Public-Private Mix for TB Care and Control: A Toolkit

Engaging all relevant health care providers in TB care and control through public-private mix approaches is an essential component of the World Health Organization’s Stop TB Strategy. This toolkit provides specific guidance to national tuberculosis programs on working with diverse care providers based on country experiences. [adapted from author]

Primary Health Care Staff's Perceptions of Childhood Tuberculosis: A Qualitative Study from Tanzania

This study explored primary health care staff’s perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania. [from abstract]

Expanding the Role of Nurses in TB Prevention, Care, and Treatment

The aim of this document is to set out the issues, challenges, and strategies for scaling up the contribution of nursing to tuberculosis (TB) prevention, detection, care, and treatment. It argues that scaling up nursing roles in TB prevention, detection, care, and treatment, as well as involvement in key policy and decision making, is the cornerstone of effective national TB programs. [from author]

Missed Opportunities in TB Diagnosis: a TB Process-Based Performance Review Tool to Evaluate and Improve Clinical Care

This study describes a novel method to review and evaluate clinical performance in TB management and for evaluating tuberculosis (TB) control at the point of care using a process-based performance review tool to identify missed opportunities for early and accurate TB diagnosis. This tool is a teaching strategy where clinicians retrospectively review patient records to evaluate crucial clinical actions, and has been shown to improve clinical performance. [from author]

Joint WHO ILO UNAIDS Policy Guidelines for Improving Health Workers' Access to HIV and TB Prevention, Treatment, Care and Support Services

Despite being workers on the front line responding to the public’s HIV and TB care needs, health workers themselves often do not have access to HIV and TB services. These guidelines aim to protect, retain and empower health workers in dealing with the dual threat of HIV and TB and reinforce good practicies for health workers who are living with HIV and/or TB. [adapted from introduction]

Infection Control and the Burden of Tuberculosis Infection and Disease in Health Care Workers in China: a Cross-Sectional Study

Hospitals with inadequate infection control are risky environments for the emergence and transmission of tuberculosis (TB). This study evaluated TB infection control practices, and the prevalence of latent TB infection and TB disease and risk factors in health care workers in TB centers in Henan province in China. [from abstract]

Research Training Needs in Peruvian National TB/HIV Programs

This article sought to systematically assess the research training needs of health care professionals working at Peruvian governmental institutions leading HIV and tuberculosis control and among senior stakeholders in the field. [from abstract]

Tuberculosis Management by Private Practitioners in Mumbai, India: Has Anything Changed in Two Decades?

The objective of this research was to study prescribing practices of private practitioners in the treatment of tuberculosis, two decades after a similar study conducted in the same geographical area revealed dismal results. [from abstract]

Public-Private Mix for DOTS Implementation: What Makes It Work?

The objective of this article is to compare the processes and outcomes of four pulic-private mix project on DOTS implementation for tuberculosis control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Keny; and Pune, India. [from abstract]

Private Pharmacists: the Missing Link in TB Control

India has the highest incidence of tuberculosis (TB) in the world. The Government’s TB programme uses Directly Observed Treatment Short course to supervise patients’ treatment. However an estimated 40-50 per cent of TB treatment is accessed through private pharmacists. A challenge is to engage these pharmacists in TB control. [from author]

Private Practitioners and Public Health: Weak Links in Tuberculosis Control

Information on health expenditure suggests that most poor countries have a large and growing private medical sector. Surveys indicate that the private sector is an important source of care, even for poor people and even where public services are widely available. Experts believe that private practitioners manage a large proportion of the unreported majority of tuberculosis cases. [adapted from author]

Cost and Cost-Effectiveness of Smear-Positive Tuberculosis Treatment by Health Extension Workers in Southern Ethiopia: A Community Randomized Trial

In this study, we aimed to determine the cost and cost-effectiveness of involving health extension workers in tuberculosis treatment in Southern Ethiopia. This paper presents an ancillary cost-effectiveness analysis of data from a randomized control trial. [adapted from introduction]

Referrals for Positive Tuberculin Tests in New Health Care Workers and Students: a Retrospective Cohort Study

Documentation of test results for latent tuberculosis infection is important for health care workers and students before they begin work. A negative result provides a baseline for comparison with future tests. A positive result affords a potential opportunity for treatment of latent infection when appropriate. This study sought to evaluate the yield of the referral process for positive baseline tuberculin tests, among persons beginning health care work or studies. [from abstract]

Planning the Development of Human Resources for Health for Implementation of the Stop TB Strategy: a Handbook

This handbook provides background information on the current workforce situation in the health sector and summarizes the issues and challenges; introduces the HRH Action Framework and the Stop TB (tuberculosis) Strategy; applies the Framework to human resource development (HRD) for comprehensive TB control; describes how to prepare a strategic plan for HRD in support of comprehensive TB control; and gives a step-by-step guide on how to develop HRD plans based on the structures and processes described. [adapted from introduction]

Sustainable Scaling Up of Good Quality Health Worker Education for Tuberculosis Control in Indonesia: a Case Study

This article describes a systematic process to develop and implement two strategic action plans focussing on competence development based on specific job descriptions. The approach was a change from only focussing on training, to a broader, long term approach to human resource development for comprehensive TB control. [adapted from abstract]

