Review of the Tuberculosis Programme in Bosnia and Herzegovina

A review of the TB programme in Bosnia and Herzegovina was organized by the WHO Regional Office for Europeon 11–22 November 2013. The review was requested by the Minister of Civil Affairs in view of the end of thesupport of the Global Fund to Fight AIDS, Tuberculosis and Malaria foreseen for September 2105. The reviewidentified the major challenges and main recommendations for improvement.

Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan.

In recent years, Kazakhstan has become an important destination for primarily undocumented seasonal workers from Uzbekistan. In a context of high tuberculosis (TB) incidence, TB treatment is provided free for all residents in Kazakhstan, but migrants rarely access these services. This paper reports findings from a qualitative study conducted with migrants, TB patients and health care workers between July and September 2008 to understand the mechanisms that impede migrants' access to care. Findings describe three structural contexts--the employment, legal and health care contexts - which act in concert to render migrants vulnerable to exploitative work conditions and cause a series of barriers to health care. These conditions contribute to increased exposure to TB, heightened risk of reactivation due to weakened immunity, treatment-seeking delays, and increased severity of disease. Seasonal migration patterns also contribute to treatment interruption, which constitutes a risk for the creation of drug resistance. Using the theory of structural violence coupled with the concept of cumulative vulnerability, this paper analyzes how illegality interacts with exploitation and social marginalization to produce vulnerability to TB and restrict access to treatment.

Review of the National Tuberculosis Programme in Ukraine: 10–22 October 2010

Ukraine has the second-highest burden of tuberculosis (TB) in the WHO European Region. In February 2010, the Minister of Health asked WHO to review the National Tuberculosis Programme and make recommendations that could be used to help develop the Programme plan for 2012–2016. On 10–22 October, 13 international and 23 national experts reviewed documents, visited institutions and interviewed people in eight oblasts and Kyiv. The reviewers found a range of problems, from inconsistent implementation of the Stop TB Strategy between and within oblasts to TB services designed for health providers, not patients. Non-supportive legislation and an outdated health system, based on hospital care and with inflexible financing, limit current efforts to improve services. Action is urgently needed to stop the increase in multidrug- and extensively drug-resistant TB (MDR-TB/XDR-TB) cases, the acceleration of HIV co-infection and high nosocomial TB transmission. The report of the review includes 14 recommendations made to the Government, the Ministry of Health and its partners.

Default from tuberculosis treatment in Tashkent, Uzbekistan; who are these defaulters and why do they default?

BACKGROUND: In Tashkent (Uzbekistan), TB treatment is provided in accordance with the DOTS strategy. Of 1087 pulmonary TB patients started on treatment in 2005, 228 (21%) defaulted. This study investigates who the defaulters in Tashkent are, when they default and why they default. METHODS: We reviewed the records of 126 defaulters (cases) and 132 controls and collected information on time of default, demographic factors, social factors, potential risk factors for default, characteristics of treatment and recorded reasons for default. RESULTS: Unemployment, being a pensioner, alcoholism and homelessness were associated with default. Patients defaulted mostly during the intensive phase, while they were hospitalized (61%), or just before they were to start the continuation phase (26%). Reasons for default listed in the records were various, 'Refusal of further treatment' (27%) and 'Violation of hospital rules' (18%) were most frequently recorded. One third of the recorded defaulters did not really default but continued treatment under 'non-DOTS' conditions. CONCLUSION: Whereas patient factors such as unemployment, being a pensioner, alcoholism and homelessness play a role, there are also system factors that need to be addressed to reduce default. Such system factors include the obligatory admission in TB hospitals and the inadequately organized transition from hospitalized to ambulatory treatment.

Health-care seeking behaviour for TB symptoms in two provinces of Uzbekistan.

In Uzbekistan, mass X-ray screening for TB is still used. The groups targeted are broad and include at least 50% of the population. Of all pulmonary TB cases, 73% are reported to be detected by this method. However, in this study of 85 randomly selected pulmonary TB patients, only 16% confirmed were been detected through this method. Having known risk factors for TB did not increase the likelihood of its being detected, which highlights the need to revise the current screening policy.

Tuberculosis-HIV co-infection in Kiev City, Ukraine.

In 2004, we tested all patients with newly diagnosed tuberculosis (TB) for HIV in Kiev City. The results were compared to information from medical records of 2002, when co-infection prevalence was 6.3%. Of 968 TB patients, 98 (10.1%) were HIV infected. TB-HIV co-infection is increasing, especially in injecting drug users.

TB manual: National Tuberculosis Programme guidelines

This manual for tuberculosis, although written for Poland, aims at being a generic manual. It provides guidelines for tuberculosis control, which can be adapted and made more specific if need be. The manual is written against the background of tuberculosis control in the former socialist countries with a vertically organized and specialized system. The manual for tuberculosis gives information about the disease and the strategy and organization of a national control programme. It deals with case definitions and treatment categories. Although the manual is based on the WHO strategy for tuberculosis control, following the five key elements as defined and illustrated by the descriptions of diagnosis, treatment and recording and reporting system, it gives more information than just that. There is a chapter on the diagnosis, treatment and prevention of tuberculosis in children, often a neglected aspect of tuberculosis control. It also deals with difficult clinical management problems, such as the adverse effects of treatment, the management of drug-resistant tuberculosis and the combination of TB/HIV. Finally, the management of tuberculosis in groups at risk and health education are discussed. It is expected that this manual will be of help to all NTPs which are changing their control strategies