Quality of TB care among people living with HIV: Gaps and solutions.

Tuberculosis (TB) is the leading infectious cause of death among people living with HIV, causing one third of AIDS-related deaths globally. The concerning number of missing TB cases, ongoing high TB mortality, slow reduction in TB incidence, and limited uptake of TB preventive treatment among people living with HIV, all indicate the urgent need to improve quality of TB services within HIV programs. In this mini-review we discuss major gaps in quality of TB care that impede achieving prevention and treatment targets within the TB-HIV care cascades, show approaches of assessing gaps in TB service provision, and describe outcomes from innovative quality improvement projects among HIV and TB programs. We also offer recommendations for measuring quality of TB care.

A case control study of risk factors associated with pulmonary tuberculosis in romania: experience at a clinical hospital of pneumology.

BACKGROUND AND AIM: Tuberculosis (TB) remains a major public health issue in Romania. The aim of the present study was to evaluate the potential demographic, socioeconomic and behavioral risk factors for TB among hospitalized patients in Romania. METHODS: This is a case-control study conducted between March 1st 2014 and March 30th 2015 at Leon Daniello Clinical Hospital of Pneumology, Cluj Napoca. A total of 150 TB patients defined as "cases" were matched for age, sex and county of residence to 150 controls selected from patients attending the same hospital with respiratory diseases other than TB. Data collection was obtained through patient interviews using a structured questionnaire. Factors potentially associated with TB infection were analyzed using univariate and multivariate logistic regression. RESULTS: Factors independently associated with TB were illiteracy (OR=2.42, 95% CI 1.09-5.37), unemployment (OR=2.08, 95% CI 1.23-3.53), low household income (OR=4.12, 95% CI 2.53-6.71), smoking (more than 20 cigarettes per day) (OR=2.12, 95% CI 1.20-3.74), poor knowledge of TB (OR=3.46, 95% CI 1.97-6.07), presence of TB patient in household (OR=4.35, 95% CI 1.42-13.36), prior TB treatment (OR=2.2, 95% CI 1.93-2.5) and diabetes (OR=3.32, 95% CI 1.36-8.08). CONCLUSION: This study provided useful information that might help to develop and adapt effective policies for TB control in Romania.

Access to new medications for the treatment of drug-resistant tuberculosis: patient, provider and community perspectives.

Multidrug-resistant tuberculosis (MDR-TB) is on the rise, and is difficult to treat. The approval of two new drugs, bedaquiline and delamanid, and growing evidence for the use of linezolid, offer renewed hope for addressing MDR-TB. However, access to these medicines remains a significant challenge. These drugs have not been registered for TB in most settings; barriers to preapproval access persist; and high pricing and intellectual property restrictions limit access. Many unanswered research questions about optimal use of these drugs also limit access, particularly for vulnerable populations. This review outlines challenges in accessing drugs encountered from the perspective of clinicians, patients and affected communities, and offers potential solutions.

Review of the national tuberculosis programme in Romania

Romania has the highest incidence of TB in the European Union (EU)/European Economic Area (EEA),representing one quarter of the EU/EEA TB burden. A review of the national TB programme in Romaniawas jointly organized by the WHO Regional Office for Europe and the European Centre for DiseasePrevention and Control, with WHO leading all operations, from 10 to 21 March 2014. The reviewacknowledged the high rates of detection and treatment success achieved among patients with drugsusceptibleforms of TB; it also pointed to the large proportion of patients with multidrug-resistant TB whoare not detected or are poorly treated. The review identified major challenges to be addressed atprogramme level as well as at health system level and gave the Ministry of Health and the national TBprogramme 14 main recommendations for improvement.

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation.

Without better vaccines it is unlikely that tuberculosis (TB) will ever be eliminated. An investment of ∼ €560 million is considered necessary to develop a new, effective vaccine in the European Union (EU). However, less is known about the costs of TB disease in the EU. We performed a systematic review of literature and institutional websites addressing the 27 EU members to summarise cost data. We searched MEDLINE, EMBASE and Cochrane bibliographies for relevant articles. Combining direct and indirect costs, we arrived at an average per-TB case costs in the original EU-15 states plus Cyprus, Malta and Slovenia of €10 282 for drug-susceptible TB, €57 213 for multidrug resistant (MDR)-TB and €170 744 for extensively drug resistant (XDR)-TB. In the remaining new EU states, costs amounted to €3427 for drug-susceptible TB and €24 166 for MDR-TB/XDR-TB. For the 70 340 susceptible TB cases, 1488 MDR-TB and 136 XDR-TB cases notified in 2011 costs of €536 890 315 accumulated in 2012. In the same year, the 103 104 disability-adjusted life years caused by these cases, when stated in monetary terms, amounted to a total of €5 361 408 000. Thus, the resulting economic burden of TB in the EU clearly outweighs the cost of investing in more efficient vaccines against TB.

Обзорная оценка Национальной программы по туберкулезу в Республике Молдова: 4–15 февраля 2013 года

Республика Молдова входит в число 18 приоритетных стран для борьбы с туберкулезом (ТБ) в Европейском регионе ВОЗ и 27 стран мира с высоким бременем ТБ с множественной лекарственной устойчивостью (МЛУ-ТБ). Согласно классификации Глобального фонда для борьбы со СПИДом, туберкулезом и малярией, Республика Молдова занимает второе место среди 110 стран по уровню средств, выделяемых на душу населения. Вторая фаза реализации консолидированного гранта в рамках раундов 8 и 9 была одобрена в декабре 2012 года с условием представления на следующем этапе обзорной оценки Национальной программы по туберкулезу и стратегического плана (на основе этой обзорной оценки) по усилению приверженности лечению и снижению числа пациентов, результаты лечения которых неизвестны. Серьезную озабоченность вызывал тот факт, что, как показала оценка, осуществление мер вмешательства и поддержка оказали лишь ограниченное воздействие на улучшение результатов лечения. В октябре 2012 года Министерство здравоохранения обратилось в Европейское региональное бюро ВОЗ с просьбой обеспечить координацию обзорной оценки Национальной программы по туберкулезу.

Review of the National Tuberculosis Programme in the Republic of Moldova: 4–15 February 2013

The Republic of Moldova is among the WHO European Region’s 18 high-priority countries for tuberculosis (TB) control and among the world’s 27 high multidrug-resistant TB (MDR-TB) burden countries. The Global Fund to Fight AIDS, Tuberculosis and Malaria ranks the Republic of Moldova second among 110 countries by level of funds provided per capita. The second phase of implementation of its consolidated Round 8 and 9 TB grant was approved in December 2012 with a request to submit, at a later stage, a review of the National TB Programme and a strategic plan (based on the review) to improve treatment compliance and reduce loss to treatment follow up. A major concern highlighted was that supported interventions have shown only a limited impact in improving treatment success. In October 2012 the Ministry of Health asked the WHO Regional Office for Europe to coordinate the review of the National TB Programme.The review took place from 4 to 15 February 2013. Twelve international and seven national experts participated, visiting 18 districts and three municipalities, the autonomous region of Gagauzia and the Transnistria region. The review team developed a strategic plan to improve treatment compliance and reduce loss to treatment follow up immediately after the review; this appears as part of the roadmap attached to this report (Annex 1). The team members conveyed their key findings and recommendations at the end of the mission to the Minister of Health.