Montenegro Achieves Stability in Tuberculosis Control Amid Challenges

Montenegro has recorded a total of 58 cases of tuberculosis in 2024, according to the Ministry of Health, as reported by the Special Hospital for Lung Diseases in Brezovik. This figure indicates a slight decrease compared to the previous year, suggesting a stable health system in managing the disease. The Ministry confirmed that the number of reported cases remains within expected limits, aided by ongoing monitoring and early detection protocols in line with recommendations from the World Health Organization (WHO).

Monitoring and Treatment Protocols

Montenegro’s tuberculosis registry, established in 2006, serves as a critical data source for tracking cases. The Ministry of Health stated that the country is experiencing a gradual stabilization in the incidence of tuberculosis due to effective disease management strategies. These strategies include the implementation of modern therapeutic protocols and continuous patient monitoring.

Despite the positive trend, there are challenges with the availability of essential medications. Specifically, the Ministry reported a shortage of rifampicin, a key drug in tuberculosis treatment during both the initial and continuation phases. This shortage has arisen due to limited production capacities. However, authorities are actively working to stabilize the supply chain to ensure uninterrupted access to necessary medications.

Recent communications from the supplier, Montefarma, indicate that deliveries of rifampicin are expected in November. Other antituberculosis medications, such as isoniazid, pyrazinamide, and ethambutol, are currently available, allowing treatment to proceed without interruption.

Collaboration with WHO

The Ministry of Health has maintained a long-standing and fruitful partnership with the World Health Organization, which has significantly contributed to improving tuberculosis control in Montenegro. Past medication shortages have been effectively addressed through WHO’s support, ensuring the provision of necessary antituberculosis drugs for various age groups and dosages.

In June 2024, WHO facilitated an online meeting with the European Tuberculosis Consortium to discuss a specific case involving a preschool-aged child diagnosed with active tuberculosis. This collaborative effort underscores the importance of expert support in managing complex cases. Furthermore, new guidelines for diagnosing and treating tuberculosis patients have been developed with WHO’s technical assistance.

Continuity of Care Post-Hospitalization

After discharge from the Special Hospital, patients continue their treatment under the supervision of healthcare professionals from local health centers, following established protocols. However, some patients receiving home treatment have reported difficulties in obtaining rifampicin from local pharmacies. To address this, the Ministry has arranged for temporary access to rifampicin from hospital reserves, ensuring continuity of therapy and monitoring recovery.

Impact of the COVID-19 Pandemic

Dr. Stevan Lučić, a microbiologist at the Special Hospital for Lung Diseases, stated that the COVID-19 pandemic has had notable repercussions on tuberculosis control programs globally and nationally. He acknowledged that Montenegro has maintained stable diagnostic and therapeutic capacities, observing a continuous decline in tuberculosis cases.

The pandemic disrupted systems globally, leading to increased tuberculosis incidences in several countries. Montenegro experienced a significant drop in diagnosed cases in 2020, primarily due to restricted access to healthcare facilities and resource reallocation towards pandemic response efforts. This disruption resulted in a subsequent rise in registered patients in 2021.

Modern Treatment Approaches

Tuberculosis is effectively treated with antimicrobial chemotherapy using antituberculosis medications. In severe cases, particularly with resistant forms of the disease, surgical interventions may be necessary. Currently, Montenegro does not have registered cases requiring such radical treatments.

Unlike acute respiratory infections such as COVID-19 and influenza, tuberculosis develops gradually and presents a more subtle clinical picture. Montenegrin healthcare facilities are equipped to rapidly triage patients with respiratory symptoms. However, confirming tuberculosis requires a different approach, relying on clinical assessments and radiographic examinations, with definitive diagnosis achieved through microbiological testing in the centralized laboratory in Brezovik.

Montenegro employs all testing methods recommended by the WHO, ensuring high reliability in diagnostics. Notably, there have been no reported cases of resistant tuberculosis in the country for an extended period, marking a significant achievement for the healthcare system.

Although the COVID-19 pandemic temporarily slowed the fight against tuberculosis, Montenegro has managed to preserve a functional monitoring, diagnostic, and treatment system for the disease. The consistent decrease in cases, alongside the absence of resistant tuberculosis cases, reflects the effectiveness and quality of Montenegro’s diagnostic and therapeutic capacities.