ATS Spearheads Publication of International Standards for Tuberculosis Care

On the eve of World TB Day, a consortium of international health agencies led by the American Thoracic Society and the World Health Organization, published the first International Standards for Tuberculosis Care (ISTC).

“The purpose of the ISTC,” said Dr. Philip Hopewell, who co-chaired the committee that produced the standards and is a past president of the ATS, “is to establish a widely accepted level of care that all practitioners, public and private, should achieve in managing patients who have, or are suspected of having, tuberculosis.”

The new standards were announced in Geneva and published simultaneously on both the ATS ( Click to download document.) and the WHO Web sites (www.who.int/tb/en/) on March 22. WHO officials also announced The Patients’ Charter for Tuberculosis Care.” The charter specifies patients’ rights and responsibilities ( Click to download the charter.).

According to Dr. Hopewell, the ISTC is designed to address the care of patients of all ages with any manifestation of the disease, including multi-drug resistant and extra-pulmonary tuberculosis and tuberculosis combined with HIV infection. The ISTC is also designed to guide providers everywhere, regardless of the circumstances of their practice.

The committee writing the new standards, however, was especially concerned about reaching healthcare providers working outside national and local tuberculosis control programs. These providers, Dr. Hopewell noted, are less likely than their government counterparts to follow proven methods for evaluating and treating patients with tuberculosis.

Numerous studies have shown that private physicians rely too heavily on chest x-rays and too little on sputum microscopy in making diagnoses, often use incorrect drug regimens and can fail to supervise adherence to treatment, which can lead to drug-resistant forms of the disease.

Private healthcare professionals are also less likely than providers in government programs to assume responsibility for controlling the spread of the disease.

“In caring for patients with tuberculosis, providers assume an important public health function,” said Dr. Hopewell. “Providers have a responsibility to their patients and to the community.”

The standards address this concern by requiring providers to evaluate all those who have come into contact with the patient and to report new cases of tuberculosis and the outcome of existing cases to local public health authorities.

According to Dr. Hopewell, fulfilling these public health responsibilities is a big challenge for physicians practicing in the developing world. The ATS has begun to address this problem by piloting an implementation program in Indonesia, where providers have been given a copy of the standards in their native language. Implementation and evaluation programs will begin soon in Kenya and in two other countries to be determined, added Dr. Hopewell.

Twenty-eight people, including nine ATS representatives, participated on the committee that formulated the ISTC. Committee members represented physicians, nurses, medical students, patients, patient advocates and public and private agencies dedicated to tuberculosis control in 14 countries.

In addition to Dr. Hopewell, ATS representatives to the committee included Drs. Kenneth Castro, Paula Fujiwara, Robert Gie, Umesh Lalloo, Richard O’Brien, and Charles Wells. Dr. Madhukar Pai, a fellow at the University of California, San Francisco, and Fran Du Melle, Director of ATS International Activities, provided scientific and administrative support to the committee.

“The international TB community owes a great debt to the ATS and to Dr. Hopewell for these standards,” said Irene Koek, M.D., Chief of the Infectious Diseases Division of USAID, which funded development of the standards. “The standards are an extremely important tool for improving the quality of care among all TB treatment providers.”

Dr. Lee Jong-Wook, Director-General of the WHO, holds up copies of the standards on the morning of publication.