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International Standards for Tuberculosis Care

Developed by the Tuberculosis Coalition for Technical Assistance (TBCTA)

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Developed by the Tuberculosis Coalition for Technical Assistance (TBCTA)

Funded by the United States Agency for International Development (USAID)


For an updated list of endorsers, see the Francis J. Curry National Tuberculosis Center website at or the Stop TB Partnership website at


Disclaimer: The information provided in this document is not official U.S. Government
information and does not represent the views or positions of the U.S. Agency for International
Development or the U.S. Government.

Suggested citation:

Tuberculosis Coalition for Technical Assistance. International Standards for Tuberculosis
Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance, 2006.


The purpose of the International Standards for Tuberculosis Care (ISTC) is to describe
a widely accepted level of care that all practitioners, public and private,
should seek to achieve in managing patients who have, or are suspected
of having, tuberculosis. The Standards are intended to facilitate the effective
engagement of all care providers in delivering high-quality care
for patients of all ages, including those with sputum smear-positive,
sputum smear-negative, and extra pulmonary tuberculosis, tuberculosis
caused by drug-resistant Mycobacterium tuberculosis complex
(M. tuberculosis) organisms, and tuberculosis combined with
human immunodefi ciency virus (HIV) infection.
The basic principles of care for persons with, or suspected of
having, tuberculosis are the same worldwide: a diagnosis should
be established promptly and accurately; standardized treatment
regimens of proven effi cacy should be used with appropriate
treatment support and supervision; the response to treatment
should be monitored; and the essential public health responsibilities
must be carried out. Prompt, accurate diagnosis and
effective treatment are not only essential for good patient careó
they are the key elements in the public health response to tuberculosis
and the cornerstone of tuberculosis control. Thus, all
providers who undertake evaluation and treatment of patients with
tuberculosis must recognize that, not only are they delivering care
to an individual, they are assuming an important public health function that entails a high
level of responsibility to the community, as well as to the individual patient.
Although government tuberculosis program providers are not exempt from adherence
to the Standards, non-program providers are the main target audience. It should be emphasized,
however, that national and local tuberculosis control programs may need to
develop policies and procedures that enable non-program providers to adhere to the
Standards. Such accommodations may be necessary, for example, to facilitate treatment
supervision and contact investigations.

In addition to healthcare providers and government tuberculosis programs, both patients
and communities are part of the intended audience. Patients are increasingly aware of
and expect that their care will measure up to a high standard as described in the Patientsí
Charter for Tuberculosis Care. Having generally agreed-upon standards will empower
patients to evaluate the quality of care they are being provided. Good care for individuals
with tuberculosis is also in the best interest of the community.
The Standards are intended to be complementary to local and national tuberculosis control
policies that are consistent with World Health Organization (WHO) recommendations.
They are not intended to replace local guidelines and were written to accommodate local
differences in practice. They focus on the contribution that good clinical care of individual
patients with or suspected of having tuberculosis makes to population-based tuberculosis
control. A balanced approach emphasizing both individual patient care and public
health principles of disease control is essential to reduce the suffering and economic
losses from tuberculosis.

The Standards should be viewed as a living document that will be revised as technology,
resources, and circumstances change. As written, the Standards are presented within a
context of what is generally considered to be feasible now or in the near future.
The Standards are also intended to serve as a companion to and support for the Patientsí
Charter for Tuberculosis Care developed in tandem with the Standards. The Charter
specifi es patientsí rights and responsibilities and will serve as a set of standards from
the point of view of the patient, defi ning what the patient should expect from the provider
and what the provider should expect from the patient.

Tuberculosis Coalition for Technical Assistance. International Standards for Tuberculosis Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance, 2006.

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