An adequate strategy for the control of tuberculosis (TB) globally calls for a comprehensive approach to address all of the main constraints facing TB control, including emerging challenges, as well as the main risk factors influencing the incidence of TB, including socioeconomic and environmental aspects. Consequently, the scope of activities undertaken by national TB control programmes has greatly increased The purpose of this handbook is to bring together in summarized form the issues, recommended strategies and practical measures involved in addressing each of the components of the WHO Stop TB Strategy.

The handbook has been prepared principally for use by national TB control programme managers and staff, as well as partner organizations and professionals involved in implementing TB control activities. Readers are provided with a concise account of the essential elements of a comprehensive TB control programme and an overview of the full range of activities that need to be implemented to achieve the TB control targets set for 2015. This publication is the successor to the WHO Tuberculosis Handbook published in 1998.

Contents

• Preface
• Acknowledgements
• Abbreviations
• Introduction
• Part I. Tuberculosis care and prevention
  • 1. Case detection
    • 1.1 Case definitions of tuberculosis
    • 1.2 Case detection of drug-resistant tuberculosis
    • 1.3 Case detection of tuberculosis and human immunodeficiency virus
    • WHO guidelines
    • Key references
  • 2. Treatment of tuberculosis patients
    • 2.1 Standardized regimens
    • 2.2 Treatment of drug-resistant tuberculosis
    • 2.3 Treatment of tuberculosis in HIV-infected patients
    • 2.4 Treatment support
    • WHO guidelines
    • Key references
  • 3. Recording and reporting
    • 3.1 Recording and reporting system
    • 3.2 Referral and transfer
    • Key references
  • 4. Tuberculosis in children
    • 4.1 Special features of tuberculosis in children
    • 4.2 Strategic approach to preventing and managing tuberculosis in children
    • 4.3 Main activities to be carried out by the national TB control programme for implementation of interventions to prevent and manage tuberculosis in children
    • WHO guidelines
    • Key references
  • 5. Contact investigation
    • 5.1 Standards for contact investigation
    • 5.2 Definitions for contact investigation
    • 5.3 Process of contact investigation
    • 5.4 Provision of treatment
    • 5.5 Follow-up of treatment
    • 5.6 Monitoring
    • 5.7 Tuberculosis and international air travel
    • WHO guidelines
    • Key references
  • 6. Infection control in health-care settings
    • 6.1 Risk of transmission of tuberculosis in health-care settings
    • 6.2 Infection control strategies
    • WHO guidelines
    • Key references
  • 7. Isoniazid preventive therapy
    • 7.1 Isoniazid preventive therapy in children
    • 7.2 Isoniazid preventive therapy in recent TST converters
    • 7.3 Isoniazid preventive therapy in people living with HIV
    • 7.4 Preventive therapy in pregnancy
    • WHO guidelines
    • Key references
  • 8. BCG vaccination
    • WHO recommendations on the use of BCG vaccine
    • Key references
  • 9. Prevention through addressing risk factors
    • 9.1 Smoking
    • 9.2 Malnutrition
    • 9.3 Diabetes mellitus
    • 9.4 Crowding
    • 9.5 Indoor air pollution
    • 9.6 Alcohol abuse and dependency
    • 9.7 Silicosis and other rare chronic conditions
    • Key references
• Part II. Programmatic management of tuberculosis
  • 10. Managerial structure
    • 10.1 Organization of national tuberculosis control programmes
    • 10.2 Functions of national tuberculosis control programmes
    • Key references
  • 11. Management cycle
    • 11.1 Planning
    • 11.2 Monitoring and review
    • Key references
  • 12. Programmatic management of drug-resistant tuberculosis
    • 12.1 Addressing the sources of drug-resistant TB
    • 12.2 Process for integration of management of drug-resistant TB
    • WHO guidelines
    • Key references
  • 13. Programmatic management of tuberculosis and human immunodeficiency virus
  • 14. Laboratory services
    • 14.1 Organization of TB laboratory services
    • 14.2 Diagnostic procedures
    • 14.3 Laboratory safety
    • 14.4 Quality system
    • 14.5 Public–private mix for laboratory services
    • 14.6 Resources
    • WHO guidelines
    • Key references
  • 15. Management of antituberculosis drug supplies
    • 15.1 Selection of anti-TB drugs
    • 15.2 Procurement of anti-TB drugs
    • 15.3 Distribution and storage of anti-TB drugs
    • 15.4 Rational use of medicines
    • WHO guidelines
    • Key references
  • 16. Supervisory support to basic management units
  • 17. Development of human resources
  • 18. Monitoring and evaluation of programme performance
    • 18.1 Indicators
    • 18.2 Cohort analysis
    • 18.3 Measurement of impact
    • 18.4 Recording and reporting
    • 18.5 Global information system
    • WHO guidelines
    • Key references
  • 19. Funding of tuberculosis control
    • 19.1 Budget planning
    • 19.2 TB planning and budgeting tool
    • 19.3 Sources of funds for TB control
    • Links for further information
  • 20. Legal and regulatory issues
    • 20.1 International Health Regulations (IHR) 2005
    • 20.2 National communicable disease legislation
    • 20.3 National legislation and regulation of pharmaceutical products
    • 20.4 Occupational health legislation
    • 20.5 International regulations on transport of infectious substances
    • Key references
• Part III. Ensuring comprehensive control of tuberculosis
  • 21. Contributing to strengthening of health systems
    • 21.1 Analysing barriers to health system strengthening
    • 21.2 Identifying opportunities and threats in processes for health sector development
    • 21.3 Contributing to system-wide solutions while protecting essential TB control functions
    • Key references
  • 22. Engaging all care providers
    • 22.1 Public-private mix
    • 22.2 Implementing public-private mix at national level
    • 22.3 Implementing public-private mix at local level
    • 22.4 Supervision and monitoring of PPM
    • Key references
  • 23. Practical approach to lung health and other integrated approaches to health care
    • 23.1 Practical approach to lung health (PAL)
    • 23.2 Integrated disease management
    • Key references
  • 24. Equity of and access to services for prevention of tuberculosis and treatment of patients
    • Step 1 Identify the vulnerable groups in the country/region
    • Step 2 Determine which barriers prevent access of vulnerable groups to TB services
    • Step 3 Assess potential actions to overcome the barriers to access
    • Step 4 Review the situations and population groups requiring special consideration
    • Step 5 Explore possibilities for harnessing additional resources
    • Step 6 Evaluate the impact of pro-poor measures
    • Key reference
  • 25. Special groups and situations
    • 25.1 TB in prisons
    • 25.2 TB control in refugee and displaced populations
    • 25.3 TB control and natural disasters
    • 25.4 TB control in other special population groups
    • WHO guidelines
    • Key references
  • 26. Involvement of communities and patients in tuberculosis care and prevention
    • 26.1 Key steps in implementing initiatives for community and patient involvement
    • Key references
  • 27. Advocacy, communication and social mobilization
    • 27.1 Advocacy and resource mobilization
    • 27.2 Communication
    • 27.3 Social mobilization
    • 27.4 Monitoring and evaluation
    • Key references
  • 28. Role of national tuberculosis control programmes in research
    • 28.1 National TB control programmes and the Research Movement to Stop TB
    • 28.2 Applied research
    • 28.3 Development of new tools for TB control
    • 28.4 Evaluation and demonstration of new tools
    • 28.5 Basic research
    • Key references
• ANNEX Strategy for the control and elimination of tuberculosis

Suggested citation:

Implementing the WHO Stop TB Strategy: a handbook for national tuberculosis control programmes. Geneva, World Health Organization, 2008 (WHO/HTM/TB/2008.401).

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