With increasing attention to the importance of infection control activities for tuberculosis control programmes and health systems, there is an urgent need for training among country personnel involved in health care delivery, planning and policy making. With support from the USAID-funded Tuberculosis Control Assistance Program (TBCAP) and the AFD (Agence Française de Développement), in March The Union conducted an infection control workshop in Conakry, Guinea.
The workshop agenda consisted of three major components:
• Natural history of TB: TB transmission, interactions with HIV and Anti-tuberculosis drug resistance
• Nosocomial TB: General overview, transmission, administrative measures, environmental measures and individual measures
• Countries’ experiences in the fight against nosocomial TB

A total of 30 participants from 10 countries – Djibouti, Guinea, Ivory Coast, Burkina Faso, Benin, Democratic Republic of Congo, Cameroon, Haiti and Congo – participated in the workshop in March.

For more information on Union training activities, go to www.theunion.org.

The programme to develop Integrated HIV Care for Tuberculosis Patients Living with HIV/AIDS (IHC) was a European Commission funded operational research initiative implemented by The Union in Benin and in the provinces of Bas Congo and North Kivu in the Democratic Republic of Congo (DRC). The first phase of the programme started on 1 December 2004 and ended on 30 November 2008, while phase two continues in North Kivu, as well as in Zimbabwe. The programme objectives were 1) to reduce the burden of TB and HIV for individuals and communities in low-income countries, and 2) to integrate comprehensive care for People Living with HIV/AIDS (PLHAs) into general health services.

A total of 15,068 tuberculosis (TB) patients were registered in the 43 pilot sites (20 in Benin and 23 in DRC). Provider-initiated testing and counselling for HIV was taken up by 14,056 (93%) patients, of whom 2,085 (15%) were found to have HIV infection. In both countries, female TB patients were more likely to be co-infected with HIV than male TB patients (22% vs 14% in Benin and 17% vs 10% in DRC). Cotrimoxazole preventive therapy was commenced during TB treatment in 1,820 (87%) co-infected patients and 704 (35%) started on or continued their previously commenced antiretroviral treatment (ART). Results showed that TB treatment outcomes were favourably affected: fewer patients interrupted their TB treatment and there was some indication of decreased mortality among co-infected TB patients taking ART. Case holding on ART compared well with reports from other sub-Saharan African countries.

The programme demonstrated that it is possible to provide good quality clinical HIV care through decentralised and non-specialist health services. This finding should strengthen national efforts to increase coverage of HIV diagnosis and care. It also confirmed that TB services can make a substantial contribution to the diagnosis of HIV among TB patients and their family contacts. In Benin, all TB clinics now implement the approach. Highlights of the socio-economic survey carried out as part of the programme, and the laboratory research component, will be shared in future newsletters.

Mizoram, a north-eastern state in India, has the highest prevalence of tobacco use in the country. Apart from smoking, other tobacco products such khaini, paan masala and gutkha (chewable forms of tobacco) as well as tobacco smoke-infused water, are consumed extensively in Mizoram. According to the National Family Health Welfare Survey 1998-1999, 60% of males and 60.7% of females in Mizoram use paan Masala, while 59.4% of Mizo men and 22.1% of the state’s women smoke.
Given the above scenario, the Mizoram Government has called for stricter tobacco control activities and expressed its support for smoke free initiatives.
The Government of Mizoram has received approval for a grant in Round 4 of the Bloomberg Initiative to Reduce Tobacco Use. The proposal focuses on making Mizoram a smoke-free state.
The Union - South East Asia Office hosted the visit of the Health Minister of Mizoram on 3 February 2009. The Health Minister pledged his full support in implementing smoke-free activities in Mizoram to make it a model for the rest of the country. The Health Minister signed a letter of political commitment and appointed Dr. Jane Ralte as the focal person for all tobacco control activities for the state. She will also communicate and undertake negotiations on behalf of the Government.

