Implementing the Stop TB Strategy: a handbook for ... - Challenge TB [PDF]

IMPLEMENTING THE STOP TB STRATEGY A handbook for national tuberculosis control programmes

-QTPIQIRXMRKXLI ;,37XST8&7XVEXIK] %,%2(&33/*362%8-32%08&'328630463+6%11)7

;,30MFVEV]'EXEPSKYMRKMR4YFPMGEXMSR(EXE -QTPIQIRXMRKXLI;,37XST8&7XVEXIK]ELERHFSSOJSVREXMSREP XYFIVGYPSWMWGSRXVSPTVSKVEQQIW ;,3,818& 8YFIVGYPSWMW4YPQSREV]¦TVIZIRXMSRERHGSRXVSP,ERHFSSOW 1ERYEPW-;SVPH,IEPXL3VKERM^EXMSR7XST8&(ITX -7&2

201GPEWWM´GEXMSR;*

4VHHFTUFE
DJUBUJPO -QTPIQIRXMRKXLI7XST8&7XVEXIK]ELERHFSSOJSVREXMSREPXYFIVGYPSWMW GSRXVSPTVSKVEQQIW+IRIZE;SVPH,IEPXL3VKERM^EXMSR ;,3,818& 

‰
8PSME
)FBMUI
0SHBOJ[BUJPO
 %PPVMKLXWVIWIVZIH4YFPMGEXMSRWSJXLI;SVPH,IEPXL3VKERM^EXMSRGERFISFXEMRIHJVSQ;,34VIWW ;SVPH,IEPXL3VKERM^EXMSR%ZIRYI%TTME+IRIZE7[MX^IVPERH XIP JE\IQEMPFSSOSVHIVW$[LSMRX 6IUYIWXWJSVTIVQMWWMSRXSVITVSHYGISVXVERW PEXI;,3TYFPMGEXMSRW¦[LIXLIVJSVWEPISVJSVRSRGSQQIVGMEPHMWXVMFYXMSR¦WLSYPHFIEHHVIWWIH XS;,34VIWWEXXLIEFSZIEHHVIWW JE\IQEMPTIVQMWWMSRW$[LSMRX  8LIHIWMKREXMSRWIQTPS]IHERHXLITVIWIRXEXMSRSJXLIQEXIVMEPMRXLMWTYFPMGEXMSRHSRSXMQTP] XLII\TVIWWMSRSJER]STMRMSR[LEXWSIZIVSRXLITEVXSJXLI;SVPH,IEPXL3VKERM^EXMSRGSRGIVR MRKXLIPIKEPWXEXYWSJER]GSYRXV]XIVVMXSV]GMX]SVEVIESVSJMXWEYXLSVMXMIWSVGSRGIVRMRKXLI HIPMQMXEXMSRSJMXWJVSRXMIVWSVFSYRHEVMIW(SXXIHPMRIWSRQETWVITVIWIRXETTVS\MQEXIFSVHIV PMRIWJSV[LMGLXLIVIQE]RSX]IXFIJYPPEKVIIQIRX 8LIQIRXMSRSJWTIGM´GGSQTERMIWSVSJGIVXEMRQERYJEGXYVIVW«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

MMM

'SRXIRXW



4VIJEGI



Z



%GORS[PIHKIQIRXW

ZMM



%FFVIZMEXMSRW

\M



-RXVSHYGXMSR



1BSU
*
5VCFSDVMPTJT
DBSF
BOE
QSFWFOUJPO






'LETXIV

'EWIHIXIGXMSR





'LETXIV

8VIEXQIRXSJXYFIVGYPSWMWTEXMIRXW





'LETXIV

6IGSVHMRKERHVITSVXMRK





'LETXIV

8YFIVGYPSWMWMRGLMPHVIR





'LETXIV

'SRXEGXMRZIWXMKEXMSR





'LETXIV

-RJIGXMSRGSRXVSPMRLIEPXLGEVIWIXXMRKW





'LETXIV

-WSRME^MHTVIZIRXMZIXLIVET]





'LETXIV

&'+ZEGGMREXMSR





'LETXIV

4VIZIRXMSRXLVSYKLEHHVIWWMRKVMWOJEGXSVW



1BSU
**
1SPHSBNNBUJD
NBOBHFNFOU
PG
UVCFSDVMPTJT






'LETXIV 1EREKIVMEPWXVYGXYVI





'LETXIV 1EREKIQIRXG]GPI



 

