ITALIAN ACTIONS TO FIGHT TUBERCULOSIS

UNCLAS SECTION 01 OF 02 ROME 000263 SIPDIS SIPDIS DEPT FOR EUR/PGI Q DAVID TESSLER OES/IHB - ANDREA LAURITZEN STATE PLEASE PASS TO HHS FOR J. COURY E.O. 12958: N/A TAGS: TBIO WHO EAID SOCI AF IT SUBJECT: ITALIAN ACTIONS TO FIGHT TUBERCULOSIS REFTEL: A) STATE 6989, B) 07 Rome 2436 ¶1. Summary. A GOI action plan pre-dating the Berlin Declaration on Tuberculosis (TB) is advancing the implementation of most of ItalyQs commitments under paragraph five of the Declaration. Italy also has significantly increased its contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria and to the World Health Organization (WHO) in recent months. In addition, Italy will be making a separate 1.5 million Euro contribution to the WHO-directed anti-TB efforts in Afghanistan. Domestically, Italy has a fairly significant problem of TB incidence among legal and illegal immigrant populations. The GOI action plan is supposed to better measure the incidence of TB among immigrant groups and improve TB-related health care services. End summary. ¶2. On January 28, Post queried the Health MinistryQs International Affairs Office and the Italian National Institute of Health re: ref a) request for information. On February 7, Dr. Maria Grazia Pompa, responsible for Infectious Disease Surveillance in the MOH Center for Disease Control, provided Post the Italian action plan to combat tuberculosis, called QStop TB in Italy,Q and issued in 2006. The action plan essentially paraphrases the World Health OrganizationQs (WHOQs) QStop TBQ plan. As such, it addresses almost all of the commitments mentioned in paragraph five of the Berlin Declaration on Tuberculosis, both at the national and the international level. ¶3. According to the planQs introduction, a 2001 Italian survey revealed great differences between ItalyQs northern and southern regions regarding TB monitoring, treatment and follow-up capabilities. Moreover, it continues, although TB incidence in the native Italian population is very low (7 cases per 100,000 inhabitants in 2004),the trend has not been decreasing in the last 10 years as has happened in the U.S. where Q according to the introduction Q action plans have been implemented effectively. For these reasons, the plan explains, the GOI decided to implement a TB action plan aimed at developing effective guidelines and increasing the quality and quantity of TB assistance in Italy. ¶4. The 17-page plan mentions all of the commitments included in paragraph 5 of the Berlin Declaration, except for the issues of Qinvolving civil societyQ and Qempowering people with TB and their communities, and removing stigma. (Since the plan is at the policy level, the different therapeutic options, such as the preference for short- course rather than normal therapy, also are not mentioned.) The plan underscores the GOIQs intention to strengthen public health and social services systems in order to enhance TB surveillance and monitoring, in both quality and quantity; to increase collaboration between TB and HIV programs; and to promote research and development of new diagnostics, drugs and vaccines, as well as program-based operational research. Moreover, the issues of monitoring and surveillance of high-risk populations, as well as addressing multi-drug-resistant TB, and HIV-related TB, are particularly stressed in the action plan. ¶5. In order to implement the action plan, in 2006 the MOH funded two national projects dedicated to TB epidemiological surveillance and TB drug resistance, allocating 130,000 and 100,000 euros to them respectively. Both projects aim at better standardization of TB monitoring and reporting across Italy. They also support a study called SMIRA (Multicentric Study of Italian Drug- Resistant Tuberculosis),begun in 1995. One of the long- term objectives is the creation of a national TB database, which would contribute to the European surveillance system. ¶6. The TB action plan states that in order to improve assistance, all TB-related health-care services will be provided for free to all patients, including immigrants. According to the plan, TB incidence has more than doubled in young immigrants (those 25-34 years old) since 1999, reaching 70 cases per 100,000 immigrants in 2004. That represents roughly 40 percent of ItalyQs total TB cases, and is ten times greater than the rate of TB incidence among the Italian population. Note: The real rate of incidence is difficult to establish, since it could be overestimated (the overall immigrant population is likely larger than that described in official figures, which donQt include illegal immigrants) or underestimated, due to incomplete TB survey data. However, it is worthy of note that according to 2004 WHO data, TB incidence in the countries providing the largest numbers of immigrants to Italy is: 110 per 100,000 in Morocco, 146 per 100,000 in ROME 00000263 002 OF 002 Romania, and 101 per 100,000 in China. TB incidence in countries sending fewer immigrants to Italy ranges from 293 per 100,000 in the Philippines to 22 per 100,000 in Albania and Tunisia. End note. ¶7. The plan calls for specific measures to monitor TB among high-risk immigrant populations, and to increase awareness among high-risk populations through outreach and educational materials. Apart from taking into consideration TB prevalence in the country of origin, the plan notes that TB screening should be performed over the first two years after immigrants arrive, since almost half of the immigrants who develop TB do so after they arrive in Italy, due primarily to over-crowding and poor living conditions. GOI outreach to high-risk populations occurs more through government channels, e.g., at out-patient care centers and through the newly-created National Immigration Medicine Institute, than through civil society organizations. ¶8. According to a 2006 MOH report on QTB and Immigration: Control Strategies,Q while some regional health authorities (e.g. Siracusa in Sicily and Treviso near Venice) rely on TB testing only of immigrants who visit public health facilities, others (Bari and Lecce in Puglia, and Brescia, Genoa, Milan, Reggio Emilia, and Turin in northern Italy) conduct active outreach efforts. These efforts include screening tests of immigrants recruited from worker dormitories, schools, assistance centers for newly-arrived immigrants, communities with large immigrant populations, prisons, and government offices where immigrants obtain work permits. Health authorities have studied characteristics of different immigrant groups (Chinese, African, Eastern European) to better target outreach efforts. One key need they identified is for more cultural mediators/interpreters: in 2006 only four of eleven centers studied had one or more of such employees. The out-patient care center in Reggio Emilia is the only one exclusively dedicated to monitoring TB in immigrant populations. The only non-governmental association mentioned in the report is the NAGA immigrant health and advocacy group in Milan, which currently provides health-care services to 100,000 immigrants Qwithout residence permitsQ per year. ¶9. On the international level, on December 20, 2007 Italy became the first donor to pay its 2008 pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria. ItalyQs 130- million-Euro contribution to the Global Fund was made possible in part by the so-called Qtesoretto,Q extra government revenue resulting from more effective tax enforcement, additional taxes, and economic growth. Per ref b),Italy also is contributing 16 million Euros to the World Health Organization (WHO) in 2008, a significant increase over ItalyQs 2007 donation of 9 million Euros and over the 4 million Euros allocated in 2006. Like the Global Fund contribution, the 2008 WHO funding benefited from the tesoretto. In addition, Ministry of Foreign Affairs Afghan Assistance Expert Walter Zucconi told Econoff on February 27 that Italy will be making a separate contribution to the WHO of 1.5 million Euros earmarked for the fight against TB in Afghanistan. This money will be in addition to the Global Fund contribution. However, given the current economic slowdown, the Finance Ministry has already warned that anticipated revenues for the 2008 tesoretto will come in under projection. It is unclear at this time whether this shortfall will impact funding in 2008 or in out years. SPOGLI