Evaluation of the impact of guidelines on tuberculosis control in Italy. National AIPO "Tuberculosis" Study Group. Associazione Italiana Pneumologi Ospedalieri.

This study was performed in Italy, where a central tuberculosis (TB) unit and national guidelines on TB control are lacking. The objectives of the study were: 1) to design comprehensive guidelines on TB control; 2) to discuss them within the scientific community and to present them to administrators and politicians: and 3) to evaluate their impact from a public health perspective. The ultimate goal was to improve TB control nationwide through a consensus-based initiative. The steps taken in planning were as follows: 1) an assessment of control activities operating in the country was made by means of three surveys: 2) guidelines on TB control were designed, presented, discussed and approved during three Consensus Conferences involving representatives of organizations operating in TB control and services; and 3) their impact was evaluated by means of objectively verifiable indicators (availability of TB case definition, regional control programmes, surveillance reports, guidelines on treatment, staff training). Regional TB control programmes were implemented in three major regions (30% of the national population), and are in advanced process in other four regions (29% of the national population). The protocol approved during the three Consensus Conferences benefited from the co-ordinated action of governmental and nongovernmental organizations. Its impact on tuberculosis control was positive, particularly at the regional level.