My selected public health initiative is the national action plan (NAP) for combating multidrug-resistant tuberculosis (MDR-TB). The United States (U.S.) initiated the NAP against the MDR-TB to expand global efforts to fight the disease, save lives, and prevent its spread both in the U.S. and worldwide. The NAP to combat the MDR-TB identifies a set of targeted interventions that address the core domestic and global challenges posed by MDR-TB (The United States Agency for International Development [USAID], 2020). The main goals of the NAP include strengthening domestic capacity to combat MDR-TB, improving the international capacity and collaboration against MDR-TB, and accelerating basic and applied research and development to combat MDR-TB (De Vries et al., 2017). For more information about NAP, click:
The rise in drug-resistant TB and the outbreaks of MDR-TB pose serious underlying problems in the health care infrastructure in the U.S. For instance, there is an increasing proportion of TB in people who were born in other countries or who are homeless, who have a mental illness or substance use, or other socioeconomic or medical problems, such as HIV, that make compliance with treatment difficult (De Vries et al., 2017; Nash et al., 2021). Thus, cultural concepts about illness causation and associated behaviors should be considered priorities to facilitate improvement in the initiative performance. Also, unethical exposure of TB patients to discriminative issues due to prejudice and bias from health care workers may negatively impact the initiative (Nash et al., 2021). Socioeconomic and patient factors such as behavior, demographic characteristics, and attitudes can lead to unfavorable MDR-TB treatment outcomes. Also, cases of unfavorable treatment outcomes may give rise to further transmission of MDR-TB, risking the development of extensive drug resistance (De Vries et al., 2017).
In the U.S., there is already political and regulatory support for the fight against MDR-TB. In collaboration with the world health organization (WHO), there has been a political will to enhance policy community cohesion (Sakamoto et al., 2019). Also, community health workers, including public health nurses, play a crucial role in reducing the MDR-TB burden globally. The contribution of public health workers in disease detection and management through regulation has resulted in a rapid decline in MDR-TB prevalence (Sakamoto et al., 2019; Nash et al., 2021).
The current health care legislation necessitates the need for TB surveillance, reporting, and vaccination (Global Health Agency, 2021). The U.S. government’s global TB efforts have increased through funding having legal support. In 2021, for instance, the U.S government released 332 million dollars to enhance the global fight against TB. Currently, USAID serves as the lead implementing agency for the U.S. global TB efforts, reaching more than 50 countries worldwide (Global Health Agency, 2021). Additionally, the current health care legislation has enhanced bilateral TB programs in sub-Saharan Africa and South Asia to accelerate detection, treatment, and scale-up prevention of MDR-TB (Global Health Agency, 2021). Thus, such U.S. involvement through regulation can enhance the fight against MDR-TB.
The U.S. government initiated the NAP program in the global effort to fight MDR-TB. Cultural and ethical issues such as patient behaviors and discrimination should be considered for the effective implementation of the NAP initiative. Also, the political and legal support of the MDR-TB initiative has enhanced its implementation through increased funding. Lastly, the current health care legislation on TB surveillance, testing, and vaccination has resulted in the decline of MDR-TB cases worldwide.
De Vries, G., Tsolova, S., Anderson, L. F., Gebhard, A. C., Heldal, E., Hollo, V., … & Van der Werf, M. J. (2017). Health system factors influencing the management of multidrug-resistant tuberculosis in four European Union countries-learning from country experiences. Bio-Med Central Public Health, 17(1), 1-12. https://dx.doi.org/10.1186%2Fs12889-017-4216-9
Global Health Agency (2021). The U.S. government and global tuberculosis efforts. https://www.kff.org/global-h