAID/Bolivia
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Bednets, Insecticides & Repellents: http://www.magellans.com
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CDC Prevention Strategy on Emerging Infectious Diseases:
http://www.cdc.gov/ncidod/publications/eid_plan/home.htm
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National Center for Infectious Diseases:
http://www.cdc.gov/ncidod/ncid.htm
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CDC Summary of Health Information for International Travel:
http://www.cdc.gov/travel/blusheet.htm
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USAID’s Global Infectious Diseases Strategy:
http://www.info.usaid.gov/pop_health/webid.htm
USAID/Bolivia