For more information on Tobacco control, please go to http://www.tobaccofreeunion.org/

Asthma Drug Facility (ADF)

The ADF is now ready to procure essential asthma medicines for countries, organisations and projects in low- and middle-income countries. To find out about the medicines available, prices, ordering process, client criteria, etc., please visit ADF’s new website www.GlobalADF.org. To guarantee the quality of the drugs provided and the best possible prices, the essential HFA inhalers proposed by ADF have been selected following a qualification process based on WHO norms and standards and a limited competitive bidding process among qualified sources. The ADF promotes the correct use of medicines and quality standardised care. It provides clients with training materials and an electronic information system based on The Union Asthma Guide. It requires clients to perform simple monitoring of patient outcome in order to evaluate care and improve asthma case management.

The Union Asthma Guide, 3rd edition, 2008

The Union has published a new edition of Management of Asthma: a guide to the essentials of good clinical practice. This Guide to the standardised case management of asthma is now available in English. To download it, please click here. Printed copies can be requested from The Union by clicking here. The French and Spanish versions will soon be available.

With affordable medicines and standardised case management of asthma, countries can work towards the objectives defined in the WHO plan for Non Communicable Diseases 2008-2013. It will allow governments to save millions in the costs of medicines and unnecessary emergency room visits and hospitalisations and, above all, improve the quality of life of asthma patients in low- and middle-income countries.

For further information on the ADF, please contact ADF@theunion.org.

India sees 1.8 million new cases of tuberculosis every year, of which 0.8 million are highly infectious. Each person can potentially infect 15 other people, escalating the size of the problem. There is, however, very little awareness of TB, which continues to be a major drawback in the health sector in India.
These were some of the concerns raised at the recent launch of the USAID (United States Agency for International Development) funded REACH (Resource Group for Education and Advocacy for Community Health) project for the Advocacy, Communications and Social Mobilisation (ACSM) Project for TB Control at the M S Swaminathan Research Foundation in Chennai, India. REACH is one of the partners in the project funded by USAID through World Vision and with technical support from The Union.
At the event, the Principal Secretary of Health, Mr. K. Subburaj, said that there is a great need for community involvement and that this is the most effective approach to bring down the number of TB cases. Ms. Kendra Phillips, deputy director, Population–Health and Nutrition, USAID India, while congratulating the Government, said a collaborative approach was needed as neither society nor the government could solve the problem on its own.
The Partnership for TB Care and Control is therefore an initiative to address this concern. Participating at the launch event, Mr. Subrat Mohanty, Technical Officer with the Secretariat of the Partnership for TB Care and Control, based at The Union South-East Asia Office, elaborated on the partnership activities and its role in TB control.

For more information on Tuberculosis, please go to www.theunion.org.

The Union recently launched Treat TB (Technology, Research, Education and Technical Assistance for Tuberculosis), a USAID-funded five-year project that aims to make significant contributions to new knowledge through field evaluations of diagnostic tools, clinical trials of priority research questions, and targeted operational research benefiting global, regional and country TB control efforts.
The Union North America Office, among other activities, hosts a small project coordinating team (PCT) for Treat TB, which is overseen by Project Director Professor Don Enarson and is led technically by Dr. I.D. Rusen. The PCT draws on specialists from throughout The Union institute to plan, implement and evaluate project activities.

First year activities are well underway, and strategic partnerships supporting action on several activities have been formed with several organisations including McGill University, the Institute of Tropical Medicine/Antwerp, Liverpool School of Tropical Medicine, Encompass LLC, and several regional partners. The PCT has been actively generating work plans, budgets, sub-agreements and evaluation frameworks. The Treat TB project will also be closely linked with the Centre for Strategic Health Information and Operational Research, recently established and housed within The Union institute.

During the first year of activities, Treat TB will focus on the following activities:

• Develop the evidence base for new diagnostic tools for TB
• Establish modelling methods to guide high-burden countries to adopt the most appropriate diagnostic tools and adjust their national policies and protocols
• Support priority countries in research capacity building, implementation and translation of research findings into policy
• Promote and develop protocols and implement clinical trials to improve patient management, treatment efficacy and disease prevention

To implement these tasks, The Union is engaging research partners and ministries of health to build on its decades-long experience in research and capacity building. The Union is also taking advantage of its strong country and regional networks to further the work of the Treat TB project.