'LETXIV 4VSKVEQQEXMGQEREKIQIRXSJHVYKVIWMWXERX  XYFIVGYPSWMW



 

'LETXIV 4VSKVEQQEXMGQEREKIQIRXSJXYFIVGYPSWMWERH  XLILYQERMQQYRSHI´GMIRG]ZMVYW





'LETXIV 0EFSVEXSV]WIVZMGIW





'LETXIV 1EREKIQIRXSJERXMXYFIVGYPSWMWHVYKWYTTPMIW



MZ

%,%2(&33/*362%8-32%08&'328630463+6%11)7



'LETXIV 7YTIVZMWSV]WYTTSVXXSFEWMGQEREKIQIRXYRMXW





'LETXIV (IZIPSTQIRXSJLYQERVIWSYVGIW



 

'LETXIV 1SRMXSVMRKERHIZEPYEXMSRSJTVSKVEQQI  TIVJSVQERGI





'LETXIV *YRHMRKSJXYFIVGYPSWMWGSRXVSP





'LETXIV 0IKEPERHVIKYPEXSV]MWWYIW



1BSU
***
&OTVSJOH
DPNQSFIFOTJWF
DPOUSPM
PG
UVCFSDVMPTJT






'LETXIV 'SRXVMFYXMRKXSWXVIRKXLIRMRKSJLIEPXLW]WXIQW





'LETXIV )RKEKMRKEPPGEVITVSZMHIVW



 

'LETXIV 4VEGXMGEPETTVSEGLXSPYRKLIEPXLERHSXLIV  MRXIKVEXIHETTVSEGLIWXSLIEPXLGEVI



 

'LETXIV )UYMX]SJERHEGGIWWXSWIVZMGIWJSVTVIZIRXMSR  SJXYFIVGYPSWMWERHXVIEXQIRXSJTEXMIRXW





'LETXIV 7TIGMEPKVSYTWERHWMXYEXMSRW



 

'LETXIV -RZSPZIQIRXSJGSQQYRMXMIWERHTEXMIRXWMR  XYFIVGYPSWMWGEVIERHTVIZIRXMSR





'LETXIV %HZSGEG]GSQQYRMGEXMSRERHWSGMEPQSFMPM^EXMSR



 

'LETXIV 6SPISJREXMSREPXYFIVGYPSWMWGSRXVSPTVSKVEQQIW  MRVIWIEVGL



"OOFY
4USBUFHZ
GPS
UIF
DPOUSPM
BOE
FMJNJOBUJPO
PG
UVCFSDVMPTJT




Z

4VIJEGI

7

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´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



86)%81)283*89&)6'9037-74%8-)287

5"#-&


6)'311)2()(86)%81)286)+-1)27*362);'%7)73*89&)6'9037-7E

4EXMIRXXVIEXQIRX GEXIKSV]

4EXMIRXHMEKRSWXMG GEXIKSV]

-

2I[WQIEVTSWMXMZITEXMIRXWRI[ WQIEVRIKEXMZITEXMIRXW[MXL I\XIRWMZITEVIRGL]QEPMRZSPZIQIRX GSRGSQMXERX,-:VIPEXIHHMWIEWIWSV WIZIVIJSVQWSJI\XVETYPQSREV]8&

---

2I[WQIEVRIKEXMZITYPQSREV]8& SXLIVXLERMR'EXIKSV]- ERHPIWW WIZIVIJSVQWSJI\XVETYPQSREV]8&

8VIEXQIRXVIKMQIRWF -RMXMEPTLEWI

'SRXMRYEXMSRTLEWI

4VIJIVVIH ,6>)G

4VIJIVVIH ,6  ,6 

3TXMSREP ,6>)

3TXMSREP ,)

3TXMSREPH  ,6>) 

3TXMSREP  ,6 

4VIJIVVIH ,6>)I

4VIJIVVIH ,6  ,6 

3TXMSREP ,6>)

3TXMSREP ,)

3TXMSREP  ,6>) 

