Background: The rise in the incidence of TB in Israel, mostly due to immigration from endemic areas, led to the establishment of a new TB control program which follows the guidelines of the World Health Organization (WHO). Reorganization of the TB infrastructure was enabled by specific legislative, administrative and budgetary measures initiated by the Ministry of Health (MOH) in conjunction with the Sick Funds.
Aim: To present the theoretical and practical aspects of this new program to the physicians of Israel.
Program outline: The essence of this program is the use of directly observed therapy (DOT) for all patients together with centralization of TB care in nine national centers, closely supervised by the MOH. This centralization allows a critical mass of patients to be seen in each clinic, thus enabling the labor-intensive task of modern TB treatment, including the supervision and/or the administration of DOT, to be performed in a cost-effective manner. Day to day treatment is conducted by general community clinics and supervised by District Health Offices. Hospitalization, a relatively rare necessity in the new program, is available in two dedicated centers with modern isolation facilities. Centralized laboratory services provide timely susceptibility testing. Billing is simplified according to disease categories, using a global assessment of costs negotiated with the Sick Funds. Management and quality control of the program are carried out on an ongoing basis by the Department of TB and AIDS at the MOH.
Preliminary outcome: In the first two years that have elapsed since the inception of the program, almost 93% of cases have documented evidence of completion of treatment (under DOT), compared to 54% (without any treatment supervision) before the program came into effect.