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Organization Contact Information

Name: National TB Programme Ministry of Health Brazil
Street 1: SCS Qd. 04 1st Floor.
Street 2:
City: Brasilia
Province: DF
Post Code: 70.304-000
Country: Brazil
Phone: 55 61 3213 8231
Email: tuberculose@saude.gov.br
Web Site: http://portal.saude.gov.br/portal/saude/profissional/area.cfm?id_area=1527

Focal Point Contact Information

Salutation: Dr.
First Name: Draurio
Last Name: Barreira
Title: National TB Programme Coordinator
Email: draurio.barreira@saude.gov.br
Phone:  

Alternate Focal Point Contact Information

Salutation: Dr.
First Name: Fabio
Last Name: Moherdaui
Title: NTP Deputy Coordinator
Email: fabio.moherdaui@saude.gov.br
Phone:  

General Information

Board Constituency: Countries
Organization Type - Primary: Governmental Organization
Organization Type - Secondary: None
Is your organization legally registered in your country: Yes
Organization Reach: International
Organization Description:
The NTP promotes the fundamental purpose of tuberculosis control in Brazil. It searches the interruption of TB transmission and as consequence to reduce the risk of illness and TB as cause of death. For that, the NTP seeks to identify in a timely manner all tuberculosis patients, especially pulmonary cases (the main form for the transmition of the disease), ensuring the completion of the treatment.

The Brazilian population as a whole is entitled to free diagnosis and treatment in the National Health System. Most cases occur in males and in productive age, further damaging the living conditions of families in need, where TB is most common. TB is clearly a diseaase determined by poverty and so, these factors have a direct connection.

Goals:

The purpose of the NTP is to meet the global targets for tuberculosis control, which is: find at least 70% of estimated cases annually for tuberculosis, and cure at least 85% of them.
 
Total number of staff in your organization: 26 - 50
Number of full-time staff who are directly involved with TB: 26 - 50
Number of part-time staff who are directly involved with TB: 0
Number of volunteers who are directly involved with TB: 0
 
What is your organization's annual budget (USD) dedicated to TB? >$10 MIL
How did you hear about the Stop TB Partnership: Involvement in TB control provision
If you were informed or referred by another partner of the Stop TB Partnership please tell us who:
Why do you wish join the Stop TB Partnership: Information on developments within the TB world
 
Are you a member of a Stop TB national partnership: Brazil
Are you in contact with your national TB programme: Yes
Please tell us how your organization is contributing to your country's national TB control plan:
Since we are the National TB Pogramme our daily basis of work is to achieve the targets in the national TB control plan.
 

Geographical Reach

Which country is your headquarters located in: Brazil
Which WHO region is the main focus of your work: American
Which countries do you do operate in:
(This includes countries you are conducting activities in)
Brazil

Specializations

Advocacy
Delivery of health services and care
Funding, including innovative and optimized approach to funding TB Care
Provision of drugs, diagnostics and commodities
Research and Development
Technical Assistance

Specializations in Countries

Delivery of health services and care Brazil

Contribution

Please tell us how your organization will contribute to the Global Plan to Stop TB by briefly describing its involvement in any of the areas of work listed below:

TB Care Delivery:
One of the strategies of the NTP to reduce morbidity, mortality and transmission of tuberculosis is trainings for multiplying health professionals working in TB control programs in Brazil, aligned to the DOTS strategy. The trainings involve several aspects to control the disease beyond the clinical management qualification in the tuberculin test for the treatment of latent infection and directly observed treatment (TDO).

To compose the DOTS strategy in search of better adherence to treatment, and also follow the recommendations of the National Health Council, the NTP encourages and supports states and cities according to social incentives provided to patients in treatment, such as nutricional support, transportation tickets, among others.

In order to execute its actions the NTP counts on the following areas: Planning and Budgeting; Healthcare Assistence; Strategic Information; Research and International Cooperation; and Advocacy, Communication and Social Mobilization (ACSM).

Aligned with the international guidelines, the NTP believes that community mobilization is an important component to contribute with disease control in Brazil. Based on this premise, in 2007, the NTP established a specific technical area in order to expand the dialogue with community leaders, health councils and legislative authority to qualify the actions of ACMS, focused on human rights and thereby promoting patient rights, reducing the stigma and the prejudice that still affect people with TB and TB/HIV.

Recent years have seen the expansion of community engagement in tuberculosis control in Brazil. In 2008 and 2009 six regional workshops were held involving state and municipal health departments advisers, community leaders of different social movements and NGOs that have joined the fight against tuberculosis.

The National Seminar on Social Control held in 2009, closed this series of meetings with the agreement to proposals for the three spheres of government, related to the strengthening of TB social control besides a higher participation of civil society in the activities developed by the public sector.

As a concrete result of interaction with the social movement, was published Recommendation No. 003 of March 17, 2011, ratified by the National Health Council, which emphasizes the necessity of joint intra and intersectoral, with the support of social movements and the National Congress to create social benefits for people with tuberculosis, in order to expand adherence to treatment and the decrease in dropout rate. It was also published last year, Resolution No. 444 in July 6, 2011, ratified by this Council, concerning the strategies that must be taken to control tuberculosis in Brazil.