Unpaid Community Volunteers - Effective Providers of Directly Observed Therapy (DOT) in Rural South Africa

This article reports on the obstacles to care and the outcome of treatment for patients presenting with tuberculosis to four hospitals in the rural South African region of Sekhukhuneland. [adapted from article]

Training Health Care Workers to Promote HIV Services for Patients with Tuberculosis in the Democratic Republic of Congo

This study involves the development and evaluation of training materials for provider-initiated HIV counseling and testing, HIV prevention and integrated primary HIV care and support for use by health care workers involved in the care of patients with TB at the primary health care clinic level in the Democratic Republic of Congo. [adapted from abstract]

Implementing a Community-Based Tuberculosis Program in the Omaheke Region of Namibia: Nurses' Perceived Challenges

The purpose of this survey was to identify nurses' perceived challenges in implementing a community-based TB program in the Omaheke region of Namibia. The HIV pandemic has increased the number of TB patients and increased nurses' workloads, aggravating the burden of TB as a resurgent disease in this region. In order to implement a successful community-based TB program, the patient-related, access-related and knowledge-related challenges, perceived by the nurses, need to be addressed effectively. [from abstract]

Lay Workers in Directly Observed Treatement (DOT) Programmes for Tuberculosis in High Burden Settings: Should They Be Paid? A Review of Behavioural Perspectives

The current global tuberculosis (TB) epidemic has pressured health care managers, particularly in developing countries, to seek for alternative, innovative ways of delivering effective treatment to the large number of TB patients diagnosed annually. One strategy employed is direct observation of treatment for all patients. In high-burden settings innovation with this strategy has resulted into the use of lay community members to supervise TB patients during the duration of anti-TB treatment.

Training of Front-Line Health Workers for Tuberculosis Control: Lessons from Nigeria and Kyrgyzstan

This article compares the quality, quantity and distribution of tuberculosis physicians, laboratory staff, community health workers and nurses in Nigeria and Kyrgyzstan, and highlights implications for (re)training tuberculosis workers in developing countries. [from abstract]

Tuberculosis Suspicion and Knowledge Among Private and Public General Practitioners: Questionnaire Based Study in Oman

Early detection of smear positive tuberculosis (TB) cases by smear microscopy requires a high level of suspicion of TB among primary care physicians. The objective of this study is to measure TB suspicion and knowledge among private and public sector general practitioners using clinical vignette-based survey and structured questionnaire. [from abstract]

Performance-Based Incentives for Health: a Way to Improve Tuberculosis Detection and Treatment Completion?

This paper analyzes the use of financial and material incentives for patients and healthcare providers to improve tuberculosis detection and successful completion of treatment.

Staff Training and Ambulatory Tuberculosis Treatment Outcomes: a Cluster Randomized Controlled Trial in South Africa

The objective of this study was to assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatement in primary care clinics with treatemet success rates below 70%. [from abstract]

Draft National Infection Prevention and Control Policy for TB, MDRTB and XDRTB

The goal of this policy is to help management and staff minimize the risk of TB transmission in health care facilities and other facilities where the risk of transmission of TB may be high due to high prevalence of both diagnosed and undiagnosed TB such as prisons.

Capacity Building: What Does It Mean? Millennium Development Goal 6: Malaria, HIV

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It provides an excellent overview of the challenges of Malaria and HIV/AIDS ; discusses the human resource needs in light of these challenges; and how to build and maintain capacity. [from author’s description]

Tuberculosis among Health-Care Workers in Low- and Middle-Income Countries: a Systematic Review

The risk of transmission of Mycobacterium tuberculosis from patients to health-care workers is a neglected problem in many low- and middle-income countries. Most health-care facilities in these countries lack resources to prevent nosocomial transmission of tuberculosis. [author’s description]

Cost-Effectiveness of Community Health Workers in Tuberculosis Control in Bangladesh

The objective of this article was to compare the cost-effectiveness of the tuberculosis programm run by the Bangladesh Rural Advancement Committee, which uses community health workers (CHWs), with that of the government program which does not use CHWs. [adapted from author]

Can Public-Private Collaboration Promote Tuberculosis Case Detection Among the Poor and Vulnerable?

Private health care plays a central role in health-care provision in many developing countries hat have a high burden of TB. It is therefore encouraging that public-private partnerships (PPM) are being set up in various countries around the world to explore possible interaction between the national TB programs and other partners in the fight against TB. The objective of this review was to use the published literature to asses the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. [abstract]

Treating Tuberculosis in the Private Sector: Cambodia

The Quality Assurance Project undertook a national assessment of private sector tuberculosis (TB) services in Cambodia to improve understanding of private sector practices and the sector’s willingness to participate in efforts to improve TB services. Over 500 respondents, including doctors, pharmacists, drug sellers, and TB patients, participated. In addition, mystery shoppers visited private pharmacists and drug sellers so that the surveyed groups’ reports could be compared to actual experiences.

Human Resources Development for TB Control

A group of individuals with expertise in areas such as TB control, human resources (HR) development and health systems (Annex 1) participated in a Consultation on HR Development for TB Control convened jointly by WHO and the Rockefeller Foundation and held at WHO headquarters in Geneva on 27 and 28 August 2003. This report summarizes the results of the consultation and the recommendations presented to the Second ad hoc Committee on the TB Epidemic.