When I was the Global AIDS Coordinator running the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), I visited Haiti on numerous occasions after the earthquake hit.  PEPFAR established a “one-stop-shop” strategy in Haiti, which offered not only care for HIV/AIDS, but TB screening, Cholera diagnosis and treatment, nutrition counseling and routine check-ups for hypertension, diabetes, lipid elevation and coronary artery disease as well.  In 2014, Haiti reached an historic milestone in its HIV/AIDS response by achieving universal access to treatment.

While the HIV/AIDS treatment results exceeded all expectations, the same was not true for tuberculosis. Even before the earthquake, Haiti had the highest tuberculosis incidence in the Americas and it’s estimated that nearly 40% of people with TB disease remain undiagnosed.  There is also a concern of growing TB drug resistance in Haiti, estimated by the World Health Organization (WHO) to consist of 2% of new and 12% of retreatment TB cases.  According to a paper published by the Bulletin of the WHO in May 2015, the TB rate is “nearly 10-fold higher than the regional incidence of 30 per 100,000 – and higher than the overall incidence of the world’s 22 high burden countries (166 per 100,000).”  The paper also noted that researchers tested people for TB in an internally displaced persons camp between 2010 and 2011 and then again between 2011 and 2013. Over the two periods, the number of new cases detected grew from 693 per 100,000 to an alarming 1,165 per 100,000.

TB is curable.  We can and must do better.

As with HIV/AIDS. the U.S. government arrived in Haiti after the earthquake to help assist the embattled national TB program, which was grappling with interrupted service and care delivery, damaged laboratories and disrupted supply chains for needed drugs.  PEPFAR, working closely with the Centers for Disease Control and Prevention’s (CDC) Division of Tuberculosis Elimination, the USAID TB office and other international and US government partners, provided a host of services, including improving TB case detection (drug sensitive and multidrug resistant TB) and treatment and rebuilding and strengthening laboratory systems.

Five years after the earthquake that devastated the country, Haiti is still feeling the aftershocks.  TB is one of those aftershocks. WHO just announced that TB has passed AIDS as the leading killer worldwide.  And TB is curable.  We can and must do better.