Drug-Resistant TB:
Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis

In order to guarantee prevention and control of drug-resistant tuberculosis (including monoresistant tuberculosis, poliresistant tuberculosis, multidrug-resistant tuberculosis and extensively drug-resistant) Brazil has adopted the following strategies:

1) Diagnosis and treatment of tuberculosis is free of charge (offered by the Unified Health System – SUS);

• The access to culture increased substantially from 2009 to 2011. This has promoted a considerable rise on the number of DRTB cases diagnosed;
• All the 26 states and Federal District have access to the drug susceptibility testing (DST) for the first line drugs. The National reference center (Centro de Referência Professor Hélio Fraga) performs the DST for the second line drugs;
• National approach for DRTB diagnosis and treatment addressed to people who are at high risk (health professional and contacts of DRTB cases) and vulnerable population (TB/HIV co-infected, indigenous, homeless people and prisoners);
• The TBDR treatment is prescribed and distributed in state reference centers (tertiary units), where there is adequate infection control, besides the multidisciplinary teams specialized and trained for the care of DRTB patients. Currently Brazil has around 96 reference centers all over the country;

2) Rational use of second-line drugs;

• In the national guidelines for tuberculosis control there is a protocol for DRTB diagnosis and treatment;
• The directly observed treatment is recommended for every TB patient, especially for those who have DRTB. In the last four years, the coverage of Family´s Health Strategy is under expansion and it is increasing substantially the number of patients receiving directly observed treatment;
• The Brazilian National Plan for DRTB (under construction) includes ACSM (Advocacy, Communication and Social Mobilization) with actions for control of TB by the participation of the civil society and people affected by TB;
• TB drugs are bought by the Ministry of Health through a centralized mechanism of acquisition and distribution, with the support of the Green Light Committee (GLC), ensuring the drugs quality required by the WHO;
• Management of second-line drugs is perfomed at National level by the Reference Center (Centro de Referência Professor Hélio Fraga), based on individual reporting and monitoring of cases;
• Drugs for TB treatment (resistant or not) are offered only by the SUS and are not available for sale on private sector.

3) Quality guarantee of the drugs used in Brazil;

• All the TB drugs (national or imported) go through internal quality control (first and second-line). The activity is conducted by the Ministry of Healh/National Tuberculosis Program (MS/NTP) jointly with the National Institute for Quality Control in Health (INCQS) and the National Agency for Health Surveillance (Anvisa);

4) National Plan for Infection Control (2012-2016)

• The National Plan for Infection Control is being drafted and it is going to be an important tool for strengthening the infection control in all the health care facilities;

5) National Plan for DRTB (2012-2016)

• The National Plan for DRTB is in the final stage of drafting (the publication is scheduled for June 2012). The plan contains the national targets for the DRTB control, based on the WHO recommendations and Goals of the Millenium;

6) Monitoring and surveillance system for resistant-TB well structured and dynamic;

• The surveillance system of resistant-TB is online, ensuring early identification of outbreaks, monitoring activities and appropriate treatment to patients, currently held by the National Reference Center (Centro de Referência Professor Hélio Fraga);
• Periodic analysis of the indicators by the MS/NTP;
• Monitoring visits to the federal units by the NTP;
• The new monitoring system for DRTB (SITE-TB), which will be managed by the MS/NTP, is in implementation phase. Besides of the TB surveillance, it will also be used as an important issue for the management of second-line drugs.


TB-HIV:
Brazil has been working to prevent and control TB/HIV co-infection by the following actions:

1. Access to tuberculosis (TB) diagnosis, prevention and treatment for the entire population, especially for those in vulnerable situations (people living with HIV/aids - PLWHA, people in prisons, homeless, indigenous and Health care workers) guaranteed by the Unified Health System (SUS), totally free of charge;

2. Strengthening the Brazilian states network in order to promote integral care of the TB/HIV co-infection in the Health Care Facilities Specialized in HIV/aids. The goal is to make them responsible for following this group of patients. The Health Care Facilities Specialized in HIV/aids offer a multidisciplinary team trained and qualified for the clinical management of people living with HIV/aids.

