The WHO European Region faces important challenges in its struggle against TB. The major constraints are:
the high rate of multidrug-resistant TB (MDR-TB), mostly in the countries of the former USSR;
the rapid growth of the HIV epidemic in eastern countries and central Asia and consequently the sharp increase in HIV-related TB;
the need to reform the health sector to include closer involvement of primary health care in TB control;
the still limited political and financial commitment to TB control;
lack of advocacy, communication and social mobilization.
In addition, prison inmates in the Region have a higher risk of developing active TB (including multidrug-resistant TB) than the general population, particularly in the former USSR. Poor infection control practices, delays in diagnosis, inadequate treatment, a high prevalence of HIV, overcrowding and poor nutrition all contribute to this risk.
Reversing the TB epidemic in the Region will require increased political and financial commitment from governments. Countries facing high TB burdens will have to increase their national expenditure on rational strategies to address the disease and its accompanying social conditions. Other countries in the Region and the European Union (EU) must raise awareness of the emergency in the Region and increase their own financial contribution to TB control