REPORT OF THE JOINT WHO-ECDC REVIEW OF TUBERCULOSIS PREVENTION, CONTROL AND CARE IN LITHUANIA 17‒21 October 2016 ABSTRACT At the request of the Ministry of Health of the Republic of Lithuania, the WHO Regional Office for Europe has conducted jointly with the European Centre for Disease Prevention and Control a review of tuberculosis prevention, control and care in Lithuania. In this document recommendations and suggestions for action that the review team has developed which will enable relevant country stakeholders to improve current TB prevention, control strategies and interventions can be found. 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CONTENTS SUMMARY ............................................................................................................................................................ 1 BACKGROUND ....................................................................................................................................................... 5 EPIDEMIOLOGY OF TB IN LITHUANIA ................................................................................................................................. 5 TB PREVENTION AND CONTROL GOVERNANCE MEASURES ................................................................................... 7 POLICIES ...................................................................................................................................................................... 7 HEALTH CARE FINANCING ................................................................................................................................................ 8 DRUG AVAILABILITY ....................................................................................................................................................... 9 DATA REGISTRATION COMMUNICATION, MONITORING AND EVALUATION SYSTEMS ................................................................... 11 INTEGRATED CARE DELIVERY MODELS WITH PARTICULAR ATTENTION TO DRUG RESISTANT TB ......................... 12 TB SERVICE DELIVERY ................................................................................................................................................... 12 CASE-FINDING ............................................................................................................................................................ 13 INPATIENT TREATMENT SERVICES .................................................................................................................................... 15 OUTPATIENT TREATMENT AND CARE SERVICES ................................................................................................................... 16 TREATMENT OUTCOME ................................................................................................................................................. 19 TB/HIV .................................................................................................................................................................... 20 TB IN PRISONS ............................................................................................................................................................ 21 HUMAN RESOURCES CAPACITIES ..................................................................................................................................... 21 TB INFECTION PREVENTION AND CONTROL ......................................................................................................... 23 ENVIRONMENTAL MEASURES ......................................................................................................................................... 23 PARTNERSHIP, COORDINATION AND COLLABORATION OF TB CONTROL WITH NATIONAL AND INTERNATIONAL STAKEHOLDERS INCLUDING THE MINISTRY OF JUSTICE ........................................................................................ 24 ANNEX 1 TERMS OF REFERENCE ........................................................................................................................... 28 ANNEX 2 METHODOLOGY AND SOURCES OF INFORMATION FOR THE NATIONAL TB PROGRAMME EVALUATION ............................................................................................................................................................................. 29 ANNEX 3 PROGRAMME OF THE VISIT ................................................................................................................... 30 ANNEX 4 MISSION ORGANIZATION AND PARTICIPANTS ...................................................................................... 33 ANNEX 5 LIST OF PARTICIPANTS OF THE REVIEW ................................................................................................. 34 REPORT OF THE JOINT WHO-ECDC REVIEW OF TUBERCULOSIS PREVENTION, CONTROL AND CARE IN LITHUANIA page iv Abbreviations ART antiretroviral therapy ARV antiretrovirals BCG bacillus Calmette-Guérin DOTS directly observed treatment and short-course ECDC European Centre for Disease Prevention and Control EU European Union GDP gross domestic product GP general practitioner GUV germicidal ultraviolet LPA line probe assays LSMU Lithuanian University of Health Sciences LTFU lost to follow-up MDR multidrug-resistant NGO nongovernmental organization NHIF National Health Insurance Fund NPHC National Public Health Centre OST opioid substitution therapy SMCA State Medicines Control Agency TB tuberculosis UV ultraviolet WHO World Health Organization XDR extensively drug resistant REPORT OF THE JOINT WHO-ECDC REVIEW OF TUBERCULOSIS PREVENTION, CONTROL AND CARE IN LITHUANIA page 1 Summary The World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) recommend that all their Member States have their tuberculosis (TB) prevention, control and care interventions reviewed every 3 to 5 years, irrespective of TB and multidrug-resistant TB (MDR TB) incidence. Following an invitation from the Ministry of Health of Lithuania, the WHO Regional Office for Europe led a joint WHO/ECDC TB and MDR TB prevention, control and care review in Lithuania from 17 to 21 October 2016. The review team included the Regional Office coordinator for communicable diseases and programme manager for TB, HIV/AIDS and viral hepatitis, the Baltic countries’ focal point officer for the Regional Office, WHO consultants (an MDR TB treatment expert and civil society representative), the head of the ECDC TB programme and representatives from the Ministry of Health of Lithuania. The TB review was carried out within the framework of implementation of the biennial cooperation agreement between the Regional Office and the Ministry of Health for 2016/2017 and with the involvement of the WHO office in Lithuania. The mission objectives were to document achievements and challenges, and develop recommendations and suggestions for action in the areas of: 1. governance and stewardship of TB prevention and control interventions; 2. human resource capacities and development plans; 3. treatment and integrated care delivery models, with particular attention to drug resistant TB patients; 4. TB infection prevention and control measures at health care facilities, including the recently built inpatient penitentiary facility; and 5. partnership, coordination and collaboration on TB control with national and international stakeholders, including the Ministry of Justice. Ultimately, the review team was expected to provide the Ministry of Health with a comprehensive set of recommendations and suggestions for action to improve TB prevention, control and care, based on their observations and