International standards for tuberculosis care (1)/ Normes internationales applicables au traitement de la tuberculose (1).

Summary

The purpose of the International standards for tuberculosis care (the standards) is to describe a widely accepted level of care that all practitioners, public and private, should seek to achieve in managing patients who have, or are suspected of having, tuberculosis. The standards are intended to facilitate the effective engagement of all care providers in delivering high-quality care for patients of all ages, including those with smear-positive, smear-negative and extrapulmonary tuberculosis, tuberculosis caused by drug-resistant Mycobacterium tuberculosis complex (M. tuberculosis) organisms and tuberculosis combined with HIV infection.

The basic principles of care for people with, or suspected of having, tuberculosis are the same worldwide: a diagnosis should be established promptly and accurately; standardized treatment regimens of proven efficacy should be used, together with appropriate treatment support and supervision; the response to treatment should be monitored; and the essential public health responsibilities must be carried out. Prompt, accurate diagnosis and effective treatment are not only essential for good patient care; they are also the key elements in the public health response to tuberculosis and are the cornerstone of tuberculosis control. Thus, all providers who undertake evaluation and treatment of patients with tuberculosis must recognize that not only are they delivering care to an individual; they are also assuming an important public health function that entails a high level of responsibility to the community as well as to the individual patient.

Although government programme providers are not exempt from adherence to the standards, non-programme providers are the main target audience. It should be emphasized, however, that national and local tuberculosis control programmes may need to develop policies and procedures that enable non-programme providers to adhere to the standards. Such accommodations may be necessary, for example, to facilitate treatment supervision and contact investigations.

In addition to health-care providers and government tuberculosis control programmes, both patients and communities are part of the intended audience. Patients are increasingly aware of, and expect that their care will measure up to, a high standard. Having generally agreed-upon standards will empower patients to evaluate the quality of care they are receiving. Good care for individuals with tuberculosis is also in the best interests of the community.

The standards are intended to be complementary to local and national tuberculosis control policies that are consistent with WHO recommendations. They are not intended to replace local guidelines and were written to accommodate local differences in practice. They focus on the contribution that good clinical care of individual patients with or suspected of having tuberculosis makes to population-based tuberculosis control. A balanced approach emphasizing both individual patient care and public health principles of disease control is essential to reduce the suffering and economic losses from tuberculosis.

The standards should be viewed as a living document that will be revised as technology, resources and circumstances change. As written, they are presented within a context of what is generally considered to be feasible now or in the near future.

The standards are also intended to serve as a companion to and support for the Patients' charter tuberculosis care. This charter specifies patients' rights and responsibilities and will serve as a set of standards from the point of view of the patient, defining what the patient should expect from the provider and what the provider should expect from the patient.

Standards for diagnosis

Standard 1. All people with otherwise unexplained productive cough lasting 2-3 weeks or more should be evaluated for tuberculosis.

Standard 2. All patients (adults, adolescents and children who are capable of producing sputum) suspected of having pulmonary tuberculosis should have at least 2, and preferably 3, sputum specimens obtained for microscopic examination. When possible, at least 1 early morning specimen should be obtained.

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