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Haiti makes solid progress in reducing TB

Posted on by Macarthur Charles, MD, PhD, CDC’s TB Advisor in Haiti
CDC CD Dave Lowrance consulting with two TB doctors at the original Partners in Health facility in Cange
CDC CD Dave Lowrance consulting with two TB doctors at the original Partners in Health facility in Cange

On World Tuberculosis Day, a personal account from the frontline, Haiti, which has the highest reported rates of TB in the western hemisphere.

Macarthur Charles, MD, PhD, CDC’s TB Advisor in Haiti
Macarthur Charles, MD, PhD, CDC’s TB Advisor in Haiti

There is a certain poetic symmetry to my return to Haiti this year as tuberculosis (TB) advisor. It was exactly 10 years ago that I first set foot on Haitian soil as a doctor. The little boy who left the little town of Deschapelles in Haiti’s Artibonite Valley years ago, was back, and now able to give back to his people.

There’s nowhere else I’d rather be right now and no other job I’d rather do. Sadly, expertise in TB is badly needed here in Haiti, which is very poor, has relatively high rates of HIV, a weak health infrastructure, and the highest reported TB prevalence rates in the western hemisphere – 300 cases per 100,000 people. The Dominican Republic, with which Haiti shares the Caribbean island of Hispaniola, has just half the number of cases. 

So the situation here is of obvious concern in global health security terms. As Dr. Frieden and others stressed at the mid-February launch of the Global Health Security Agenda, the frontline is wherever diseases break out. Disease knows no borders, and we live in an age of increased mobility. But more specifically, Haiti is known to be one of the top ten contributors of TB cases to the United States. To combat TB in the U.S., we have to fight it abroad, especially in countries like Haiti where multidrug-resistant (MDR) TB has emerged as a particular concern since the earthquake struck in 2010.

Dr. Charles and a patient at the field TB hospital in 2010
Dr. Charles and a patient at the field TB hospital in 2010

The quake damaged TB hospitals, displaced 1.5 million people and forced them to crowd into cramped quarters – a classic situation conducive to the transmission of an infectious disease. I was here in Port au Prince the whole of 2010. At the main (and, at the time, only functioning) field TB hospital in the Haitian capital, we were seeing twice as many TB patients as before the quake. We were seeing many more children with TB. Most of the new TB cases were HIV-negative. CDC helped reinforce surveillance in crowded camps in Port au Prince in the months after the earthquake.

Four years on, we’re making solid progress in the battle to reduce TB prevalence 25% by 2015. This is an important public health goal for the U.S. government, Haiti’s Ministry of Public Health and Population (MSPP), and other partners. CDC is contributing to this by working on better diagnostics, better treatment, and better surveillance – the holy trinity of TB diagnosis and treatment. We’re providing support to two TB hospitals badly damaged by the quake – SanaPaP, as it’s colloquially called, in Port au Prince and Sigueneau in Gressier in the Ouest department – . We’re also working with the National Laboratory and the National TB Program to implement a country-wide surveillance program.

CDC’s TB Advisor, Dr. Macarthur Charles (Left), and Dr. Charles Vilbrun (Right), GHESKIO IMIS TB Medical Coordinator (Haiti MOH MDR TB hospital) are pictured at the innovative GHESKIO HIV and MDR-TB facility in Haiti whose open-air layout, creative design, state-of-the-art laboratory and focus on the quality of life of patients has been lauded in the New York Times and Wired Magazine.
CDC’s TB Advisor, Dr. Macarthur Charles (Left), and Dr. Charles Vilbrun (Right), GHESKIO IMIS TB Medical Coordinator (Haiti MOH MDR TB hospital) are pictured at the innovative GHESKIO HIV and MDR-TB facility in Haiti whose open-air layout, creative design, state-of-the-art laboratory and focus on the quality of life of patients has been lauded in the New York Times and Wired Magazine.

On the last day of February, I attended the launch of a pilot scheme for MDR TB surveillance in the Ouest department, where a third of all cases are concentrated. As I stood there, I thought back to my childhood and the Albert Schweitzer Hospital in Deschapelles, where I got all my shots and which was one of the first hospitals in the world to run a hugely successful community care program for TB patients.

If Haiti could do that back then, I thought, it can do even more today.

Posted on by Macarthur Charles, MD, PhD, CDC’s TB Advisor in HaitiTags , , , , , ,

4 comments on “Haiti makes solid progress in reducing TB”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Have you actually seen drug-resistant TB or are you only concerned that it may occur? Since the earthquake, the HIV kids at my home who had previously been treated successfully for TB, have been treated with a second round of INH. Is this due to the fears of recurrence? I laud your efforts and love the fact that you, Dr. McArthur, have returned to Haiti to help your people. I wish you much success in all your efforts.

    We have actually seen and treated patients with drug-resistant tuberculosis in Haiti. Yes, providing INH to HIV-positive children after successful completion of TB treatment is done to reduce the risk of recurrence. I hope they’re also receiving antiretroviral therapy. Thank you for your comments. — Dr. Macarthur Charles, CDC-Haiti TB Coordinator

    Could you provide TB incidence rate for Haiti in 2014? How are the trends for the past 5 years? Thank you

    Jacques Clerville

    Hi Dr Macarthur
    I am well aware of many issues health care workers and patient are facing in Haiti ,I am maternal /child nurse ,actually in USA we are promoting breast feeding ,we encountered patient with HIV and those patient are well informed about the benefits of breast feeding for self and baby and the risks of passing the virus to their newborn child through the breast milk ,In fact breast feeding is not an option for them .
    In Haiti mostly in the Country side what other alternative those mother have to prevent the newborn from getting the HIV virus/ TB as well with the economic hardship those patients are going through .

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