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Geneva, Switzerland, WHO, 2009 Nov. 25 p.Based on the latest scientific evidence, the World Health Organization (WHO) has released new recommendations on HIV treatment and prevention and infant feeding in the context of HIV. WHO now recommends earlier initiation of antiretroviral therapy for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.
Strategic approach for the strengthening of laboratory services for tuberculosis control, 2006-2009.
Geneva, Switzerland, World Health Organization [WHO], 2006.  p. (WHO/HTM/TB/2006.364)Bacteriology is one of the fundamental aspects of national tuberculosis (TB) control programmes (NTPs) and a key component of the DOTS strategy. However, TB laboratory services are often neglected components of these programmes. Given existing constraints, it will be difficult for many countries to achieve the global targets of 70% detection of infectious cases and 85% cure of these incidents by the year 2005. Although the global success rate under DOTS has reached 82%, the detection rate of the estimated prevalence has increased at a far slower rate (53% in 2004). In order to improve the case-detection rate, a global strategy for the development and strengthening of TB laboratory networks needs to be implemented urgently. In addition to improving sputum smear microscopy, the strategy recognizes the need to upgrade existing laboratory services and to strengthen/build capacity to perform culture and drug susceptibility testing (DST) in areas experiencing a high burden of acid-fast bacilli (AFB) smear-negative TB associated with human immunodeficiency virus (HIV) infection and to support DOTS-Plus projects. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006 Apr. 20 p. (WHO/HTM/TB/2003.328 Rev.2)The IDA Foundation is a non-profit organization supporting health care in low- and middle-income countries by providing high-quality drugs and medical supplies at the lowest possible price. In addition, IDA provides procurement agency services and offers consultancy and training on topics related to the various aspects of pharmaceutical supply management. IDA is based in the Netherlands and is ISO 9002-2000 and GDP certified. The quality of IDA products is verified in IDA's GcLP-approved laboratories. GLC is a subgroup of the Stop TB Working Group on DOTS-Plus for MDR-TB. GLC has been established to review applications from potential DOTS-Plus pilot projects and determine whether they are in compliance with WHO's Guidelines for establishing DOTSPlus pilot projects for the management of MDR-TB. Projects that are approved will benefit from second-line anti-TB drugs at concessional prices and from technical assistance from the GLC. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006.  p. (WHO/HTM/TB/2006.361)The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug-resistant TB, including MDR-TB. These guidelines offer updated recommendations for TB control programmes and medical workers in middle- and low-income countries faced with drug-resistant forms of TB, especially MDR-TB. They replace two previous publications by the World Health Organization (WHO) on drug-resistant TB. Taking account of important developments in recent years, the new guidelines aim to disseminate consistent, up-to-date recommendations for national TB control programmes and medical practitioners on the diagnosis and management of drug-resistant TB in a variety of geographical, political, economic and social settings. The guidelines can be adapted to suit diverse local circumstances because they are structured around a flexible framework approach, combining a consistent core of principles and requirements with various alternatives that can be tailored to the specific local situation. (excerpt)
Strengthening the teaching of tuberculosis control in basic training programmes. A manual for instructors of nurses and other health-care workers.
Geneva, Switzerland, World Health Organization [WHO], 2006. 95 p. (WHO/HTM/TB/2006.367)Approximately one third of the world's population is infected with Mycobacterium tuberculosis and at risk of developing the disease. Every year, more than 8 million people develop active tuberculosis (TB) and approximately 1.9 million people die. More than 90% of global TB cases and deaths occur in the developing world, where 75% of cases are in the most economically productive age group (15--54 years). Once infected with M. tuberculosis, a person is infected for life. While only 1 in 10 of infected people with healthy immune systems will develop TB symptoms during their lifetimes, infected people with weakened immune systems, such as those with the human immunodeficiency virus (HIV), are at much greater risk of becoming ill with TB. At the same time, multidrug resistance, which is caused by poorly managed TB treatment, is a growing problem of serious concern in many countries throughout the world. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006.  p. (WHO/HTM/ TB/2006.371; WHO/FCH/CAH/2006.7)This document complements existing national and international guidelines and standards for managing TB, many of which include guidance on children. It fills the gaps in the existing materials and provides current recommendations based on the best available evidence. National and regional TB control programmes may wish to revise and adapt this guidance according to local circumstances. This document reflects two important recent policy changes. Firstly, NTPs should record and report two age groups for children (0--4 years and 5--14 years) using the quarterly reporting form. Routine reporting of these two age groups has considerable benefits. Enumerating children with TB is a key step in bringing their management into the mainstream of the Stop TB Strategy as part of routine NTP activities. This age breakdown is crucial in ordering drugs (since child-friendly formulations are particularly important in children aged 0--4 years) and in monitoring of trends in these two distinct age groups (since children aged 0--4 years are the most vulnerable and infection at these early ages indicates recent transmission). In addition, routine NTP data collection will provide valuable and sustainable information on market needs concerning child-friendly formulations of anti-TB drugs. Secondly, the revised recommended dose of ethambutol is now 20 mg/kg (range 15--25 mg/kg) daily. Although ethambutol was previously often omitted from treatment regimens for children, due in part to concerns about toxicity (particularly optic neuritis), a literature review indicates that it is safe in children at this dose. (excerpt)
Instructions for applying to the Green Light Committee for access to second-line anti-tuberculosis drugs.
