Table 2– Wolfheze Workshops: priorities identified and public-health answers given in period 2 (1996–2005)
Wolfheze WorkshopsPublic-health problemPublic-health responseRef.
III 1996Monitoring of treatment outcome: little information on effectiveness of interventions of tuberculosis control in European countries is availableEmphasis is placed on cohort analysis of definite cases of pulmonary tuberculosis, using a minimal set of six mutually exclusive categories of treatment outcome: cure, treatment completed, failure, death, treatment interrupted, and transfer out16
IV 1998Drug resistance surveillance: vountries use their own definitions and methods to determine anti- tuberculosis drug resistanceMethods to test susceptibility for anti-tuberculosis drugs must be internationally standardised and quality assuredPatients who never been treated before and those that had previous treatment should be analysed separately17
V 1999Framework for tuberculosis control in low incidence countries: in the elimination phase of tuberculosis, specific problems and challenges emerge (importation of tuberculosis and latent tuberculosis infection; emergence of risk groups)An overall control strategy aimed at reducing tuberculosis infection and an elimination strategy aimed at reducing the prevalence of tuberculosis infection by using risk group and outbreak management oriented interventions18
Framework for tuberculosis control in low-incidence countries: the steady decline of tuberculosis for 150 yrs in many Western European countries leads to complacency and neglect of all aspects of disease controlEach European country must scrutinise the framework document carefully to find out how best to apply the principles outlined and draft country-specific guidelines19
Tuberculosis control in prisons: correctional facilities have often been cited as reservoirs for tuberculosis, presenting a potential threat to the general populationPrisoners have 15 times more risk of tuberculosis than civilians (up to 84 times in one country) highlighting the vulnerability of prisoners to tuberculosis and emphasises the need for containment strategies29
Public-health nurse: patient compliance and contact investigations need close follow-upThe public-health nurse is key in patient and risk-group managementA public-health nurse network in Europe is advocated
Clinical specialist in tuberculosis: in low-incidence settings expertise to detect and treat tuberculosis is difficult to maintainGood tuberculosis control in situations with multidrug-resistant tuberculosis and tuberculosis/HIV needs close cooperation and exchange of information between various clinical specialists and public health tuberculosis specialists
VI 2000Management of multidrug-resistant tuberculosis: countries have difficulties in priority settingDrug resistance surveillance, clinical management with access to essential drugs and full treatment compliance, and prevention of transmission are all important in tuberculosis control
Transmission in healthcare workers: no information on risk of tuberculosis infection in healthcare workers is generally availableWorking groups discussed risk assessment and how to develop an infection control plan
VII 2001Migration: migrants move freely across borders, screening points are not always accessible; magnitude of contribution to transmission is unknownOptions are screening for tuberculosis at every visit to a health facility and treatment of latent infectionsMonitoring of transmission (DNA tests) can help in the development of a screening policy and practice
Tuberculosis surveillance in Europe: the global rate of increase of tuberculosis is predicted to be 3% per year on average, but is much higher in eastern Europe (8%)Expand the DOTS strategy DOTS is among the most cost-effective of all healthcare interventions available to low- and middle-income countries21
VIII 2002tuberculosis/HIV: HIV/AIDS is increasing dramatically in eastern Europetuberculosis/HIV-related morbidity and mortality are expected to accelerate significantly in the futureA framework sets out the rationale for effective collaboration between HIV/AIDS and national tuberculosis programmes30
IX 2003Metropolitan tuberculosis: infectious diseases are more prevalent in marginalised population groups that are difficult to reach for healthcare workersCase finding and treatment adherence is difficultData are often unreliableSet up a service oriented organisation for treatment delivery; strengthen outcome monitoring and other local surveillance needs and intensify contact tracing and screening of risk groups
Patient treatment adherence: patients interrupt or decline from treatment for various reasons Ignorance and stigma are important contributing factorsPatient education and information are effective Proper communication (information, education and communication) is done best by the public-health nurse
X 2004Laboratory harmonisation: tuberculosis laboratories can be governmental, private profit or non-profit basedHarmonisation of procedures and establishing a network of national and supranational reference laboratories for quality assurance will contribute to strengthening laboratory organisation
X 2004 continuedTreatment outcome monitoring: there are unsolved issues in outcome monitoring in EuropeInclude all definite pulmonary cases, apply the standard period of observation and revised categories, and preferably report individual data25
XI 2005Infection control: restriction fragment length polymorphism testing shows that many multidrug-resistant tuberculosis cases are caused by re-infection in an institutional settingNational tuberculosis programmes must include infection control development plans; laboratory managers must produce guidelines for cost-effective infection control in laboratories; national tuberculosis programme nurses should be responsible for quality assurance of infection control
Human resource development: for many years human resource development has been used as a synonym for training and organising coursesTraining has become a routine activity in nation tuberculosis programmes with output measured in numbers and not in quality improvementHuman resource development wants to “ensure that the right number of personnel with the appropriate competences is available at the right place at the right time” Human resource capacity strengthening should be part of a 5-yr development plan