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<p> The vertical program to control tuberculosis in the 1950’s through 1960’s helped the development of the horizontal program of Universal Health Coverage launched in 1961 in Japan. Vertical and horizontal intervention do not compete each other but collaborate with each other. The same should be true for the present day context of global health, namely vertical intervention for tuberculosis, HIV/AIDS and malaria control and the horizontal UHC intervention.</p>
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The proportion of foreign-born people among the newly notified tuberculosis (TB) patients has been increasing in recent years and potentially poses a new challenge to TB control in Japan. In this report, we analysed the data from the Japan TB surveillance system between 2007 and 2014 to gain an overview of the trends and characteristics of foreign-born TB patients in Japan. We found that the proportion of foreign-born TB patients was especially high among the younger age groups – 44.1% among the 20–29 years age group in 2014. The largest groups of foreign-born patients were from China and the Philippines; however, the number of those from Nepal and Viet Nam was on the rise. Students comprised the second largest professional category group for TB after regular workers, and its proportion increased over the study period. Compared to Japan-born TB patients, foreign-born patients were more likely to be diagnosed through routine medical check-ups. Treatment successes and patients still on treatment were significantly lower among foreign-born patients than their Japan-born counterparts; and transferred-out and unknown outcomes were higher. Our results indicated that distinctive subgroups within the foreign-born population in Japan, especially students and regular workers, might have a higher risk of developing TB. Measures to ensure early diagnosis and treatment adherence should be adapted to such populations.
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"Go to the people" composed by James Yen or Yen Yang Chu is well known as an instructive poem or credo for rural reconstruction workers in various versions. One version commonly used includes the part of ‘when the task is done, people remark we have done it ourselves.’, but the authorized version by his successor does not include this part. The author tried to explore the roots of the poem and each version through interviewing with key people who knew Dr. Yen and using other information. The author concludes that Yen expressed his message in various ways according to the audience, and understanding the philosophy and spirit behind is most important.
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<B>Background</B><br>The national tuberculosis (TB) control program established Phnom Penh as a pilot area for TB and human immunodeficiency virus (HIV) infection collaborative activities because of the high prevalence of HIV among patients with TB.<br><B>Process</B><br>In 2005, we provided transportation fees so that patients could travel to an operational district referral hospital for HIV counseling and testing by dispatched counselors. However, only around 10.3 patients with TB (range 0-21) per month in all 4 operational districts made use of this service. In 2006, we modified the program by providing HIV counseling and testing by four trained TB/HIV coordinators in TB wards. Thereafter, in-depth, individual, semi-structured interviews were conducted with the TB staff (not the coordinators) of 18 health facilities from April through November 2006 to identify problems in the current TB/HIV collaborative activities in Phnom Penh and to investigate ways for further improving the program.<br><B>Results</B><br>TB staff members encouraged their patients to undergo an HIV test under directly observed treatment, short course. Some TB staff lacked confidence to discuss HIV issues because they lacked sufficient HIV/ acquired immunodeficiency disease syndrome (AIDS) knowledge. Furthermore, there was no formal referral structure between TB and HIV services or sharing of information on the treatment of patients co-infected with TB/HIV with the antiretroviral treatment clinic.<br><B>Conclusions</B><br>We started the program to enable TB patients to receive HIV counseling and testing at the same venue as they received TB treatment. However, problems such as low confidence among TB staff in discussing HIV/AIDS and weak collaboration between TB and HIV services were identified. We found that training of TB staff, development of Information, Education and Communication (IEC) materials, regular meetings among stakeholders, and encouragement for the TB/HIV coordinators to supervise all TB/HIV activities in their operational districts were needed to improve the program.
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Tuberculosis (TB) is a global public health problem. The HIV⁄AIDS epidemic negatively affects tuberculosis control in many countries. The United Nations has set the Millennium Development Goals (MDGs) aiming to halve TB prevalence and mortality by the year 2015. In this paper, the authors summarize the global situation of TB associated with HIV⁄AIDS (TB⁄HIV), WHO‘s interim policy on TB⁄HIV, as well as the status and needs of social science research. The authors reviewed two major social interventions which are critical for TB control in HIV high prevalence settings, namely those to reduce stigma and those to promote adherence to TB⁄HIV medication. The review suggests that more social science research should be implemented in resource limited countries.