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Table 3 Selective experiences and good practices in four selected European Union countries in treating MDR-TB patients successfully

From: Health system factors influencing management of multidrug-resistant tuberculosis in four European Union countries - learning from country experiences

Austria
1. Initial hospitalisation of MDR/XDR-TB patients during the intensive phase of treatment in an environment conducive for long term admission, including intensive physiotherapy, sports and leisure activities. In-patient management of MDR-TB patients is concentrated in a limited number of health facilities.
2. Patient-centred care with drug-substitution for illicit drug users, antiretroviral treatment for HIV-infected MDR/XDR-TB patients and attention for other medical conditions.
3. In Vienna, social workers of the municipality provide intensive support to hospitalised (MDR/XDR)-TB patients, prepare for discharge and the ambulatory care and continue support during the ambulatory phase, including directly observed treatment.
4. Free TB treatment, exempting TB patients to pay the compulsory food contribution fee during admission and the general fee for drug prescription, and the ministry of health covering the cost of TB treatment for undocumented migrants.
5. Use of data at level of collection and monitoring of treatment outcome by the MDR-TB specialist.
Bulgaria
1. The Global Fund supported the TB programme with establishing a case-based TB register (in place since 2007), accreditation of the National Reference Laboratory, development of guidelines (including MDR-TB guidelines), renovation of TB wards, improvement of infection control and procurement of MDR-TB drugs (available since September 2009).
2. National MDR-TB Expert Committee deciding on treatment of all MDR-TB patients, follow-up of all patients during the whole treatment, including patients in the prison sector.
3. Prison health staff and social workers educating TB patients in the prison as well as ensuring continuation of care for prisoners with TB moving to another prison in the country. After release, patients are directed to the regional health facility of their region of residence with a stock of drugs for 5 days. A document accompanies the patient that needs to be signed by the regional TB coordinator to state that the patient has reported in the region, and is returned to the prison health authorities to ensure that TB treatment is continued.
4. Nongovernmental organisations, with representatives from the hard-to-reach populations, raising community awareness, doing active case finding and supporting TB and MDR-TB case management. In-patient nurses working outside of the hospital providing ambulatory support, including directly observed treatment to MDR-TB patients.
5. Centralized management of MDR-TB drugs, including storage and disbursement, organized through one pharmacy.
Spain
1. Strong interest of autonomous regions and national minister of health in public health that resulted into legislation for free preventive services and also free treatment for TB and other diseases, also for uninsured undocumented migrants. (MDR)-TB patients exempted from the out-of-pocket contributions for drugs.
2. Multidisciplinary consilium in place in some autonomous regions that decides on MDR-TB treatment of patients, e.g. the “Galician Consilium for the assessment of treatment of resistant TB cases”.
3. Red Cross nurses providing directly observed treatment as a contracted service in the autonomous region of Madrid accompany patients into the hospital consultation room during ambulatory follow-up visits.
4. Vigorous monitoring of side effects in patients on MDR-TB treatment in the hospitals and adjustment of treatment as needed (e.g. due to ototoxicity of aminoglycosides).
5. Well-organized referral system from prisons to the primary care physician with involvement of the Surveillance Unit in the autonomous regions.
United Kingdom
1. Hospital nurses continue to visit the patients at home after discharge from hospital.
2. Well-planned discharge from hospitals of MDR-TB patients (hospital discharge plan).
3. MDR-TB patients receive different kinds of social support, including housing, and bed and breakfast arrangements.
4. MDR-TB Advisory Group provides advice to clinicians treating MDR/XDR-TB patients in the country.
5. A project with a faith-based organisation providing housing to Eastern European TB and MDR-TB patients and assisting them to find work.