Tuberculosis in the Yungas Area of Bolivia: Use of Peace Corps Volunteers in a Control Program

Between 1967 and 1969 the U.S. Peace Corps, the Bolivian Ministry of Public Health, and the U.S. Agency for International Development cooperated in a pilot project, in the mountainous Yungas area of Bolivia, designed to demonstrate that tuberculosis could be controlled inexpensively by properly supervised lay personnel with short-term technical training. A total of 40,153 people (78 percent of the estimated population) were contacted by specially trained Peace Corps volunteers; 33,481 skin tests were given and read. The positive reactor rate was about 50 percent. More than 90 percent of the negative reactors received BCG vaccine. Active tuberculosis was diagnosed in 1,225 persons, and 1,214 were started on therapy. Overall, less than 30 percent abandoned therapy. Drug toxicity was not a major problem. An area of low incidence was discovered, and the data suggest the presence of hypersensitivity to an atypical mycobacterium in that area. It was concluded that isoniazid combined with thioacetazone is an acceptable therapeutic regimen for extensive use in Bolivia, and that volunteer lay personnel can successfully implement an inexpensive program of tuberculosis control.