Tuberkuliozė: tikslai ir iššūkiai naujoje Lietuvos sveikatos programoje

Abstract

The goals of the Lithuanian Health Programme (1998-2010) tuberculosis (TB) section were achieved, majority of planned measures successfully implemented, however, Lithuania ranks last or among the last on the European Union (EU) countries’ list by the spread of majority of TB epidemic indicators. It is a signal for the reconsideration of TB programme’s strategic goals, aims and measures in order to decrease the lag behind the EU countries. The matter in question is the continuity of the former Lithuanian Health Programme (LHP) and which new goals and aims should be included in a new LHP. Along with the main epidemic indicators (TB incidence, morbidity and mortality), which should be compared with corresponding EU countries mean in order to achieve it at the end of the LHP (2020), it is proposed to leave the non-achieved goal from the previous LHP – to cure more than 85 % of newly detected smear positive TB cases and increase this indicator to 90% by 2015. Non-achievement of this indicator incurs substantial financial costs to the country, because of poor cure of new cases increases amount the repeatedly treated TB cases and multi-drug resistant cases among them, which are considerably more complicated to cure, expensive and take longer time. That is why the decrease of a number of multi-drug resistant TB cases by one third by the end of the LHP (2020) as the effectiveness indicator is proposed as the third goal of the TB programme. The author proposes the aims and necessary measures to implement in order to achieve the main goals of the new LHP. One of the objectives is to implement the provision of the STOP TB strategy to provide patients with all necessary TB drugs fully free of charge. The importance of non-interrupted supply of second-line TB drugs, incentives for primary health care providers for sputum investigation, detection of smear positive TB case and cure of such cases are discussed as well. Other issues discussed in the article are: recommendations to screen TB patients for HIV and vice versa - to investigate HIV positive people for TB, notification of countries reference TB laboratory; strengthening the management of the National TB programme by clearly defining obligations of all participants and ensuring full financing of National TB programme.