Practical challenges and solutions to TB control in a lower–middle-income country: Experiences from Mongolia

Abstract

© ERS 2018.

The challenges of tuberculosis (TB) control vary significantly between countries with a low and high incidence of TB. A major focus of TB control efforts in countries with a low incidence of TB is on treatment of latent TB infection in high-risk groups [1] including contacts of patients with active TB [2], patients with medical conditions that increase the risk of TB reactivation [3–5] and migrants from settings with a high incidence of TB [6, 7]. By contrast, in low- and middle-income countries with a high incidence of TB, the major focus of TB control programmes is on the detection and management of cases with active TB [1]. Frequent challenges include resource limitations, barriers to accessing TB care including distance to travel for patients to attend centralised services, indirect and direct cost associated with TB treatment for patients, limited staff capacity, and need for capacity building in health systems management and operational research. Using the example of Mongolia, we illustrate the role of operational research, community initiatives and nongovernmental organisations (NGOs) to improve TB care in low- and middle-income countries with a high incidence of TB.