To learn more about Treat TB and the work of The Union North America Office please call +1 212 500 5720 or email Mark Fussell, Director, at mfussell@theunion.org.

5th Conference of The Union Europe Region, 27-30 May 2009, Dubrovnik, Croatia
“Bridging East and West: the challenges of respiratory diseases in Europe”

The deadline for late registrations is 15 May 2009. Those participants not able to register by that time will be given the opportunity to register on-site.
Relevant information, including the preliminary programme and exhibition and sponsorship opportunities, is accessible by visiting the official website of the conference: http://www.depol.org/TheUnion2009/

“Becoming a Union Member is being instrumental to support efforts and continue launching new resources and programmes in the global fight against tuberculosis and lung disease” Scott Mc Donald, Executive Director of the British Columbia Lung Association.

Now is the time to join or renew your Union membership. Continue your support to The Union's 89-year tradition of public health activism as we work toward global targets to stop TB. The 20 Euro individual Union membership for low-income countries is the popular option. It includes an online-only subscription to the International Journal of Tuberculosis and Lung Disease, as well as all other member benefits.

In 2009, the membership with the print and electronic versions of the Journal is at the special rate of 450 Euros for 2 years (1 year fee is 240 Euros). Benefactor membership fee starts at 500 Euros per year; benefactors are acknowledged in the annual Union Activity Report and invited to the President’s cocktail during the Union World Conference.


Visit http://membership.worldlunghealth.org for a description of membership categories, benefits and fees.
Clicking on « Membership online » will take you to the new, interactive membership form for renewals and new memberships. If you are already a member, ensure that you receive the best service from The Union by using your existing membership number.
Forgot your membership number? Contact Thuy Duong or Florence Desparmet at membership@theunion.org

The success of a comprehensive approach and improving the quality of care for tuberculosis patients has been recognised, and leads us to believe that similar improvements in quality of services should also be possible for other conditions. With funding from the World Bank, and building on The Union’s base of field experience in the care for children with pneumonia, for smoking cessation and improvement in the quality of care for asthma patients, we have tested a comprehensive approach to improving health services for a broad range of diseases. These publications form the basis of this approach.

This new CD-ROM includes the following publications, which are also available for free download from The Union website
- Tobacco cessation interventions for tuberculosis patients: a guide for low-income countries, 2008. Download
- Management of the child with cough or difficult breathing: a guide for low income countries, Second edition, 2005. Download
- Inpatient management of childhood pneumonia: clinical course: Instructor Manual – Participant Manual – Slide Presentations, 2005. Download
- NEW - Lung Health consequences of exposure to smoke from domestic use of solid fuels. a guide for low-income countries on what it is and what to do about it, 2009. Download
- NEW - Management of asthma: a guide to the essentials of good clinical practice, Third edition, 2008. Download
- Management of asthma: Instructor Manual – Participant Manual – Slide Presentations, 2008. Download
- NEW - Participating in global tobacco research: the experience of a low-income country, Sudan, 2009. Download.

Publication of this CD-ROM was made possible thanks to the support of the World Bank.

Reviewers for the IJTLD

The Editorial Board of The International Journal of Tuberculosis and Lung Disease receives invaluable help from many experts in the fields of tuberculosis and respiratory health in the evaluation of manuscripts submitted for publication. Reviewing for scientific journals is a complicated task, and we are very grateful for their help.
It has been decided as of this year (2009) to thank our reviewers by offering a year’s online subscription to the IJTLD. If reviewers already have access to the Journal, we request that they provide the details of a colleague in a low-income country to whom we can send it.
The list of reviewers who kindly worked for the IJTLD in 2008 can be found on the Union website http://www.theunion.org/ijtld/information-for-reviewers.html. They will be contacted shortly by the Membership Services of The Union.

