Tuberculosis in Mozambique: Where Do We Stand?

Abstract

Tuberculosis (TB) is a global health concern, and Mozambique is one of the few high burden tuberculosis countries where the estimated TB incidence has not improved in recent years. The objective of this review is to provide a snapshot of the current situation of the TB epidemic in Mozambique, highlighting the main epidemiological features and particularities of TB care and control in the country. Despite several efforts aimed at improving diagnosis and treatment success, the overall burden of TB, HIV-TB, and multidrug-resistant (MDR)-TB is enormous, with high TB-associated mortality. Improving surveillance is a key step for understanding the TB epidemic in the country, and the first TB prevalence survey is underway. Overall, drug-sensitive and MDR-TB notifications have increased markedly over the last 5 years, likely due in part to a more active case finding approaches, but the diagnosis gap is still substantial. The roll-out of Xpert technology to decentralized settings is improving TB diagnosis in the country, particularly for MDR-TB. Although some progress has been made in TB control in Mozambique, the challenges for TB control and elimination are enormous. More actively finding cases at health facilities and in communities via contact tracing, improving national surveillance/monitoring and evaluation systems, expanding TB molecular diagnosis, implementing shorter MDR-TB treatments, and improving HIV-TB case management (including rigorous TB screening and higher coverage of preventive therapies in people living with HIV) are considered key priorities for the National TB Control Program.