Although Peru is no longer listed as one of the World Health Organization’s (WHO’s) highest tuberculosis (TB) burden countries, TB remains a serious public health threat in the country.  After becoming the first high-burden TB country to implement Directly Observed Therapy, Short-Course (DOTS) in 1990, Peru experienced a sharp decline in TB incidence over the next decade. While internal issues led to a deterioration of the TB situation in 2004, Peru has maintained its commitment to fighting TB disease.

The USAID TB CARE II project led by University Research Co., LLC (URC) has worked in conjunction with Partners in Health (PIH) in Peru on several core activities including a study on the inclusion of TB in National Health Insurance and an annual fellowship program aimed at assisting TB practitioners in addressing critical MDR-TB challenges.

The inclusion of TB in National Insurance Programs –

Increasingly lower-middle income countries have moved towards adoption of National Health Insurance (NHI) models as a means to support sustainable financing for Universal Health Care. National Health Insurance in the form of government-led, publically supported and/or centrally managed insurance programs in various forms have been introduced in countries such as Brazil, Cambodia, China, Rwanda, Mexico, South Africa, and Thailand and have demonstrated important successes. The impact of these insurance programs on use of tuberculosis (TB) services and outcomes is unclear.

The USAID TB CARE II project led by University Research Co., LLC (URC) in 2011-2012 undertook an examination of how TB is included (or neglected) in the service delivery package in NHI programs and how effectively NHI programs interact with National TB Programs (NTP) and other TB control stakeholders to plan, implement, and measure TB service use. Assessments were conducted in four countries – Peru, Thailand, Philippines, and India – which have adopted publically supported health insurance programs. The four case studies demonstrate that integration of TB services with national health insurance can have a positive effect on access to services and their quality; however, each of the models assessed imposes different types of restrictions which can limit utilization of services.

TB CARE II MDR-TB Fellowship Training Program –

Few countries have managed to stabilize or reverse multidrug-resistant tuberculosis (MDR-TB) epidemic. According to the WHO, MDR-TB occurs in approximately 5.3% of new TB patients, and levels are much higher in those previously treated, such that 20% of retreatment cases are identified as MDR-TB.

A higher morbidity and mortality, long duration of treatment, and general complexities associated with MDR-TB cases, combined with a lack of clinical and programmatic experience among TB practitioners poses significant MDR-TB management challenges. To assist in addressing these critical MDR-TB challenges, TB CARE II offers TB practitioners an opportunity to participate in a yearly PMDT fellowship training in Russia, Lesotho, and Peru.

The MDR-TB epidemic is far from uniform within regions, and each region faces a variety of challenges. In Peru, the MDR-TB epidemic has been compounded by poverty, perceived isolation, and stigmatization. The PMDT fellowships are tailored to the context in which they are hosted to address the specific needs of the fellows working in these areas.