CURRENT SITUATION of TB in ALBANIA Hasan HAFIZI

CURRENT SITUATION of TB in ALBANIA Hasan HAFIZI NTP Manager

Country profile of Albania • Albania is located in the Balkan peninsula. • Population in 2001 is estimated 3. 3 million, the same as 10 years before. • Tirana, capital city with a daily increasing population, currently more than 700, 000 inhabitants. • Albanian GDP : 1100 US $

Trend of case notification in Albania from 1990 to 2002

Extent of TB problem in Albania • Case notification in 2002 - 571 new cases, 612 total number • Incidence: 18 per 100, 000 inhabitants • Underreporting of cases is suspected. • Young adults are especially affected with TB, indicating active transmission in the population. • Multiple drug resistance is no problem for the time being.

TB notification in 2002 • • • New cases ( never treated ) 571 Relapses 28 Other previously treated 13 Total 612 Pulmonary 378 – 62% » smear positive 225 - 60% » Smear negative 148 • Extra –pulmonary 193 – 38% – Over diagnosed ?

Regional distribution of TB Incidence: dark > 40, grey >20, white <10

Total DST results and resistant cases, by previous anti-TB treatment status, 2002

Organisation of TB network lab. in Albania • One National TB laboratory reference at University Lung Diseases Hospital for culture and susceptibility test • Three regional laboratories for culture at pulmonary hospitals at regional level • 13 laboratories at prefecture level for smear examination

Organizational diagram

DOTS in Albania • Albania has initiated DOTS implementation in January 2001. • We have preferred a gradual implementation of DOTS strategy • A combination of a hospital-based model (diagnosis and intensive phase) and a rural-based model (case finding and follow up) for the treatment of tuberculosis is chosen as the initial strategy. • Two districts in 2001, plus one in 2002 (30% of population and 1/3 of new TB cases at national level) are covered by DOTS, all components • The rest of the country is doing also DOTS, but not DOT at follow up treatment

Achievement • Establishment of the new system of recording and reporting according to WHO recommendation • NTP manual • Rehabilitation and refurbishments of all laboratories at three levels • Training and refreshment of all personnel involved directly in TB control (pulmonologists, nurses and lab technicians), GP and nurses in primary Health care • Centralized drug purchase and distribution • Public awareness about TB is increased

CONSTRAINTS • Sustainability of the project – Lack of funding for monitoring, training – Lack of logistic (car ) for drug delivery and supervising visits • Physicians, nurses motivation for DOT at continuation phase • Integration of TB in primary health care

CONCLUSION • TB is not a priority for Albanian government, but • DOTS expansion is not feasible as long as the Mo. H doesn’t consider TB a public health issue • 2005 WHO targets ? ? ?