Law for the Prevention and Control of Tuberculosis Title I Purposes of the Law, Objectives and General Provisions Chapter I on the Purposes of the Law

The purpose of this Law is to establish a legal framework and specific measures to prevent, control, and eliminate the spread of tuberculosis. It also aims to protect public health, reduce the incidence of the disease, and improve treatment outcomes for affected persons. Similarly, it seeks to guarantee comprehensive health access for persons with Tuberculosis through the adoption of necessary measures for prevention, promotion, early diagnosis, control, treatment, rehabilitation, and research.

Comprehensive and continuous health care of the population is considered as that which is oriented to the health needs of the community and which promotes prevention, promotion, and protection against risks, damages, and diseases, and the elimination of barriers that limit access to health care.

The prevention, control, and fight against Tuberculosis is declared to be of national interest, considering as fundamental pillars: The impact on the national educational system and the faculties of health sciences to promote protection of the general population, as well as the understanding of the rights that all persons have to remain healthy and free from disease. Where applicable, the promotion of respect for the rights and social responsibility of persons with Tuberculosis in any sphere.

The provisions of this Law and any other norms that are enacted shall protect at all times the confidentiality of data, clinical information, and personal situation of users of health services. This information may be used for public health purposes in interventions that merit it.

This Law has the following objectives:

• 1)

  To establish measures to prevent the transmission of Tuberculosis from one person to another;

• 2)

  To control and stop the transmission of Tuberculosis in Honduras;

• 3)

  To establish the necessary mechanisms for inter-institutional and intersectoral coordination, conducive to prevention, promotion, diagnosis, control, treatment, rehabilitation, and research;

• 4)

  To define the attributions and responsibilities of the State and its institutions, as well as of individual or collective persons linked to the problem of Tuberculosis; and,

• 5)

  To establish the rights and responsibilities of persons affected by Tuberculosis.

For the purposes of this Law, the following shall be understood as:

• 1)

  Tuberculosis (TB): It is a chronic infectious-contagious disease, caused by the Mycobacterium Tuberculosis complex, with broad links to social determinants that favor transmission, contagion, and development of the disease. Tuberculosis primarily affects the lungs of human beings (pulmonary TB in 85% of cases), but can affect any other organ, mainly pleura, lymph nodes, nervous system, kidneys, bones (extrapulmonary TB). It is transmitted by airway, which makes containment of contagion difficult;

• 2)

  Presumptive Tuberculosis: Person with clinical manifestations that justify greater evaluation with respect to TB;

• 3)

  Pulmonary Tuberculosis (PTB): Any case of TB confirmed bacteriologically or diagnosed by clinical criteria that affects the pulmonary parenchyma or the tracheobronchial tree;

• 4)

  Person affected by Tuberculosis: Is that person who has suffered or currently suffers from TB;

• 5)

  Contact person: Is any person who lives or works with a person sick with TB;

• 6)

  First-line medications for Tuberculosis: Are the main anti-TB medications due to their greater bactericidal and bacteriostatic effect and lower risk of adverse events. They are used for treatment of drug-sensitive Tuberculosis;

• 7)

  Second-line medications for drug-resistant Tuberculosis: Are reserve medications due to their lesser bactericidal effects and greater frequency of adverse events. They are used for treatment of Tuberculosis resistant to anti-TB medications; and,

• 8)

  The definitions established in normative documents such as: Technical norms, manuals, protocols, guidelines, and current directives issued by the State Secretariat of Health are incorporated in this Law.

The provisions of this Law shall govern throughout the entire territory of the Republic of Honduras.

The State Secretariat of Health is the authority responsible for the implementation of this Law, for which it must conduct national efforts with other local and international bodies, regarding prevention, promotion, diagnosis, control, treatment, rehabilitation, and research of the affected population. The State Secretariat of Health must coordinate its work to receive feedback and induce participation in the planning, as well as the evaluation of governmental actions.

For the purposes of executing this Law, the State Secretariat of Health must:

• 1)

  Monitor medications for the treatment of all patients and the incorporation of cases into the Information System of the State Secretariat of Health;

• 2)

  Schedule and request national and international economic resources for the Unit in charge of the Tuberculosis issue necessary for adequate functioning and its coordination with other bodies;

• 3)

  Coordinate and strengthen programs aimed at compliance with this Law, managing resources for its functioning and execution;

• 4)

  Promote the training of human resources and the development of study and research activities, coordinating its activities with other public, private, national, and international organizations;

• 5)

  Encourage the adaptation of national plans to international agreements and evaluate national and international agendas for the formulation and execution of joint programs, related to the objectives and purposes of this Law; and,

• 6)

  Manage the ratification and compliance with agreements, covenants, and programs that it enters into with national or international organizations.

