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Cablegate: Croatia's Efforts at Fighting Tuberculosis

VZCZCXRO0812
PP RUEHAG RUEHAST RUEHDA RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA RUEHLN
RUEHLZ RUEHPOD RUEHROV RUEHSR RUEHVK RUEHYG
DE RUEHVB #0169 0600815
ZNR UUUUU ZZH
P 290815Z FEB 08
FM AMEMBASSY ZAGREB
TO RUEHC/SECSTATE WASHDC PRIORITY 8635
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE PRIORITY

UNCLAS ZAGREB 000169

SIPDIS

SIPDIS

DEPARTMENT FOR EUR/PGI TESSLER AND OES/IHB LAURITZEN

E.O. 12958: N/A
TAGS: TBIO WHO HR
SUBJECT: CROATIA'S EFFORTS AT FIGHTING TUBERCULOSIS

REF: STATE 6989

1. SUMMARY: This cable responds to reftel. According to 2005
data, Croatia is a middle incidence country for tuberculosis,
with about 23 new cases per 100,000 people per year. About
one to two percent of new cases are multidrug resistant
(MDR). GoC efforts to implement the Berlin Declaration on
Tuberculosis have focused on improved application of the
WHO's Stop TB Strategy. In 1998, the GoC established a
national strategy for TB prevention that included expanding
the use of directly observed treatment, short course (DOTS).
The Croatian Ministry of Health is now revising the national
strategy to include other components of the Stop TB Strategy.
Areas for improvement include outreach and education for
medical staff and further expansion of DOTS. End Summary.

TB in Croatia: Mid-level Incidence, Low MDR Incidence

2. In regard to tuberculosis, Croatia is a middle incidence
country, recording 23 new cases per 100,000 people in 2005,
according to statistics from the Croatian Ministry of Health.
With the exception of a leveling from 1991 to 1998 due to the
effects of war, the incidence of TB in Croatia has fallen
steadily since 1981, when the incidence was 87 cases per
100,000. According Dr. Valerija Stamenic at the Croatian
Ministry of Health Office of Technical Medical Affairs and
Dr. Aleksander Simunovic, TB program manager at the Croatian
National Institute of Public Health, about one to two percent
of new cases are multidrug resistant (MDR), such that five to
ten MDR patients are being treated at any given time.
Stamenic told us Croatia also has a low incidence of TB-HIV
interaction, although she did not have exact numbers.
Patients with MDR TB or TB and HIV are treated in specified
hospitals in Zagreb.

Berlin Declaration: Focus on Stop TB Strategy

3. GoC efforts to implement the Berlin Declaration on
Tuberculosis have focused on improved application of the
WHO's Stop TB Strategy. The Ministry established its current
national TB prevention strategy in 1998 but expects to
release a revised strategy in the next few months. Simunovic
said that while the 1998 strategy included the first
component of the WHO Stop TB Strategy (pursue expansion and
enhancement of high-quality DOTS), the new strategy will
incorporate additional components of the WHO strategy. In
particular, he noted the new strategy will address the need
for a public-private mix approach, as private practitioners
play an increasing role in healthcare in Croatia. In line
with the WHO strategy, Stamenic said the Ministry's goal is
to detect 70% of cases and cure 85% of detected cases.
Simunovic said the follow-up program begun five years ago to
determine treatment outcomes indicates 75% of patients
complete treatment, and most of those are cured. He said
achieving an 85% cure rate will be difficult, as it can be
hard to convince busy doctors to take the time to ensure
their patients complete the full treatment.

4. Three years ago, with a grant from the Soros Foundation,
the Ministry developed a course for general practitioners to
improve detection and control of TB. The Ministry provided
the course to practitioners in several high-incidence
counties but had to stop the program after the first year
because of a financial gap. Stamenic said, however, that the
Ministry's budget does include funds for educating
practitioners and others regarding the new national strategy
upon its release.

Areas of Need: Education and DOTS Expansion

5. Simunovic identified outreach to general practitioners as
the key area for additional effort. He said an average
practitioner sees 50 patients a day, but encounters a TB case
only once in two years. Given this low frequency of cases,
practitioners can easily forget to watch for TB and often do
not recognize it in the first couple months. Simunovic
believes a relatively small effort at outreach--perhaps
building from the course developed a few years ago--could
have a big effect at improving detection. Stamenic agreed
that education is a key area for further effort, saying
training of laboratory staff and pulmonologists, as well as
general practitioners, could be improved. She also identified
two other areas of need: further expansion of treatment in
line with DOTS and improved outcome monitoring.

6. For a practitioners perspective, we spoke with Dr. Darko
Richter from the Srebrnjak Children's Hospital in Zagreb. His
primary concern is latent TB. Because eradicating latent TB
is not part of the national strategy, Richter fears it is
more widespread than Ministry of Health officials realize.
Bradtke

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