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Roadmap to Prevent and Combat Drug-Resistant Tuberculosis

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Roadmap to Prevent and Combat Drug-Resistant Tuberculosis Roadmap to prevent and combat drug-resistant tuberculosis ROADMAP TO PREVENT AND COMBAT DRUG-RESISTANT TUBERCULOSIS The Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the WHO European Region, 2011-2015 Abstract In response to the alarming problem of multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) in the WHO European Region, and in order to scale up a comprehensive response and to prevent and control M/XDR-TB, a consolidated action plan has been developed for 2011–2015 for all 53 Member States of the WHO European Region and partners. The Plan was endorsed by the sixty-first session of the WHO Regional Committee in Baku on 15 September 2011. It has six stra- tegic directions and seven areas of intervention. The strategic directions are cross-cutting and highlight the corporate priori- ties of the Region. The areas of intervention are aligned with the Global Plan to Stop TB 2011–2015 and include the same targets as set by the Global Plan and World Health Assembly resolution WHA62.15, to provide universal access to diagnosis and treatment of MDR-TB. The implementation of the Consolidated Action Plan would mean that the emergence of 250 000 new MDR-TB patients and 13 000 XDR-TB patients would be averted, an estimated 225 000 MDR-TB patients would be diagnosed and at least 127 000 of them would be successfully treated thus interrupting the transmission of M/XDR-TB, and 120 000 lives would be saved. The cost of implementing the Plan is estimated at US$ 5.2 billion. Based on the economic analysis of lives saved and disability-adjusted life years, the Plan should prove to be highly cost-effective. Keywords EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS – diagnosis – prevention and control TUBERCULOSIS, MULTI-DRUG RESISTANT – diagnosis – prevention and control DELIVERY OF HEATLH CARE – organization and administration STRATEGIC PLANNING EUROPE Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 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). ISBN 978 92 890 0246 2 Images: © Maxim Dondiuk, Ivan Chernichckin and Carl Cordonnier. Graphic Design and Production by Phoenix Design Aid A/S, ISO 9001/ ISO 14001 certified and approved CO2 neutral company. © World Health Organization 2011 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. Contents Acknowledgements _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ v Abbreviations _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ v Foreword _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ vi Executive summary _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 Introduction and background _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4 Outline of the Consolidated Action Plan _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9 Strategic directions _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10 Areas of intervention_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10 Milestones _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10 Costs and economic benefits of implementing the Plan _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 11 Expected achievements _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 12 Regional analysis of the strengths, weaknesses, opportunities and threats in relation to M/XDR-TB _ _ _ _ _ _ _ _ _ _ _ _ _ _ 13 Strengths _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 14 Weaknesses _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 14 Opportunities _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 16 Threats _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 18 Areas of intervention (adapted from the objectives of the Global Plan 2011–2015) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 19 1. Prevent the development of M/XDR-TB cases _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 20 1.1 Identify and address social determinants related to M/XDR-TB _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 20 1.2 Improve patient adherence to treatment _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 20 1.3 Increase the efficiency and availability of health financing for TB control_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 20 1.4 Apply the full capacity of PHC services in TB prevention, control and care _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 21 1.5 Consider management of M/XDR-TB contacts _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 21 2.
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