The Mutual Assistance Programme of the IUATLD. Development, contribution and significance

The Mutual Assistance Programme of the IUATLD is aimed at trying to compensate for the neglect into which tuberculosis had fallen from the part of governments, teaching institutions and international agencies, and represents an innovative approach to promote solidarity between governments and voluntary organizations of low tuberculosis prevalence countries and those of high prevalence countries. The main objective has been to develop a system of delivery of treatment and diagnosis of tuberculosis that would be efficacious even under the difficult conditions of high prevalence of tuberculosis, low resources and/or socio-political disturbances. The system turned out not only to be efficacious in terms of cure rates and epidemiological impact but also to be efficient in terms of cost/benefit. The National Tuberculosis Programme's approach includes the application of short-course chemotherapy, the regular provision of drugs and products, a system of registers, forms and periodic reports, the assessment of the yield of case-finding and, most important of all, the analysis of the therapeutic results in successive cohorts of patients. Cure rates repeatedly reach around 85% in new cases and approximately 80% in retreatment cases, nationwide, in the countries where such programmes have been successively implemented. Each national programme has an important role of training and of capacity building. While serving the populations, the national programmes also provide the framework for relatively inexpensive operational research and, finally, the careful collection of data represents a basis--unique of its kind in the world--for the study of the clinical and epidemiological relationships between tuberculosis and HIV. The method has been endorsed by the WHO and has the support of the World Bank, the United Nations Development Plan and the main government Agencies for Development Cooperation. It is part of the new Global Strategy against Tuberculosis which is presently being developed under the WHO TB Unit. The other aspects of Mutual Assistance concern courses, consultation to programmes not directly sponsored by the IUATLD and publications.