Table 2– Rationale for the four key components of the European Union (EU)/European Economic Area (EEA) Standards for Tuberculosis Care (ESTC)
DiagnosisThe ESTC are based not only on TB suspects identified through sputum smear microscopy, but are adapted to the EU/EEA setting including culture, DST and rapid testing including rapid identification for rifampicin resistance. This is consistent with the culture-based definition used in the EU/EEA.
TreatmentGiven the availability of rapid diagnostic tests for TB and rifampicin resistance, the need to start MDR treatment from the beginning, under high-quality management conditions.
To ensure quality treatment monitoring based on culture.
HIV/TB and comorbiditiesUniversal access to anti-retroviral treatment is available to all HIV infected people, as is the capacity to detect all cases. This impacts on the management of provision of IPT.
Not only HIV-infected individuals, but also those with a range of immunosuppressive conditions (such as TNF-α antagonist, corticosteroid, cancer treatment, diabetes, intravenous drug use and alcohol abuse) should be evaluated for IPT and proper follow-up for TB.
Public health and preventionIn the absence of vertical TB programmes and with the full integration of services, healthcare providers are assuming an important responsibility for ensuring key public health and infection control functions related to detection and prevention of TB.
  • TB: tuberculosis; DST: drug susceptibility testing; MDR: multidrug resistant; IPT: isoniazid preventive therapy; TNF: tumour necrosis factor.