CDC History of Tuberculosis Control - Medical and Public Health ...

to contribute to the global
control of TB and HIV/
AIDS co-epidemics. In
February 1995, at the
request of the Ministry of
Health in Botswana, the
BOTUSA Project was
Project
established as a TB
epidemiologic research
collaboration located in Botswana.
Approximately 25% of the adult population
and 75% of TB patients are HIV-infected. The
BOTUSA Project activities have focused on
improving TB surveillance and electronic
reporting, improving Botswana National TB
Programme (BNTP) activities through
operational research, improving diagnostics
through laboratory and clinical research
studies, and studying the epidemiology of the
disease. At least 17 different formal studies
have been completed to date and highlight the
tremendous impact of the HIV epidemic on
the TB epidemic in the country.
BOT
The site is collaborating with WHO and other
countries on several projects, including
involvement of the community in the care of
patients with TB and advanced AIDS,
provision of TB preventive therapy to persons
living with HIV, and improvement of TB
surveillance through the use of a software tool
initially developed by BOTUSA and recently
adopted by the World Health Organization
(WHO) for global application. Through
collaboration with the US Food and Drug
Administration, the site and DTBE have
raised global awareness of the potential for
substandard TB drugs in the market through
the pilot-testing of appropriate technology for
the rapid screening of drugs. Specific research
projects completed in 1998 included a
spectrum of lung disease study in adults
hospitalized with AIDS, an autopsy study to
determine causes of death in adults and
children dying of AIDS, a validation study of
the TB surveillance system, a study of risk
factors for TB transmission in the household,
and a study of transmission at the population
Notable Events in TB Control
67
level through the use of RFLP techniques.
Another study underway is assessing the
malabsorption of TB drugs in patients with
TB and HIV, as well as conducting long-term
follow-up of these treated patients to
determine risk factors for relapse, reinfection,
and death.
Strengthening the capacity of laboratory
facilities to cope with the ever-increasing
demands brought on by the TB and HIV
epidemics has been a component of the
BOTUSA project. Substantial support in
terms of equipment, training, and supplies has
been provided to the national TB Reference
Laboratory. BOTUSA also serves as an
important training site for EIS officers, US
medical students, and public health students
from UC-Berkeley.
Russia and countries of the former Soviet
Union
As a result of a joint Department of Health
and Human Services and White House
conference, the Russian Federation and the
countries of the former Soviet Union have
been targeted for CDC TB control technical
assistance efforts. The number of TB patients
and the levels of drug resistance are increasing
at alarming rates. Contributory factors include
an inability to financially support the previous
infrastructure for TB diagnosis and treatment,
the lack of availability of quality drugs, high
levels of TB transmission in prison settings,
and reluctance to adopt the DOTS strategy as
employed in the US and elsewhere and
recommended by the WHO. The DTBE,
USAID, and WHO are collaborating to
institute basic DOTS programs in two oblasts
(territorial administrative divisions) that have
indicated a willingness to begin the DOTS
strategy, and to strengthen DOTS in Ivanovo
oblast, where a WHO-supported program was
implemented in 1995 but where cure rates
remain unacceptably low. A recent study in
this second oblast has documented further
increases in the levels of multidrug-resistant
(MDR) TB. DTBE will also implement