All Institutions of the Public Sector that manage programs or activities linked to what is established in this Law shall include in their respective Budgets the necessary line items to carry them out. Likewise, they shall strengthen and establish the necessary internal structure for their execution and administration.

The National Commission on Tuberculosis of Honduras (CONATBH) is created, coordinated by the State Secretariat of Health, comprised of the following institutions and organizations:

• 1)

  State Secretariat of Health;

• 2)

  State Secretariat of Education;

• 3)

  State Secretariat of Labor and Social Security;

• 4)

  State Secretariat of Foreign Relations and International Cooperation;

• 5)

  State Secretariat of Human Rights;

• 6)

  State Secretariat of Social Development;

• 7)

  State Secretariat of Internal Affairs, Justice and Decentralization;

• 8)

  National Penitentiary Institute (INP);

• 9)

  National Migration Institute (INM);

• 10)

  Honduran Social Security Institute (IHSS);

• 11)

  Honduran Council of the Private Enterprise (COHEP);

• 12)

  Public and Private Universities;

• 13)

  National Commissioner for Human Rights (CONADEH);

• 14)

  National Cardiopulmonary Institute (Thorax);

• 15)

  Honduran Association for the Fight Against Tuberculosis;

• 16)

  Medical Association of Honduras.

The National Commission on Tuberculosis of Honduras (CONATBH) is a body of consultation and guidance for the national response on Tuberculosis matters and, without prejudice to the specific competencies that this Law and other laws impose on other institutions, likewise for inter-institutional and multisectoral coordination and as an interdisciplinary body for the promotion of public policies on Tuberculosis.

For the purposes of executing this Law, the institutions that are part of the National Commission on Tuberculosis of Honduras (CONATBH) and all those linked to the national response on this matter must:

• 1)

  Coordinate the necessary programs to guarantee compliance with the actions established in Article 2 of this Law, ensuring the adequate management of the necessary resources for its functioning and execution. This coordination must be carried out through the competent body and within the framework of its attributions and responsibilities;

• 2)

  Promote the training of human resources and the development of study and research activities, coordinating its activities with other public and private organizations, national and international;

• 3)

  Encourage the adaptation of national plans to international agreements for the formulation and execution of joint programs, related to the objectives and purposes of this Law;

• 4)

  Follow up on compliance with the agreements, covenants, and programs of which the State of Honduras is a signatory that are entered into with national and international organizations; and,

• 5)

  Integrate the Framework of Multisectoral Responsibilities as part of the national response to Tuberculosis.

All Institutions of the Public Sector that have programs or activities linked to what is established in this Law must include in their respective Annual Operating Plans (POA) and Budgets the necessary line items to carry them out; likewise, they must strengthen and establish the necessary internal structure for their execution and administration. The State Secretariat of Finance must comply with what is provided in this Article. For this purpose, it must identify sources of income and guarantee the necessary financial availability for the programs or activities established in this Law.

The fulfillment of human rights contemplated in the Constitution of the Republic, the various international treaties, and other national laws is guaranteed. Specifically:

• 1)

  RIGHT TO LIFE: Every person diagnosed and those who are at risk of suffering from Tuberculosis have the right to access the conditions that guarantee a dignified quality of life.

• 2)

  RIGHT TO NON-DISCRIMINATION: It consists of access and guarantee of human rights contemplated in national and international regulations without any restriction.

• 3)

  RIGHT TO HEALTH: It is recognized that every person affected with Tuberculosis has the right to receive medical attention without any distinction. The person affected by Tuberculosis has the right to access free of charge the treatment regimen established by the State Secretariat of Health, through its first and second level care facilities.

• 4)

  RIGHT OF MIGRANTS AND PERSONS DEPRIVED OF LIBERTY: Every migrant person or person deprived of liberty with suspicion of or affected by Tuberculosis has the right to receive comprehensive medical attention.