3TXMSREP  ,6 

E

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¦  I  )XLEQFYXSPMRXLIMRMXMEPTLEWIQE]FISQMXXIHJSVTEXMIRXW[MXLPMQMXIHRSRGEZMXEV]WQIEVRIKEXMZITYP QSREV]8&[LSEVIORS[RXSFI,-:RIKEXMZITEXMIRXW[MXLPIWWWIZIVIJSVQWSJI\XVETYPQSREV]8&ERH TEXMIRXW[MXLORS[RWYWGITXMFPIWXVEMRW F

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



%,%2(&33/*362%8-32%08&'328630463+6%11)7

XSXLITEXMIRX«WLSQI-XMWEPWSIEWMIVJSVXLITEXMIRXXSVIQIQFIVXSXEOIXLI QIHMGMRI MJEXVIEXQIRXWYTTSVXIVMWRSXEZEMPEFPI ERHXLIGSRWIUYIRGISJE QMWWIHHSWIMWPIWWHIXVMQIRXEP8LVIIXMQIW[IIOP]XLIVET]EP[E]WVIUYMVIW HMVIGXSFWIVZEXMSRERHMJXEOIRVIKYPEVP]MXWIJJIGXMZIRIWWMWWMQMPEVXSXLEXSJ HEMP]XLIVET];,3HSIWRSXVIGSQQIRHIHEX[MGI[IIOP]VIKMQIR -RXLIGSRXMRYEXMSRTLEWIEWIPJEHQMRMWXIVIHVIKMQIRGSQTVMWMRKHEMP]XVIEX QIRX[MXLWM\QSRXLWSJMWSRME^MHERHIXLEQFYXSP ,) MWERSTXMSRMJEHLIV IRGIXSXVIEXQIRX[MXLMWSRME^MHERHVMJEQTMGMR ,6 GERRSXFIIRWYVIHJSV I\EQTPIMRQSFMPITSTYPEXMSRWERHJSVTEXMIRXW[MXLZIV]PMQMXIHEGGIWWXS LIEPXLGEVI,S[IZIVMREGSQTEVEXMZIMRXIVREXMSREPQYPXMGIRXVIGPMRMGEPXVMEP ,)[EWJSYRHXSFIMRJIVMSVXSXLI,6GSRXMRYEXMSRTLEWIVIKMQIR[MXLEWMK RM´GERXP]LMKLIVYRJEZSYVEFPISYXGSQI JEMPYVISVVIPETWI EXQSRXLWEJXIV XLIIRHSJGLIQSXLIVET]8LITVSTSVXMSRW[MXLYRJEZSYVEFPISYXGSQIW[IVI  JSVXLI,6>),)VIKMQIR MRMXMEPERHGSRXMRYEXMSRTLEWIWEHQMRMWXIVIH HEMP]    JSV  ,6>) ,) MRMXMEP TLEWI EHQMRMWXIVIH XLVII XMQIW [IIOP]  ERH JSV,6>),6 4VIKRERG] ERH PEGXEXMSR 3J XLI ´VWXPMRI HVYKW MWSRME^MH VMJEQTMGMR ERH IXLEQFYXSP QE] FI KMZIR WEJIP] HYVMRK TVIKRERG] 7XVITXSQ]GMR QE] GEYWI SXSXS\MGMX]MRXLIJIXYWERHMWGSRXVEMRHMGEXIH1SWXERXM8&HVYKWETTIEVMRPS[ GSRGIRXVEXMSRWMRFVIEWXQMPOEXPIZIPWXLEXHSRSXTVSHYGIXS\MGMX]MRMRJERXW &VIEWXJIIHMRKMWRSXGSRXVEMRHMGEXIH 


1SFWJPVTMZ
USFBUFE
DBTFT

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ˆ ´ZIHVYKWMRXLIMRMXMEPTLEWI VMJEQTMGMRMWSRME^MHT]VE^MREQMHIIXLEQ FYXSPERHWXVITXSQ]GMR 8LIMRMXMEPTLEWIMWEHQMRMWXIVIHJSVXLVIIQSRXLW [MXLEPP´ZIHVYKWEHQMRMWXIVIHJSVXLI´VWXX[SQSRXLW7XVITXSQ]GMRMW HMWGSRXMRYIHEJXIVX[SQSRXLWERHXLIJSYVVIQEMRMRKHVYKWEVIKMZIRMR XLIXLMVHQSRXL;,3VIGSQQIRHWHEMP]EHQMRMWXVEXMSRSJHVYKWMRXLIMRMXMEP TLEWI



