Collaborative action on tuberculosis and alcohol abuse in Estonia (2013)
Estonia has the highest per capita alcohol consumption in Europe. Alcohol consumption and its associated alcohol use disorders are seen as major obstacles to increasing the treatment success achieved under the National Tuberculosis Programme. The National Institute for Health Development, the World Health Organization and the European Centre for Disease Prevention and Control worked jointly on a demonstration project aiming to improve treatment compliance and outcomes of tuberculosis and multidrug resistant tuberculosis patients through collaborative tuberculosis, mental health and social services. A specific conceptual framework was developed for this collaboration.
Some achievements of the demonstration project included: implementing necessary guidelines and tools; providing specific training to staff; introducing routine alcohol use disorder treatment for tuberculosis patients; and consideration of project interventions in the current draft of the National Alcohol Policy Green Paper, along with reimbursement of alcohol use disorder-related services. However, some of the project's objectives were not achieved: staff shortages and lack of financial incentives hindered collaboration within mental health services; alcohol use disorder screening was not routinely offered to all tuberculosis patients; and the short project time frame and low number of enrolled patients limited the evaluation of the impact of interventions on treatment outcomes. Nevertheless, the available evaluation data are encouraging.