3. Publication of the new Brazilian Guidelines for Tuberculosis Control (2011), with chapters focused on the management of TB in vulnerable populations (PLWHA, homeless, people in prisons, indigenous and health care workers) and one specific chapter for the management of the TB/HIV co-infection. The guidelines recommends specific actions aimed at PLWHA such as: early access to culture and susceptibility testing, latent TB infection (LTBI) treatment, provision and guidance on the use of Rifabutin in the co-infected population;

4. Ongoing coordination with the Department of Sexually Transmitted Diseases/Aids for activities related to TB/HIV co-infection, in order to strengthen both programs and prioritization of the co-infection

5. All the TB drugs undergo a process of quality, with selection of producers and quality evaluation of the received batches before distribution in the whole country;

6. The National Plan for TB Infection Control is in the final stage of development, a essential tool to strengthen infection control in the health facilities, including the Health Care Facilities Specialized in HIV/aids;

7. Use of the TB/HIV collaborative activities as a mentor for the co-infection control in Brazil. Diffusion of information and the strengthening of the program through meetings, workshops and training;

8.In partnership with USAID, State Health Departments and the Municipal Health Secretariats of Rio Grande do Sul, Santa Catarina and Paraná, the NTP is implementing the TB/HIV Project, in the Southern of Brazil, involving ten Health Care Facilities Specialized in HIV/aids (SAEs) in nine priority municipalities (2011/12). The project aims to strengthen TB/HIV collaborative activities. Among the activities addressed in the project are:

• TB screening for PLWHA
• LTBI diagnosis and treatment;
• TB/HIV co-infection treatment;
• TB/HIV treatment adherence;
• Health education and involvement of civil society;
• Launch of the campaign “TB and HIV don´t match” on the TB week (March 24) in Porto Alegre; Rio Grande do Sul;
• TB infection control measures in health care settings.

9. Recommendation of using the rapid diagnosis testing for HIV as a strategy for early diagnosis and reduction of mortality in the TB/HIV co-infection;

10. Civil society constantly involved in order to increase social control, mainly as related to coinfection. There were several educational basis and empowerment trainings for civil society representatives.

Laboratory Strengthening:
According to Article 1 of the Ordinance No. 2031 of September 23, 2004, the National System of Public Health Laboratories – SISLAB "is a set of national laboratory networks, organized into subnets, by diseases or programs, prioritized by degree of complexity of activities related to healthcare surveillance - including the epidemiological, environmental and health surveillance, besides medical assistence".

Thus, each injury or program has a laboratory system that may consist of local, state and national reference laboratories, according to the specificity of each disease and/or laboratory infrastructure.

The national reference for TB laboratories is the Reference Center Professor Hélio Fraga (Centro de Referência Professor Hélio Fraga), located in Rio de Janeiro. It has the capacity to perform all tests for diagnosis, since smear sputum to second-line drug susceptibility testing (DST), including identification of species. It is also responsible for external quality assessment test (EQA) and technical advisor throughout the state reference laboratory network, the LACEN (Central Public Health Laboratory).

The LACEN are present in all federal states and are responsible for performing cultures for tuberculosis and susceptibility to first-line drugs in their respective states. They are also responsible for coordinating the statewide laboratories network of all diseases of public health interest.

The LACEN conduct training, technically advise for municipal laboratories and perform the quality control of sputum. Occasionally, in order to supply deficiencies in municipal networks, they perform smear sputum for diagnosis.
The municipal laboratories are responsible for diagnosis of tuberculosis by smear sputum. Some of them do culture by the Ogawa method because the decentralization of culture, increasing the number of laboratories performing culture, in highly desirable, since the NTP plans to offer universal culture until 2015.


New Diagnostics:
The NTP, together with Bill and Mellinda Gates foundation, is carrying out an implementation project of rapid diagnosis using GeneXpert in two municipalities with high burden of TB.

The project started in December 2011 and is to be completed (field component) in November 2012.
The NTP is supporting (including financially) a research project on the cost-effectiveness of three technologies to the early detection of drug resistance: LPA (Genotype TBDRplus), automated liquid culture and DST (MGIT 960) and GeneXpert.

The NTP is supporting (including financially) a research project on a nationally developed colorimetric molecular detection kit for TB. The grant has been disbursed and the project is to be initiated.

These research projects have the objective of producing evidence to support their incorporation in the public health sector.

The NTP is negotiating within the Ministry of Health the launching of a grant for the evaluation of a rapid, immunocromatographic identification method for the M. tuberculosis complex, in November 2012.


New TB Drugs:
There are great expectations in the design of new drugs and new regimens. Brazil is a candidate for compassionate use and therefore, has been discussing with the National Health Surveillance Agency (ANVISA) the possibility of authorizing the implementation of this practice.

Fundamental Research:
The NTP and the Ministry of Health themselves are not responsible for fostering fundamental research but, through the Department of Science and Technology (from the MoH) it plays a guiding role towards the Ministry of Science and Technology in which themes of fundamental research should be fostered.

Research:
From 2009 to 2011, the NTP supported a project with the objective of strengthen capacity to conduct operational research at country level. A training course of scientific methodology was conducted in some of the Brazilian States, targeting health professionals working with TB, aiming to provide a theoretical background in research methods to stimulate the conduction of operational research in those settings.

The NTP is currently selecting for funding operational research projects in: (i) geographical mapping of morbidity and mortality in large cities; (ii) Treatment default causes and vulnerable populations; (iii) Evaluation of directly observed treatment implementation and its results.


Declaration

Declaration of interests:
No conflicts of interest were delacred.

Application date: February 17, 2010
Last updated: June 16, 2014