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Best Practices in Prevention, Control and Care for Drug-resistant Tuberculosis (WHO/EURO, abstract, edited)

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  • Best Practices in Prevention, Control and Care for Drug-resistant Tuberculosis (WHO/EURO, abstract, edited)

    [Source: World Health Organization, Regional Office of Europe, full PDF document: (LINK). Extracts.]


    Best Practices in Prevention, Control and Care for Drug-resistant Tuberculosis

    A resource for the continued implementation of the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011–2015


    Abstract

    The WHO European Region has the highest proportion of multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) patients in the world. In response to this alarming problem, the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011–2015, was developed for all 53 Member States and endorsed at the sixty-first session of the WHO Regional Committee on 15 September 2011. In the two years since the implementation of the plan, much progress has been made, however critical challenges also remain. In order to improve the transfer of knowledge and experiences between countries, and help in improving the health system approach, the TB and M/XDR-TB Control Programme of the WHO Regional Office for Europe launched an initiative to collect examples of best practices in M/XDR-TB prevention, control and care. Submission of best practices was open to all stakeholders in the Region, and examples were collected from May to August 2013. In total, 82 best practices were submitted from 30 countries. All practices, for which there was enough information (76 practices), were evaluated against defined selection criteria by an expert committee. The selected best practices were compiled to form this compendium. This compendium is intended to be a resource for stakeholders at all levels of health systems for the continued implementation of the Consolidated Action Plan in the Region.


    Keywords

    BEST PRACTICES - CONTROL, INFECTION - DELIvERY OF HEALTH CARE – organization and administration - EXTREMELY DRUG-RESISTANT TUBERCULOSIS – SURvEILLANCE - TUBERCULOSIS, MULTI-DRUG RESISTANT


    Address requests about publications of the WHO Regional Office for Europe to: Publications, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark

    Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest ).

    © World Health Organization 2013

    All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization.

    ISBN 978 92 890 0046 8


    Scientific Editors

    Dr Masoud Dara, Programme Manager, TB and M/XDR-TB, WHO Regional Office for Europe / Ms Colleen Acosta, Temporary Adviser, TB and M/XDR-TB, WHO Regional Office for Europe


    Acknowledgements

    The WHO Regional Office for Europe would like to thank the ministers of health, country representatives, and national and international experts from the Region who contributed to and/or provided support for the submission of best practices received during this initiative.

    Special thanks go to members of the Green Light Committee/Europe, Technical Advisory Group of the WHO Regional Office for Europe and the TB Europe Coalition who participated in the selection committee of the best practices submitted.

    From the TB and M/XDR-TB programme Dr Pierpaolo de Colombani and Dr Andrei Dadu provided expert input. Ms Nonna Turusbekova, WHO temporary adviser, assisted us with the work.


    Foreword

    Countries of the WHO European Region have been at the forefront of tuberculosis (TB) prevention and control for centuries; however, the emergence of multidrug-resistant and extensively drug-resistant TB (M/XDR-TB) in the Region has seriously complicated the efforts to achieve the Millennium Development Goals. Despite the steady decline of TB incidence, our Region has faced the largest proportion of M/XDR-TB among individuals diagnosed with TB, requiring a stronger link between health system strengthening and M/XDR-TB control to adequately prevent and treat this deadly disease. In response to this alarming problem, I established a special project in 2011 to prevent and combat M/XDR-TB with a health systems focus for better health outcomes. In consultation with the Member States, civil society organizations, communities and partners, a Consolidated Action Plan was developed as a roadmap for Member States, the WHO Regional Office for Europe and partners to scale up the comprehensive response and to work towards the prevention and control of M/XDR-TB. In September 2011, with unprecedented support and commitment from all 53 Member States, the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011–2015 and its accompanying resolution EUR/RC61/R7 were endorsed at the sixty-first session of the WHO Regional Committee for Europe in Baku, Azerbaijan.

    This plan, with technical support from my office, takes account of new diagnostic techniques, patient-centred models of care and tailored services for vulnerable populations. Full implementation of the plan is projected to avert the emergence of 250 000 new MDR-TB cases and 13 000 XDR-TB cases and save US$ 7 billion.

    As we mark two years since the implementation of the Consolidated Action Plan, much progress has been made. The MDR-TB detection rate, the proportion of TB notification among health-care workers and the default rate among new laboratory-confirmed TB patients have all been improved.

    The percentage of M/XDR-TB patients enrolled in treatment has significantly improved from 63% to 96%. However, critical challenges also remain. The percentage of MDR-TB among re-treated cases, coverage of first-line drug susceptibility testing and the treatment success rate of MDR-TB patients still remain below their targets.

    Several countries have made strides in their progress and response to M/XDR-TB. These successes are a product of outstanding work by Member State national TB control programmes, nongovernmental and partner organizations. It is this work that is exemplified by the best practices presented in this compendium. The successes of the Consolidated Action Plan thus far and the work of partner organizations serve as a foundation for TB prevention, control and care as we move towards the framework of the new European health policy, Health 2020.