86)%81)283*89&)6'9037-74%8-)287

5"#-&


6)'311)2()(86)%81)286)+-1)27*3646):-3970=86)%8)(4%8-)287 6)86)%81)286)+-1)27 E

4EXMIRX HMEKRSWXMG GEXIKSV]

8&TEXMIRXHMEKRSWXMG GEXIKSV]

--

6IPETWIW 8VIEXQIRXEJXIVHIJEYPX

--

8VIEXQIRXJEMPYVISJ'EXIKSV]-

8&XVIEXQIRXVIKMQIRW -RMXMEPTLEWI

'SRXMRYEXMSRTLEWI

4VIJIVVIH ,6>)7,6>)

4VIJIVVIH ,6)

3TXMSREP  ,6>)7  ,6>) 

3TXMSREP  ,6) 

4VIJIVVIH ,6>)7,6>)

4VIJIVVIH ,6)

-RWIXXMRKW[LIVI 3TXMSREP 6ITVIWIRXEXMZI(67HEXEWLS[PS[  ,6>)7  ,6>)  VEXIWSJ1(68&SVMRHMZMHYEPM^IH (78WLS[WHVYKWYWGITXMFPIHMWIEWI SV -RWIXXMRKWSJ ˆ 4SSVTVSKVEQQITIVJSVQERGI ˆ %FWIRGISJVITVIWIRXEXMZI(67HEXE  ERHSVGETEGMX]JSV(78SJGEWIW ˆ -RWYJ´GMIRXVIWSYVGIWXSMQTPIQIRX  'EXIKSV]-:XVIEXQIRX -:

8VIEXQIRXJEMPYVISJ'EXIKSV]-RWIXXMRKW[MXL ˆ %HIUYEXITVSKVEQQITIVJSVQERGI ˆ 6ITVIWIRXEXMZI(67HEXEWLS[MRK  LMKLVEXIWSJ1(68&ERHSVGETEGMX]  JSV(78SJGEWIW ˆ %ZEMPEFMPMX]SJRHPMRIHVYKW

-:

7XMPPWQIEVSVGYPXYVITSWMXMZIEJXIV WYTIVZMWIHVIXVIEXQIRXVIKMQIR  TVSZIRSVWYWTIGXIH1(68&GEWIWG

3TXMSREP  ,6) 

7TIGMEPP]HIWMKRIHWXERHEVHM^IHFSV MRHMZMHYEPMWIHVIKMQIRW[MXLXLI YWISJRHPMRIHVYKW

7TIGMEPP]HIWMKRIHWXERHEVHM^IHSV MRHMZMHYEPMWIHVIKMQIRW[MXLXLI YWISJRHPMRIHVYKW

(67!HVYKVIWMWXERGIWYVZIMPPERGI(78!HVYKWYWGITXMFMPMX]XIWXMRK1(68&!QYPXMHVYKVIWMWXERXXYFIV GYPSWMW E %HETXIHJVSQ8VIEXQIRXSJXYFIVGYPSWMWKYMHIPMRIWJSVREXMSREPTVSKVEQQIWVHIH+IRIZE;SVPH,IEPXL 3VKERM^EXMSR ;,3'(78&  F -XMWVIGSQQIRHIHXLEXWXERHEVHM^IHVIKMQIRWEVIFEWIHSRVITVIWIRXEXMZI(67HEXEJVSQTEXMIRXGEXIKS VMIWSVKVSYTW G  (VYKWYWGITXMFMPMX]XIWXMRKMWVIGSQQIRHIHJSVTEXMIRXW[LSEVIGSRXEGXWSJORS[R1(68&GEWIW

ˆ XLVIIHVYKWMRXLIGSRXMRYEXMSRTLEWI VMJEQTMGMRMWSRME^MHERHIXLEQFYXSP  8LIGSRXMRYEXMSRTLEWIMWEHQMRMWXIVIHJSV´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



