Fourth meeting of national tuberculosis programme managers : report on a WHO meeting, Helsinki, Finland 8-10 June 2000

Tuberculosis (TB) control in parts of Europe requires urgent action. Drug-resistant TB is increasing rapidly. In parts of central and eastern Europe, economic decline, poverty, overcrowded prisons and fractured medical services mean that TB rates are increasing and multidrug-resistant strains are rapidly emerging. There is also a growing epidemic of HIV infection, which is likely to compound TB control problems. This fourth biennial meeting of national tuberculosis programme managers was convened to facilitate the exchange of information on TB control from countries across Europe and from international partners. Also addressed were problems in and successes relating to DOTS implementation, the influence of health care reform on national TB control programmes, and strategies to respond to multidrug-resistant strains.Ten recommendations were agreed, among which was the recognition that national TB programmes needed to be strengthened. There was also a need to adopt an internationally recognized TB control strategy and to accelerate its implementation. TB services needed to be integrated into wider (changing) health structures, and drug supplies needed to be centralized and maintained and their quality assured. It was also agreed that, in relation to multidrug-resistant TB, the first priority from a public health perspective was prevention through an effective and comprehensive TB programme (DOTS); the introduction of a programme specifically to control multidrug-resistant TB should be considered only in areas where there was a national TB programme with proven effectiveness according to internationally recommended guidelines. The support of international partnerships and collaboration were recognized as being essential components in the improvement of TB programmes in a number of countries in the WHO European Region