Stopping Tuberculosis in Peru

Internationally recognized for its outstanding directly observed treatment, short-course (DOTS) program, today 100 percent of Peru’s population has access to tuberculosis treatment.

Between 1990 and 2000, Peru succeeded in reducing the incidence of tuberculosis by an estimated 7 percent per year in areas implementing DOTS. Despite its successes and the fact that Peru accounts for only 5 percent of the population of Latin America, it reports 16 percent of all tuberculosis cases in the region, with a rate that is second only to Brazil’s.

The rise of multidrugresistant tuberculosis is particularly troubling, given that it is impervious to the most readily available drugs and its victims thus remain infectious over a longer period of time.

Peru was one of the first countries in the world to address multidrug-resistant tuberculosis with the implementation of DOTS+, which introduces second line treatment. However, at an estimated treatment cost of US$10,000 to US$16,000 per patient over approximately two years, the treatment of multidrug-resistant tuberculosis is beyond the reach of most people in Peru and throughout the developing world.

In 1998, the World Health Organization, Médecins Sans Frontières, Harvard Medical School and other partners established a Working Group on DOTS+ for multidrug- resistant tuberculosis.

One of the group’s objectives was to negotiate with pharmaceutical companies to reduce the cost of second-line tuberculosis drugs, and it was successful in lowering the price of a course of drugs to US$3,000 per patient. This led to the creation of the Green Light Committee. Composed of the World Health Organization, the International Union Against Tuberculosis and Lung Disease, the U.S. Centers for Disease Control and Prevention, the Royal Netherlands Tuberculosis Association, Harvard Medical School and Estonia’s National Tuberculosis Program, the Green Light Committee offers countries an opportunity to purchase second-line drugs for tuberculosis at deeply discounted prices after demonstrating that they have the infrastructure in place to distribute the drugs.

The Global Fund grant of US$20 million over two years will finance the treatment of multidrug-resistant tuberculosis for 2,000 patients and their families. By extending existing multidrug-resistant tuberculosis treatment to every patient who needs it over the next two years, the program supported by the Global Fund will co-finance the largest multidrug-resistant tuberculosis intervention in history. Moreover, the policy of the Global Fund requiring multidrug-resistant tuberculosis medications be purchased through the Green Light Committee will optimize the use of funds and bolster a critical purchasing mechanism.

The grant will also aid Peru in its goal to increase its tuberculosis detection rate from 94 to 100 percent. The program will focus on populations considered at high risk, including prisoners and residents of the urban areas of Lima and Callao. Financing from the Global Fund will enable the Ministry of Health to develop community-based surveillance programs, to initiate compulsory testing for tuberculosis for all prisoners and to administer first- and second-line tuberculosis treatment to all prisoners diagnosed with the disease.

The program has been developed with full cooperation between the government and non-governmental organizations, and CARE International is poised to serve as the Principal Recipient.