    Many lives depend on the targets yet to be met to prevent and combat M/XDR-TB. These targets are achievable; however, continued commitment and sustained funding are imperative. At all levels of Member State health systems, sharing of knowledge and experiences between countries is a critical tool in formulating and improving health strategies. Therefore, I encourage all stakeholders to look to this compendium as a resource in the further implementation of the Consolidated Action Plan and our efforts to beat this insidious disease.

    Zsuzsanna Jakab, WHO Regional Director for Europe


    Preface

    In line with the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011–2015, the WHO Regional Office for Europe, in collaboration and coordination with WHO country offices and partners, has provided guidance and technical assistance to Member States to improve prevention, control and care for TB, M/XDR-TB and TB/human immunodeficiency virus (HIV) coinfection. These efforts are closely linked to health system strengthening efforts in the Region. The work has been guided by the WHO Regional Director for Europe’s Special Project to Prevent and Combat M/XDR-TB through a close collaboration between the Division of Communicable Diseases, Health Security and Environment and the Division of Health Systems and Public Health.

    Areas of assistance have included governance; planning and programme management; technical assistance in diverse areas including airborne infection control, surveillance, monitoring and evaluation, health financing, development of human resources capacity, quality-assured laboratory diagnosis guidelines and policy development; provision of high-quality medicines through the Global Drug Facility; state-of-the-art clinical and programmatic guidance by the Green Light Committee (Europe); and advocacy, communication and social mobilization.

    Specifically, the Regional Office has also assisted 18 high-priority countries (15 high burden MDR-TB countries, plus Romania, Turkey and Turkmenistan) to develop national M/XDR-TB response plans based on their TB drug-resistance data, resource availability, HIV burden and other national specificities. In addition, the European TB Laboratory Initiative was launched in 2012 to scale up quality diagnosis, and task forces have been established to improve prevention and control of childhood TB, develop the role of surgery in TB treatment, draft a consensus document on cross-border TB control and care, and assess and address health systems and social determinants of TB in line with Health 2020.

    Treatment coverage for MDR-TB has increased from 63% of estimated MDR-TB patients in 2009 to 96% in 2011, although the treatment success for MDR-TB is as low as 48.5% and below the 75% target due to a lack of efficient medicines, suboptimal programme performance, an increase in the proportion of TB cases with HIV coinfection, high prevalence of XDR-TB in some settings, inadequate patient-centred approaches and lack of a functioning mechanism for cross-border care. Of the 15 countries with high MDR-TB burdens, 9 had achieved universal access to MDR-TB treatment and care by September 2013.

    Six other Member States are progressing towards the provision of treatment for all patients.

    We hope that this compendium of best practices in M/XDR-TB prevention, control and care will inspire Member States through sharing of successful policy directions and concrete country experiences and, above all, by demonstrating that it is possible to turn the tide against the M/XDR-TB epidemic through a strong and sustained political commitment towards evidence-based prevention and treatment practices.

    Dr Hans Kluge, Special Representative of the WHO Regional, Director for Europe on M/XDR-TB, Director, Division of Health Systems and Public Health / Dr Guenael Rodier, Director, Division of Communicable Diseases, Health Security and Environment


    Executive summary

    The WHO European Region has the highest proportion of M/XDR-TB patients in the world.

    In order to address this alarming problem, in September 2011, with support from all 53 Member States of the WHO European Region, the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011–2015 and its accompanying resolution EUR/RC61/R7 were endorsed at the sixty-first session of the WHO Regional Committee for Europe in Baku, Azerbaijan.

    The plan, which has six strategic directions and seven areas of intervention, is aligned with the Global Plan to Stop TB 2011–2015, and has the following specific targets to be met by the end of 2015: decrease by 20% the proportion of MDR-TB among re-treatment patients, diagnose at least 85% of all estimated MDR-TB patients, and successfully treat at least 75% of all patients notified as having MDR-TB.

    As we approach two years since endorsement of the Consolidated Action Plan, much progress has been made. However, critical challenges also remain. For example, the treatment success rate of MDR-TB is still below its target. In order to improve the transfer of knowledge and experiences between countries, and help in improving the health system approach, in May 2013 the TB and M/XDR-TB Control Programme of the WHO Regional Office for Europe, launched an initiative to collect examples of best practices in M/XDR-TB prevention, control and care in the Region.

    Submission of best practices was open to all stakeholders (ministries of health, national TB control programmes, partners and nongovernmental organizations working to combat tuberculosis and M/XDR-TB in the Region), and examples were collected over a 4-month period, from May to August 2013.

    In total, 82 best practices were submitted from 30 countries. All practices, for which there was enough information (76 practices), were evaluated against defined selection criteria by an expert committee. The selected best practices were compiled to form this compendium.

    This compendium is intended to be a resource for stakeholders at all levels of health systems for the continued implementation of the Consolidated Action Plan in the Region. Descriptions of the best practices are the work of the authors and institutions listed. Best practices will continue to be collected after publication of this compendium, and shared on an online platform linked to the Regional Office web site (http://www.euro.who.int ).

    (...)


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