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Tuberculosis Control in the Eastern Mediterranean Region: Progress Report 2009 / World Health Organization

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Tuberculosis Control in the Eastern Mediterranean Region: Progress Report 2009 / World Health Organization WHO-EM/TUB/256/E Tuberculosis control in the Eastern Mediterranean Region Progress report 2009 WHO-EM/TUB/256/E Tuberculosis control in the Eastern Mediterranean Region Progress report 2009 WHO Library Cataloguing in Publication Data World Health Organization. Regional Office for the Eastern Mediterranean Tuberculosis control in the Eastern Mediterranean Region: progress report 2009 / World Health Organization. Regional Office for the Eastern Mediterranean p. WHO-EM/TUB/256/E 1. Tuberculosis, Pulmonary – prevention and control – economics – Eastern Mediterranean Region 2. Regional Health Planning 3. National Health Programs 4. Research I. Title II. Regional Office for the Eastern Mediterranean (NLM Classification: WF 300) © World Health Organization 2010 All rights reserved. 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 expressed 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. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +202 2670 2535, fax: +202 2670 2492; email: [email protected]). Requests for permission to reproduce, in part or in whole, or to translate publications of WHO Regional Office for the Eastern Mediterranean – whether for sale or for noncommercial distribution – should be addressed to WHO Regional Office for the Eastern Mediterranean, at the above address: email: [email protected] . Design, layout and printing by WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt Contents Foreword ............................................................................................................................................. 5 Executive summary ............................................................................................................................ 7 1. Introduction ................................................................................................................................... 9 2. Epidemiology ................................................................................................................................... 9 2.1 Estimated burden of tuberculosis ................................................................................................................ 9 2.2 Case notification ........................................................................................................................................... 10 2.3 Achievement of case detection and treatment success targets .......................................................... 10 2.4 Other challenges ........................................................................................................................................... 10 3. Main activities in DOTS expansion and enhancement .......................................................18 3.1. Political commitment .................................................................................................................................. 18 3.2 Case detection through quality-assured tuberculosis laboratory network ..................................... 18 3.3 Standardized treatment with supervision and patient support .......................................................... 26 3.4 Medicine supply and management ............................................................................................................. 29 3.5 Monitoring and evaluation ......................................................................................................................... 33 4. Challenges and high-risk groups ...............................................................................................40 4.1 Collaborative HIV/tuberculosis activities ................................................................................................. 40 4.2 Management of multidrug-resistant tuberculosis .................................................................................. 43 4.3 Management of household contacts ......................................................................................................... 49 5. Health system strengthening .....................................................................................................52 5.1 Leadership and governance ......................................................................................................................... 52 5.2 Finance ............................................................................................................................................................. 53 5.3. Workforce ...................................................................................................................................................... 53 5.4 Health service provision .............................................................................................................................. 57 5.5 The Practical Approach to Lung Health initiative .................................................................................. 58 5.6 Health information system ........................................................................................................................ 58 6. Public–private mix ......................................................................................................................59 6.1 Background ..................................................................................................................................................... 59 6.2 Achievements ................................................................................................................................................. 60 6.3 Challenges ....................................................................................................................................................... 64 6.4. Recommendations ........................................................................................................................................ 64 7. Empowering people with tuberculosis and communities ...................................................65 7.1 Advocacy, communication and social mobilization ................................................................................. 65 7.2 Technical support ........................................................................................................................................... 65 7.3 Advocacy products ....................................................................................................................................... 66 7.4 Case studies in six countries ..................................................................................................................... 67 7.5 Other advocacy activities ........................................................................................................................... 67 7.6 The Eastern Mediterranean Partnership to Stop TB ............................................................................. 67 8. Operational research ..................................................................................................................68 8.1 Operational research studies ..................................................................................................................... 68 8.2 Use of new technology and strategies ..................................................................................................... 68 8.3 Research capacity strengthening ............................................................................................................... 68 8.4 Research dissemination .............................................................................................................................. 72 8.5 Recommendations ....................................................................................................................................... 72 9. Impact measurement ...................................................................................................................72 9.1 The WHO Global Task Force on Tuberculosis Impact Measurement ................................................ 72 9.2 Progress to date in the three strategic areas of work .......................................................................... 73 References .........................................................................................................................................76
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