[Geneva, Switzerland], World Health Organization [WHO], 2006. 15 p. (WHO/HTM/TB/2006.369)Controlling multi-drug resistant tuberculosis (MDR-TB) is one of the six components of the WHO Stop TB strategy. Although prevention must be the highest priority for TB control programmes, many countries have patients with drug-resistant TB who must be treated too. Such countries should take specific measures to gradually incorporate appropriate strategies for treatment of this form of tuberculosis into their programmes and prevent propagation of drug-resistant TB. Misuse of second-line anti-TB drugs results in further resistance to these same second-line drugs, creating incurable forms of tuberculosis. It is imperative that second-line anti-TB drugs are used wisely. The WHO Guidelines For The Programmatic Management of Drug Resistant Tuberculosis (herein after referred to as the Guidelines) provide recommendations for appropriate management of drug-resistant TB so as not to generate further drug resistance. To help programmes develop and implement develop and implement strategies for the management of drug resistant TB, the Green Light Committee for Access to Second-line Anti-tuberculosis Drugs (GLC) was created by WHO and its partners in January 2000. (excerpt)
Challenging, changing, and mobilizing: a guide to PLHIV involvement in country coordinating mechanisms.
Washington, D.C., Futures Group, POLICY Project, 2004 Dec. 99 p.The aim of the handbook is to increase and improve the meaningful participation of PLHIV on CCMs across the world. This development will undoubtedly enhance the ability of the Global Fund to be an effective force in serving the communities most in need and will also contribute to facilitating PLHIV access to Global Fund resources. There are already many useful resources available nationally (though not in every country) and internationally to assist PLHIV in developing various types of skills and knowledge; however, none is specific to PLHIV who are involved in Global Fund CCM processes. We realized during the consultations that we could fill hundreds of pages with useful and relevant information, so instead of duplicating material that already exists, we will refer to it where appropriate. To the greatest extent possible these resources have been included on the CD that accompanies this handbook. (excerpt)
Manila, Philippines, World Health Organization [WHO], Regional Office for the Western Pacific, 1999.  p.Each of the small Pacific island countries has its own characteristics that need specific approaches in the implementation of DOTS strategy. The available tuberculosis guidelines are often too complex and too difficult to adapt. So health managers and health workers of these small countries need to have operational guidelines that are practical and simple to assist them in implementing an effective tuberculosis control programme based on the WHO recommended DOTS strategy. The main objectives of the guidelines are as follows: to guide tuberculosis programme managers in the implementation of DOTS strategy and the control of tuberculosis; to guide health workers and community leaders in identifying and referring suspect cases; and to guide health workers, patients and their families towards achieving a cure. As the guidelines are tested in a variety of different situations in the field, comments would be welcome and will help to improve future editions. Comments can be sent to WHO Regional Office for the Western Pacific, Tuberculosis Programme, Chronic Communicable Disease Unit. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2003.  p. (WHO/CDS/TB/2003.319; WHO/HIV/2003.01)The main aim of the guidelines is to enable the central units of national TB and HIV/AIDS programmes to support districts to plan, coordinate and implement collaborative TB/HIV activities. The guidelines are intended for countries with either an overlapping TB and HIV epidemic or where there is an increasing HIV rate which may fuel the TB epidemic. The WHO “Strategic Framework to Reduce the Burden of TB/HIV" provides the evidence base for these guidelines. The guidelines are designed to implement the interventions as described in this framework. The guidelines reflect lessons learned from TB/HIV field sites including ProTEST with experience from comprehensive TB/HIV health services and interventions. The guidelines are structured in line with the main theme of putting these interventions into action: what to implement, how to implement it and by whom. The health situation is urgent and requires a move away from small scale, often costly and time-limited pilot projects to phased implementation of collaborative TB/HIV activities. Phased implementation will build on experience learned form ProTEST pilot sites. Human and financial constraints make phased implementation necessary. (excerpt)
Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach. Rev. ed.