Chinese IJTLD now online

We are pleased to announce that the last 6 issues (September 2007 – December 2008) of the Chinese version of the IJTLD are now available for download in pdf format from the Union website. (Please note that the files are relatively large, 3-7 Mo.) http://www.theunion.org/component/option,com_ijtld/Itemid,96/

March IJTLD highlights

In the March issue of the Journal, World TB Day (24 March) is marked by the editorial by Drs Gie and Matiru on supplying quality-assured child-friendly anti-tuberculosis drugs to children, and an Editor’s note by Dr Nulda Beyers, Editor in Chief for Tuberculosis.
The Editorial and the Editor’s note can be downloaded free of charge from:

http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00001 and http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00002 The second editorial in this issue, by Professor Moira Chan-Yeung and Dr Christopher Carlsten, addresses the problem of the peak flow meter in the diagnosis of COPD.
http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00003
The annual Year in Review, previously published as a single report written by the Editors in Chief of the IJTLD and Senior Advisor Professor Donald Enarson, is now published as four quarterly articles on a specific subject, each a review of papers published in the IJTLD on the topic as well as those published in other journals during the same period. In this issue, Drs Chiang and Yew cover MDR-TB and XDR-TB published in the IJTLD and key articles published in other journals in 2008.
The article can be downloaded free of charge from:
http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00006

Record 1.
TI: Supplying quality-assured child-friendly anti-tuberculosis drugs to children [Editorial]
AU: Gie, Robert P.; Matiru, Robert H.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00001

Record 2.
TI: World TB Day, 24 March 2009 [Editors note]
AU: Beyers, Nulda
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00002

Record 3.
TI: Reasonable alternatives to spirometry for diagnosing chronic obstructive pulmonary disease: is the peak flow meter the answer? [Editorial]
AU: Chan-Yeung, Moira; Carlsten, Christopher
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00003


Record 4.
TI: Florence Barbara Seibert and purified protein derivative [Founders of our knowledge]
AU: Daniel, T.M.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00004

Record 5.
TI: The measurement and estimation of tuberculosis mortality [State of the art series. Tuberculosis. Edited by I. D. Rusen. Number 5 in the series]
AU: Korenromp, E.L.; Bierrenbach, A.L.; Williams, B.G.; Dye, C.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00005

Record 6.
TI: Multidrug-resistant and extensively drug-resistant tuberculosis [Year in review 2008]
AU: Chiang, C-Y.; Yew, W.W.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00006

Record 7.
TI: Comparative study of RT23 and Merieux tuberculin tested among healthy volunteers
AU: Sgountzos, V.; Simopoulou, S.; Kretsou, S.; Sakayianni, K.; Pavlerou, S.; Gourgoulianis, K.; Grigorakos, L.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00007

Record 8.
TI: First molecular epidemiological study of tuberculosis in Benin
AU: Affolabi, D.; Anyo, G.; Faihun, F.; Sanoussi, N.; Shamputa, I.C.; Rigouts, L.; Kestens, L.; Anagonou, S.; Portaels, F.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00008

Record 9.
TI: Legal intervention for non-adherent patients in the treatment of tuberculosis
AU: Pritchett, E.N.; Schlossberg, D.; Lovett-Glenn, G.; Beck, J.; Dickman, B.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00009


Record 10.
TI: Mortality among tuberculosis patients on treatment in Singapore
AU: Low, S.; Ang, L.W.; Cutter, J.; James, L.; Chee, C.B.E.; Wang, Y.T.; Chew, S.K.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00010

Record 11.
TI: Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure
AU: Lin, S-M.; Wang, T-Y.; Liu, W-T.; Chang, C-C.; Lin, H-C.; Liu, C-Y.; Wang, C-H.; Huang, C-D.; Lee, K-Y.; Kuo, H-P.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00011

Record 12.
TI: Analyses of fluoroquinolones and Clostridium difficile-associated diarrhoea in tuberculosis patients
AU: Chang, K.C.; Leung, C.C.; Yew, W.W.; Lam, F.M.; Ho, P.L.; Chau, C.H.; Cheng, V.C.C.; Yuen, K.Y.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00012