• 5)

  RIGHT TO CHOOSE: Every person has the right to choose whether or not to participate in medical research;

• 6)

  RIGHT TO WORK: Access to work and job stability of persons with suspicion of or affected by TB is guaranteed. Such condition does not annul the right to enjoy the labor guarantees stipulated in the Labor Protection Laws and International Regulations. With respect to incapacities, the provisions of the Labor Code, the Social Security Law, and its Regulations shall apply.

• 7)

  RIGHT TO PROTECTION OF HONOR AND DIGNITY: It consists of privacy and respect for his dignity regarding his health condition;

• 8)

  RIGHT TO PERSONAL INTEGRITY: It contemplates respect for the physical, psychological, and moral integrity of persons, guaranteeing the confidentiality of affected persons in all spheres in which they operate.

• 9)

  RIGHT OF ACCESS TO EDUCATION: To guarantee to persons affected by Tuberculosis access to the right to education regarding their disease.

• 10)

  RIGHT OF ACCESS TO INFORMATION: It contemplates receiving a timely, concise, and clear description of his diagnosis, treatment, examinations, complications, adverse reactions of medications, preventive education of his contacts, prognosis and evolution of the disease; It also includes the obligations to keep under legal protection all personal information of users and that this be handled with confidentiality; to access the necessary information to prevent infection of the disease or its spread.

• 11)

  RIGHT TO ADMINISTRATIVE AND JUDICIAL GUARANTEES: To present claims or complaints in the corresponding administrative bodies through the channels established at the level of each institution for services received in health facilities or for any act of discrimination received.

• 12)

  RIGHT TO COMMUNITY SUPPORT: Persons who have had Tuberculosis can support community activities in their community by identifying respiratory symptomatic persons and directing them to go to the health facility.

• 13)

  RIGHT TO RECEIVE NUTRITIONAL SUPPORT: To receive from the State through the pertinent institutions quality nutritional support, according to special cases (extreme poverty, compromised nutritional status, lives alone, informal employment, functional limitation, domestic service, among others), while they are in treatment.

Persons affected by TB have the following responsibilities:

• 1)

  Notify in writing, attaching a document supporting their medical diagnosis, to their employer as soon as possible regarding their condition of being affected by TB;

• 2)

  Strictly comply with the prescribed treatment scheme and their incapacity due to illness in order to protect their health and that of others, as well as attend their follow-up and monitoring appointments;

• 3)

  In case of migrating to another country, they must notify the health establishment in the zone to make the respective coordinations in order to continue treatment;

• 4)

  In case of internal migration, they must notify the health establishment in the destination community to make the respective coordinations in order to continue treatment;

• 5)

  Provide truthful information regarding their address, responsible person, telephone number, as well as notification of any updates to any of these in order to provide follow-up and epidemiological investigation; and,

• 6)

  To prevent TB transmission in diagnosed persons undergoing treatment, the mandatory use of surgical masks is required for a period of no less than three (3) weeks, while their sputum smear becomes negative.

All conduct and actions prohibited in this Law shall be sanctioned in accordance with the legal regulations in force in our country.

The Secretary of State in the Department of Education, Public and Private Universities, Associations and Professional Colleges in the Health Area, Formal and Informal Education Institutions, External Cooperation Organizations, and Non-Governmental Organizations (NGOs), must educate and inform the population they serve regarding aspects concerning the characteristics of Tuberculosis, its forms of prevention, and its mechanisms of transmission and control. The institutions previously mentioned must educate, inform, and promote on the basis of respect, self-esteem, care, and non-discrimination of persons living with Tuberculosis, while they must also promote and strengthen community response based on the National Health Model.

Public and private educational institutions must guarantee not to restrict the right to education, providing the pertinent facilities to students affected by Tuberculosis in order that they may comply with their treatment and follow-up and that their educational process is not negatively affected. Patients with Tuberculosis may return to their school and work activities under a medical opinion that guarantees that the patient is not in a contagious phase.

Under the guidelines of the Secretary of State in the Department of Health, the Education authorities must proceed with the review and reform of the curricular plan of public and private Universities in the health areas in order to include in them the modules of Tuberculosis.

Under the guidelines of the Secretary of State in the Department of Health, Health Establishments must design and execute educational programs on Tuberculosis aimed at parents and other community members.

The Secretary of State in the Department of Health must establish continuous training programs on Tuberculosis for all its human resources.

The Secretary of State in the Department of Health must implement an information system that captures data in nominal and functional form, guaranteeing the confidentiality of the data, excepting from this the epidemiological information of the disease.