Geneva, Switzerland, WHO, 2003. 67 p.Currently, fewer than 5% of people in developing countries who need ART can access the medicines in question. WHO believes that at least 3 million people needing care should be able to get the medicines by 2005. This represents almost a tenfold increase. These treatment guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by proposing a public health approach to achieve the goals. The key tenets of this approach are as follows. 1) Scaling-up of antiretroviral treatment programmes with a view to universal access, i.e. all persons requiring treatment as indicated by medical criteria should have access to it. 2) Standardization and simplification of ARV regimens so as to support the efficient implementation of treatment programmes in resource-limited settings. 3) Ensuring that ARV treatment programmes are based on scientific evidence in order to avoid the use of substandard protocols that compromise the outcomes of individual patients and create a potential for the emergence of drug-resistant virus. However, it is also important to consider the realities with respect to the availability of human resources, health system infrastructures and socioeconomic contexts so that clear and realistic recommendations can be made. (excerpt)
The Manager: Management Strategies for Improving Health Services. 2001; 10(4): p..This issue of The Manager offers policymakers and managers of TB programs at all levels a practical, systematic approach to strengthening drug management so that TB drugs reach and are appropriately used by patients. It introduces the drug management cycle and describes how effective drug policies and laws can support this cycle. The issue also explains how specific improvements in drug selection, procurement, distribution, and use, as well as in management support, can help to maintain an adequate flow of TB drugs. (author's)
Geneva, Switzerland, World Health Organization [WHO], 1998. 87 p. (WHO/TB/98.250)Tuberculosis (TB) is common in many prisons worldwide and treatment is often ill-informed and inadequate. In this perspective, the WHO and the International Committee of the Red Cross (ICRC) have joined forces to produce guidelines for the control of TB in prisons. This document presents the results of the collaborative effort of WHO and ICRC. The guidelines, based on recent experience, outline the many obstacles to effective diagnosis and treatment and it gives useful guidance as to how to overcome these obstacles. Outlined into three parts, these guidelines are primarily for prison authorities, policy- makers and decision-makers in relevant ministries, nongovernmental organizations (NGOs) and donor agencies, and National TB Program staff. Part I provides background information on TB and prisons, of particular relevance to prison authorities and decision-makers in relevant ministries. Part II provides guidelines for the control of TB in prisons, of particular relevance to prison health staff. Finally, Part III gives guidance to national prison authorities and NGOs on how to establish a prison TB control program.
Geneva, Switzerland, WHO, Global Tuberculosis Programme, 1997. , 35 p. (WHO/TB/96.216)Drug resistance is becoming an increasing threat to the effectiveness of national tuberculosis programs in many parts of the world. Knowledge of the prevalence of antituberculosis drug resistance is essential for evaluating and improving national tuberculosis control efforts. However, there are few rigorously documented, directly comparable statistics in this area. This document presents guidelines to assist national programs in adopting standardized methods for drug resistance surveillance. This surveillance should adhere to three principles: 1) the sample of specimens should be representative of the patients from the area under study and the sample size should be determined to permit standard epidemiologic analyses, 2) the patient's history should be carefully obtained and available medical records reviewed to clearly determine whether the patient has received prior antituberculosis drugs in order to distinguish between primary and acquired drug resistance, and 3) the laboratory materials for susceptibility testing of antituberculosis drugs should be selected from among those that are internationally recommended. This report includes chapters on choice of drugs, definitions of resistance, laboratories and diagnostic centers, sampling strategies, organization of surveys, intake of patients, the national reference laboratory, and data management and analysis.