Record 13.
TI: Predictors of smear-negative pulmonary tuberculosis in HIV-infected patients, Battambang, Cambodia
AU: Tamhane, A.; Chheng, P.; Dobbs, T.; Mak, S.; Sar, B.; Kimerling, M.E.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00013

Record 14.
TI: Potentially preventable tuberculosis among HIV-infected persons in the era of highly active antiretroviral treatment
AU: Pettit, A.C.; Barkanic, G.; Stinnette, S.; Rebeiro, P.; Blackwell, R.; Raffanti, S.P.; Shepherd, B.E.; Sterling, T.R.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00014

Record 15.
TI: Safety and efficacy of nevirapine- and efavirenz-based antiretroviral treatment in adults treated for TB-HIV co-infection in Botswana
AU: Shipton, L.K.; Wester, C.W.; Stock, S.; Ndwapi, N.; Gaolathe, T.; Thior, I.; Avalos, A.; Moffat, H.J.; Mboya, J.J.; Widenfelt, E.; Essex, M.; Hughes, M.D.; Shapiro, R.L.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00015

Record 16.
TI: Radiographic manifestations of culture-positive pulmonary tuberculosis: cavitary or non-cavitary?
AU: Al-Tawfiq, J.A.; Saadeh, B.M.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00016

Record 17
TI: Combining the Capilia TB assay with smear morphology for the identification of Mycobacterium tuberculosis complex
AU: Shen, G-H.; Chen, C-H.; Hung, C-H.; Wu, K-M.; Lin, C-F.; Sun, Y-W.; Chen, J-H.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00017

Record 18.
TI: Multicentre study of nitrate reductase assay for rapid detection of rifampicin-resistant M. tuberculosis
AU: Shikama, M.L.; Ferro e Silva, R.; Villela, G.; Sato, D.N.; Martins, M.C.; Giampaglia, C.M.S.; da Silva, R.F.A.M.; Ferro e Silva, P.; da Silva Telles, M.A.; Martin, A.; Palomino, J.C.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00018

Record 19.
TI: Diagnostic value of vascular endothelial growth factor and endostatin in malignant pleural effusions
AU: Zhou, W-B.; Bai, M.; Jin, Y.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00019

Record 20.
TI: Can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease?
AU: Perez-Padilla, R.; Vollmer, W.M.; Vazquez-Garcia, J.C.; Enright, P.L.; Menezes, A.M.B.; Buist, A.S.; for the BOLD and PLATINO study groups,
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00020

Record 21.
TI: Age and sex variations in hospital readmissions for COPD associated with overall and cardiac comorbidity
AU: Chen, Y.; Li, Q.; Johansen, H.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00021

Record 22.
TI: Agreement of a child’s respiratory symptom diary with parental reports and peak expiratory flow
AU: Hov, J.R.; Clench-Aas, J.; Bartonova, A.; Stavem, K.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00022

Record 23.
TI: Factors influencing the case-fatality rate of Legionnaires disease
AU: Dominguez, A.; Alvarez, J.; Sabria, M.; Carmona, G.; Torner, N.; Oviedo, M.; Cayla, J.; Minguell, S.; Barrabeig, I.; Sala, M.; Godoy, P.; Camps, N.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00023

Record 24.
TI: Clinical scoring system for paediatric tuberculosis in HIV-infected and non-infected children in Rio de Janeiro [Short communication]
AU: Pedrozo, C.; SantAnna, C.; de Fatima March, M.; Lucena, S.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00024

Record 25.
TI: Use of asthma medications among elite Danish athletes [Correspondence]
AU: Lund, Thomas Kromann; Pedersen, Lars; Backer,
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00025

Record 26.
TI: Factors predictive of adherence to tuberculosis treatment, Valle del Cauca, Colombia [Correspondence]
AU: Moulding, Thomas; Mateus-Solarte, J.C.; Carvajal-Barona, R.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00026

Record 27.
TI: Primary versus reactivated TB [Correspondence]
AU: Lim, T.K.
URL: http://www.ingentaconnect.com/content/iuatld/ijtld/2009/00000013/00000003/art00027