%,%2(&33/*362%8-32%08&'328630463+6%11)7

FIEXXVMFYXEFPIXSERMRMXMEPVIWMWXERGIXSXLIHVYKWJEMPYVIMRWMXYEXMSRW[LIVI XVIEXQIRXLEWRSXFIIRHMVIGXP]SFWIVZIHQE]FIXLIVIWYPXSJTSSVXVIEXQIRX EHLIVIRGIGLESXMGXVIEXQIRXSVMRWYJ´GMIRXHVYKHSWEKIW 8LI'EXIKSV]--WXERHEVHM^IHVIKMQIRLEWTSSVVIWYPXWMR1(68&GEWIW PIWW XLER GYVIVEXI ERHQE]VIWYPXMRXLIEGUYMWMXMSRSJEHHMXMSREPVIWMWXERGI XSXLSWIHVYKWXLEX[IVIWXMPPIJJIGXMZIEXXLIWXEVXSJXVIEXQIRX IK)ERHSV > 'SYRXVMIW[MXLELMKLTVSTSVXMSRSJ1(68&EQSRKJEMPYVIWSJXLI'EXIKSV] - VIKMQIR WLSYPH GSRWMHIV XVIEXMRK WYGL GEWIW [MXL E VIKMQIR GSRWMWXMRK SJ WIGSRHPMRIHVYKW WII'LETXIV  7XVITXSQ]GMRWLSYPHFIEHQMRMWXIVIHF]MRNIGXMSRYWMRKHMWTSWEFPI WMRKPIYWI  SVWXIVMPI VIYWEFPI RIIHPIWERHW]VMRKIW-XWLSYPHRSXFIYWIHMRWIXXMRKW [LIVIXLIYWISJHMWTSWEFPISVWXIVMPIRIIHPIWERHW]VMRKIWMWRSXEWWYVIH8LI YWISJMREHIUYEXIP]WXIVMPM^IHVIYWEFPIW]VMRKIWERHRIIHPIWGEVVMIWEVMWOSJ XVERWQMWWMSRSJ,-:ERHSXLIVFPSSHFSVRITEXLSKIRW

%HZIVWIIJJIGXWSJERXM8&HVYKW %QMRSVMX]SJ8&TEXMIRXW ¦ XVIEXIH[MXL'EXIKSV]-SV'EXIKSV]--VIKM QIRWI\TIVMIRGIEHZIVWIIJJIGXW8LIWIMRGPYHI ˆ QENSVEHZIVWIIJJIGXWKMZMRKVMWIXSWIVMSYWLIEPXLLE^EVHWERHVIUYMVMRK HMWGSRXMRYEXMSRSJERXM8&XVIEXQIRX ˆ QMRSVWMHIIJJIGXWGEYWMRKVIPEXMZIP]PMXXPIHMWGSQJSVXERHSJXIRVIWTSRHMRK XSW]QTXSQEXMGSVWMQTPIXVIEXQIRXXLI]QE]SGGEWMSREPP]TIVWMWXJSVXLI HYVEXMSRSJERXM8&XVIEXQIRX (IXEMPWSRXLIQSWXMQTSVXERXERHJVIUYIRXWMHIIJJIGXWEVITVSZMHIHMR8VIEX QIRXSJXYFIVGYPSWMWKYMHIPMRIWJSVREXMSREPTVSKVEQQIW -REHIUYEXIQEREKIQIRXSJEHZIVWIIJJIGXWMWPMOIP]XSGSRXVMFYXIXSMVVIKYPEV XVIEXQIRXERHHIJEYPX8LI284WLSYPHMQTPIQIRXETLEVQEGSZMKMPERGIW]WXIQ

 8VIEXQIRXSJHVYKVIWMWXERXXYFIVGYPSWMW 4EXMIRXWMR[LSQHVYKVIWMWXERX8&MWHMEKRSWIHERH[LSVIUYMVIXVIEXQIRX [MXLWIGSRHPMRIHVYKWEVIGPEWWM´IHEW;,38&HMEKRSWXMG'EXIKSV]-:ERH VIUYMVIVIKMQIRWXIVQIH¨'EXIKSV]-:VIKMQIRW©8LMWWIGXMSRTVSZMHIWKYMH ERGISRXLIWXVEXIK]STXMSRWMRGPYHMRKWXERHEVHM^IHIQTMVMGEPERHMRHMZMHYEP M^IHETTVSEGLIWJSVXVIEXMRKHVYKVIWMWXERX8&%HIWGVMTXMSRSJHVYKWHSWIW ERHGSHMRKSJXVIEXQIRXVIKMQIRWMWTVSZMHIHMR+YMHIPMRIWJSVXLITVSKVEQ QEXMGQEREKIQIRXSJHVYKVIWMWXERXXYFIVGYPSWMW