The State entities involved in the fight against TB, through the dissemination media available to the State, must periodically publish information regarding the activities of promotion, prevention, and control of TB.

The Secretary of State in the Department of Health must publish periodically or at least every six (6) months the situation and statistics of TB in the country.

Reports regarding the situation or any other document associated with TB control must be made and issued without affecting the rights of persons affected by TB.

The Secretary of State in the Department of Health must supervise the content of messages transmitted through radio, print, television, or any other medium, aimed at informing the population regarding preventive measures and forms of transmission of Tuberculosis.

The National Telecommunications Commission (CONATEL), at the request of the Secretary of State in the Department of Health, must order the broadcast of messages free of charge in public and private mass media outlets, aimed at guiding the general population regarding the prevention of Tuberculosis.

The Secretary of State in the Department of Health, in accompaniment with the institutions that comprise the multisectoral responsibility framework, must conduct educational campaigns regarding the prevention and transmission of Tuberculosis, through programs directed at employees and employers in all private companies in the country.

Tuberculosis detection tests must be prioritized for key and vulnerable populations such as persons with HIV, persons with diabetes, kidney disease patients, persons deprived of liberty, migrants, factory and maquiladora workers, indigenous peoples, health workers, children under five (5) years of age, and persons in contact with TB patients, drug-dependent patients, psychiatric patients, and patients receiving immunosuppressive treatment.

The State Secretariat of the Health Bureau must establish the appropriate control mechanisms and data registers to exercise epidemiological surveillance that ensures the confidentiality of detected cases, in accordance with what is established in the Health Code. Such activity is the responsibility of the Information Management Unit and the Health Surveillance Unit. Such mechanisms must be uniform for all hospitals, clinics, and public and private health establishments, as well as for medical professionals who practice independently.

All clinical laboratories that perform tests for Tuberculosis, bacteriology, or molecular biology must be duly registered with the State Secretariat of the Health Bureau and are obligated in accordance with Article 160 of the Health Code to maintain an information registration system guaranteeing the confidentiality of this patient information for the health authorities.

The State Secretariat of the Health Bureau must guarantee the provision of necessary biosafety equipment to health personnel who attend to, manage, and provide follow-up care to persons with Tuberculosis.

To prevent TB transmission by persons in contact with diagnosed and treated patients, it is required that the latter mandatorily use surgical masks while sputum smear microscopy is positive.

The State Secretariat of the Health Bureau must provide anti-TB treatment free of charge to affected persons, respecting their cultural, ethnic, religious, political, and social beliefs, provided that such treatment does not imply a risk to the health of the community.

The State Secretariat of the Health Bureau, through the Health Surveillance Unit by means of the National Tuberculosis Surveillance Laboratory, must provide the necessary guidelines for the diagnosis of Tuberculosis.

The prevention of Tuberculosis transmission is the responsibility of the State and its institutions, organized civil society, the private sector, and the general population; with the State Secretariat of the Health Bureau being the institution responsible for establishing the guidelines to be followed on this matter.

The State Secretariat of the Health Bureau must prepare updated semiannual lists of reagents, medications, vaccines, biological products, materials, and equipment that have demonstrated effectiveness in the diagnosis and specific treatment of Tuberculosis infection for import purposes, which shall be exempt from the payment of corresponding import tariff taxes. The State Secretariat of the Health Bureau may make use of the multiple acquisition mechanisms for products necessary to address Tuberculosis that offer the best conditions regarding delivery time, quality, cost, and product expiration date.

The Sanitary Regulatory Agency (ARSA) in coordination with the State Secretariat of the Health Bureau shall apply the control and regulation mechanisms it deems necessary for the importation of products essential to address Tuberculosis.

Treatment scheme: the TB treatment and control schemes approved by the State Secretariat of the Health Bureau must be complied with in all public health establishments in the country.

Guaranteed reserve and quality standards: 1) The State Secretariat of the Health Bureau must guarantee necessary and sufficient supply to meet the demand for anti-TB medications at the national level. 2) The State Secretariat of the Health Bureau must guarantee the storage and transportation of medications in accordance with quality standards.

The General Directorate of Regulatory Framework Surveillance is the body responsible for maintaining a registry of all adverse reactions presented by persons to anti-TB medications.

Persons diagnosed with TB have the right to access, as appropriate, the health establishments of the State Secretariat of the Health Bureau (SESAL) or the Honduran Social Security Institute (IHSS); to comply with strictly supervised treatment, the provision establishes free services and strict supervision of medication administration.

