Context:

Tuberculosis was previously a major health problem in Iran, but the burden of disease has reduced during the last 4 to 5 decades; annual incidence of new smear positive TB cases has reduced from 143 per 100,000 in 1964 to 13 per 100,000 people in 2008. Currently TB affects around 16,000 people and kills around 2,000 people every year in Iran.

Although 23% of the country’s population lives in the target provinces, more than 50% of TB cases are identified in these areas. Socioeconomic and health indicators like education, unemployment, and child mortality rate in most of these provinces are significantly higher than the average national level. In some provinces, like Sistan-o-Balochestan and Khorasan Jonobi, women have undesirable condition regarding health, economy, and education.

There are four key objectives in this project.  These are to:

1. Pursue high quality Directly Observed Treatment Short Courses (DOTS) expansion and enhancement;
2. Address TB/HIV and Multi-drug Resistant TB (MDR-TB) and other challenges;
3. Empower people with TB and their communities;
4. Strengthen programme management capacities.

Project activities are implemented in vulnerable groups residing in high TB incident areas in the country.  These geographic areas include seven provinces that are mostly located in eastern and southern parts of the country. These target provinces are; Hormozgan, Sistan-o-Balochestan, Khorasan Jonobi, Khorasan Razavi, Khorasan Shomali, Golestan and Khozestan.  The project has certain target groups that it focuses its efforts on.  These include those with MDR-TB and TB-HIV, and prisoners. MDR-TB occurs when those with TB fail to take enough medication to fully eradicate the TB bacterium in their body.  Also, TB is the highest cause of death for people with HIV/AIDS.  The prison population is a target group because has a TB prevalence at five times the national average.

Results:

• Reduction in Incidence Rate – On average, 583 new smear positive pulmonary TB cases have been detected in each quarter in year two in target provinces.  Cumulatively, this is a decrease from the number of cases detected in the first year of the project (a decrease from 2370 to 2333).  This is supported by the fact that the WHO has also reported that there has been a 10% decrease in the incidence of TB in the country.  This suggests that the project’s efforts, at least in part, is helping to reduce the overall incidence of TB in Iran.
• Improvement in the treatment success rate – There has been an increase in the treatment success rate.  Of the 2307 new cases identified in 2008, 2021 have been successfully cured or completed their course of treatment.  This is 85.27% of all cases, which is above the project target of 83%.  This is a direct benefit for the project communities as it suggests that they now have access to better health care facilities and procedures.
• Improvement in number of cases detected – According to a 2010 WHO report, there has been a 10% decrease in overall TB incidence rate in the country.  This indicates that there has been good progress in case detection rate at the national level (72.93% compared to 70% at baseline level).
• Increase in DOTS Coverage – On average, 437 patients have received Directly Observed Treatment Short-Course (DOTS) visits in each quarter in year two in target provinces.  These visits are critical in ensuring that cases of TB do not develop in to multiple drug resistant cases (MDR-TB).  Among those that did not receive DOTS visits, 83% were newly diagnosed TB cases and 17% were re-treatment cases.  By increasing access to DOTS treatment, the project has worked to ensure existing cases do not worsen and fully treated.
• Prison Programme – A further notable achievement has been the level of cooperation with the Prisons Office (PO) and the programmes that have been implemented.  Documents received from the PO indicate that there were over 31,000 DOTS visits in year two of Phase I.  Further, the treatment success rate in prisons has also increased and is now at 81.7% of all cases, which is 11.7 percentage points above the baseline of 70%.  In order to effectively put this strategy in place, PO has decided to use TB registry log and e-registry system in Prisons Office; similar to those that which is in place at the national level.  These improvements show that although the interventions are for prisoners, the PO and the Project are working to ensure their medical rights and condition are protected.

Partners:

Global Fund for HIV/AIDS, Tuberculosis and Malaria (Global Fund)

Principle Recipient: United Nations Development Programme (UNDP)

Sub-recipients: Ministry of Health (MOH); Prisons Organisation (PO); and the World Health Organisation (WHO)

Related links:

Project Website: http://www.undp.org.ir/index.php/component/content/article/94

Global Fund Information Page: http://portfolio.theglobalfund.org/Country/Index/IRN?lang=en

For more information contact:

Ahmad Danesh
Project Officer/M&E Analyst
TB Grant
UNDP Iran
Tel: (9821) 2286 0691-4 (x 438)
Fax: (9821) 2286 9547
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Footnotes:

Last updated March 2011