The following missive was posted to the Stop TB online eforum by Project Director Roumyana Benedict

March 30, 2006

Greetings,

On behalf of the CIDA- funded Public Health Strengthening Project in Guyana, executed by the Canadian Society of International Health.

This CAN $5.6m project is running in its third year and has a large TB prevention and control component. This has built capacity for the National TB program, implemented DOTS and entirely set up laboratory capacity in several regions in Guyana to respectively do concentrated smears diagnosis as well as TB culture in the capital region. The following document was drafted by Dr Lafleur, our technical coordinator, re World TB Day celebrations in Guyana.

Theme: Actions for Life: towards a world free of tuberculosis

Aims and objectives

The aim of World TB Day 2006 is to mobilize support for the fight against TB. By mobilizing communities, raising awareness, encouraging governments and donors to invest in TB control, and calling for strengthened commitment, we can ensure that TB is placed prominently on the global agenda and is eliminated by 2050.

In order to accelerate social and political action to stop the unnecessary spread of TB around the world, World TB Day 06 aims to:

• Engage government and donor agencies for strengthened commitment
• Promote TB control and care
• Serve as an advocacy and educational opportunity
• Increase public awareness, engagement and support in the fight against TB
• Place TB higher on the international agenda

Guyana's National TB Control Programme

In 1994 the Ministry of Health in Guyana recognized the need for a revised TB control programme based on the WHO/ PAHO recommendation and the World Health Resolution of 1993 declaring TB a global emergency.

The aim of the new Tuberculosis Control Programme (TCP) is to reduce the incidence and prevalence of tuberculosis in Guyana so that it no longer poses a public health threat. The general objective is to decrease the morbidity and mortality caused by tuberculosis in the Guyanese population.

Targets of the Programme

• To detect 75% or more of existing cases of sputum smear positive tuberculosis in population
• To treat and cure 85% of newly identified sputum smear positive tuberculosis in population
• To prevent the emergence of acquired drug resistant M. tuberculosis

Underlying principals

Tuberculosis is largely a disease of the poor; those at lower socio-economic levels are mainly affected. As a general principal, the Government of Guyana, through the National Tuberculosis Control Programme, will provide all treatment and essential services free of charge to all persons seeking such services.

Epidemiology of TB in Guyana

Tuberculosis is historically one of the five most important infectious diseases in Guyana. During colonial period TB reportedly had devastating impact on many indigenous communities. There was progressive decline in the burden of TB in Guyana during the 1970's and 1980's. Tuberculosis resurged in Guyana during the 1990's closely linked to poverty, economics and the emergence of HIV/AIDS . Tuberculosis continues to pose a significant public health threat to Guyana.

It is estimated that 14 % of Guyana's population (approximately 115, 800 persons) is infected with the TB bacilli of which some 2 900 are active cases (persons who are ill). The annual incidence of tuberculosis is approximately 81 per 100 000 inhabitants and the mortality rate 3.25 per 100 000.

Tuberculosis affects persons of both sexes mainly those between the ages of 25 and 44 years old. In all age groups however, males are more affected by TB than females.

The sex, age and geographic distribution of TB mirrors that of HIV. Approximately 13 % of TB patients in Guyana are also infected with HIV. This twinning of the TB and HIV epidemics poses a significant challenge to the control of TB in Guyana.

DOTS in Guyana

Guyana began implementing the DOTS strategy as a pilot project in 2002 in Georgetown and a few villages in regions 1 and 8. In 2003, the implementation of DOTS was extended to the Georgetown Prisons. From 2004, the CIDA funded Public Health Strengthening Guyana project facilitated the expansion of the DOTS programme to Regions 4 (East Coast and East Bank Demerara), 10, 6 and 3. Guyana now has a complement of 17 dedicated DOT outreach workers in the four regions who are contributing to controlling TB in Guyana. DOTS outreach workers regularly visit patients in their homes and observe them taking their anti-TB medicines.

The Public Health Strengthening Guyana project has also worked closely with the National TB Programme (NTP), Georgetown Public Hospital Corporation (GPHC), New Amsterdam Hospital and Linden Hospital Complex to set up sputum microscopy laboratories at these facilities and in the case of GPHC the capacity to do cultures to grow the TB bacillus. TB patients can now have their sputum checked for the TB bacillus in regions where they live.

During 2006-2007 the NTP will further expand the DOTS programme to Regions 2, 5 and the hinterland regions of Guyana. Guyana's National TB Control Programme has gotten off to a good start with its DOTS strategy.

For the DOTS strategy to be successful in Guyana it requires further integration into the primary health care services and the participation of families and community members.