Dismissal due to TB is considered in the following cases: 1) When dismissal is executed after the employer has been notified of their condition of being affected by TB directly or indirectly; and, 2) When it occurs during their TB treatment. In case it is suspected that dismissal has occurred due to the employee's tuberculosis (TB) condition, the worker may sue their employer in accordance with what is established in current laws. According to this Law, any dismissal based on this condition is considered unjustified, provided that the employee complies with their work responsibilities and maintains proper administration of their medications according to medical instructions. In addition to the sanction established in labor laws, a pecuniary penalty shall be imposed in favor of the person affected by TB, which must be developed in the Regulation of this Law.

Continuity of employee employment. In case the person affected by TB is recovered and returns to work and by medical prescription cannot perform the same activities due to their condition, the employer must reassign them functions that they can perform without jeopardizing their health.

The employer must guarantee the provision of necessary facilities so that the person with Tuberculosis receives and complies with their Anti-TB treatment. CHAPTER II TUBERCULOSIS CARE IN PENITENTIARY CENTERS

The Ministry of State in the Office of Health as the governing entity must coordinate with the National Penitentiary Institute (INP) the necessary actions so that the disease is prevented, diagnosed in a timely manner, treated, and controlled in persons deprived of liberty in cases of suspected or evident TB. Considering that within penitentiary institutions there are budgets for the activities corresponding to such purpose; it is the institutional and financial responsibility of the penitentiary administration (for sentenced inmates) and preventive detention (for persons in temporary custody during trial) to make use of the aforementioned financing under the supervision, coordination, and direction of the Ministry of State in the Office of Health.

The National Penitentiary Institute (INP) must comply with the TB prevention and control regulations in force, issued by the Ministry of State in the Office of Health, in order to guarantee the infrastructure conditions and infection control that contribute to preventing the spread of the disease within the penitentiary population, as well as among the personnel working in each penitentiary center.

The National Penitentiary Institute (INP) in coordination with the Ministry of State in the Office of Health must take the necessary actions to guarantee the continuity of anti-TB treatment to all persons deprived of liberty who are located or transferred from one penitentiary center to another.

The National Penitentiary Institute (INP) must transfer care to the corresponding health facility of persons from the penitentiary center affected by TB who merit medical attention of greater complexity, applying all biosafety measures, both for the person deprived of liberty and for the personnel responsible for carrying out the transfer and custody.

The National Penitentiary Institute (INP) must notify the corresponding Health Region of the discharge of the person deprived of liberty with TB, in order to ensure continuity of treatment and prevent new infections. CHAPTER III PROMOTION AND ENCOURAGEMENT OF RESEARCH

Under the guidelines of the Ministry of State in the Office of Health, it must promote and coordinate the development of research on topics related to Tuberculosis in Honduras with higher education centers or medical research centers and other instances dedicated to research in different fields.

The Ministry of State in the Office of Health must ensure compliance with the ethical provisions of research conducted on the subject of Tuberculosis. CHAPTER IV FINANCING

It is an obligation of the State to assume explicit financing in annual budgets to comply with the commitments established in this Law; the permanent evaluation of the sufficiency of financing, the expression of progressive increase to adjust it to the needs identified by each Ministry of State according to the evaluations that they conduct.

Financing cannot be decreased over time. TITLE VIII FINAL PROVISIONS

This Law must be regulated by the Ministry of State in the Office of Health, within sixty (60) days after its publication in the Official Gazette "La Gaceta".

Within two (2) months following the approval of this Law, the Ministry of State in the Office of Health shall submit to the consideration of the Executive Branch the corresponding Regulations.

This Law shall enter into force on the day of its publication in the Official Gazette ("La Gaceta"). Given in the city of Tegucigalpa, municipality of the Central District, in the session hall of the National Congress, on the sixth day of the month of May of two thousand twenty-five. LUIS ROLANDO REDONDO GUIFARRO PRESIDENT LUZ ANGÉLICA SMITH MEJÍA SECRETARY JOSUÉ FABRICIO CARBAJAL SANDOVAL SECRETARY To the Executive Branch. Therefore: Let It Be Executed. Tegucigalpa, M.D.C., May 13, 2025 IRIS XIOMARA CASTRO SARMIENTO PRESIDENT OF THE REPUBLIC THE MINISTRY OF STATE IN THE OFFICE OF HEALTH