Law for the Prevention and Control of Tuberculosis

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 seeks to protect public health, reduce the incidence of the disease, and improve treatment outcomes for affected persons. Similarly, it seeks to guarantee access to comprehensive health care 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 to be that which is oriented to the health needs of the community and which promotes prevention, health promotion, protection against risks, harms, 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 education system and the faculties of health sciences to promote the 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 appropriate, 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 may be enacted protect at all times the confidentiality of data, clinical information, and personal situation of health care service users. This information may be used for public health purposes in interventions that warrant 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 inter-sectoral coordination, leading 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 natural or legal persons linked to the Tuberculosis problem; and,

• 5)

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

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

• 1)

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

• 2)

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

• 3)

  Pulmonary Tuberculosis (PTB): Any case of TB confirmed bacteriologically or diagnosed through 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: They are the main anti-TB medications due to their greater bactericidal and bacteriostatic effect and lower risk of adverse events. They are used for the treatment of drug-susceptible Tuberculosis;

• 7)

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

• 8)

  The definitions established in regulatory documents such as: technical standards, manuals, protocols, guidelines, and procedures in effect issued by the Ministry of Health, are incorporated into this Law.

The provisions of this Law are applicable throughout the territory of the Republic of Honduras.

The Ministry 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, with respect to prevention, promotion, diagnosis, control, treatment, rehabilitation, and research of the affected population. The Ministry of Health must coordinate its work to receive feedback and promote participation in the planning, as well as in the evaluation of governmental actions.

For the purposes of implementing this Law, the Ministry of Health must:

• 1)

  monitor the medications for the treatment of all patients and the incorporation of cases in the Information System of the Ministry of Health;

• 2)

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

• 3)

  coordinate and strengthen programs aimed at compliance with this Law, managing resources for its operation and implementation;

• 4)

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

• 5)

  promote 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, conventions, and programs entered into with national or international organisms.

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

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

• 1)

  Ministry of Health;

• 2)

  Ministry of Education;

• 3)

  Ministry of Labor and Social Security;

• 4)

  Ministry of Foreign Affairs and International Cooperation;

• 5)

  Ministry of Human Rights;

• 6)

  Ministry of Social Development;

• 7)

  Ministry of Interior, Justice and Decentralization;

• 8)

  National Penitentiary Institute (INP);

• 9)

  National Migration Institute (INM);

• 10)

  Honduran Social Security Institute (IHSS);

• 11)

  Honduran Council of Private Enterprise (COHEP);

• 12)

  Public and Private Universities;

• 13)

  National Commissioner of 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 for 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, it is also for inter-institutional and multisectoral coordination and as an interdisciplinary body for the promotion of public policies on Tuberculosis.

For the purposes of implementing 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 subject must:

• 1)

  coordinate the necessary programs to ensure compliance with the actions established in Article 2 of this Law, ensuring proper management of the resources necessary for its operation and implementation. This coordination must be carried out through the competent body and within the framework of their 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 organisms, national and international;

• 3)

  promote 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 agreements, conventions, and programs of which the State of Honduras is a signatory that are entered into with national and international organisms; and,

• 5)

  integrate the Multisectoral Responsibilities Framework 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 internal structure necessary for its implementation and administration. The Ministry of Finance must comply with what is provided in this Article. For this purpose, it must identify income sources and guarantee the financial availability necessary 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 with or at risk of suffering from Tuberculosis has the right to access conditions that guarantee a dignified quality of life.

• 2)

  RIGHT TO NON-DISCRIMINATION: It consists of access to 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 care without any distinction. The person affected by Tuberculosis has the right to access free of charge the treatment scheme established by the Ministry of Health, through its first and second level health facilities.

• 4)

  RIGHT OF MIGRANTS AND PERSONS DEPRIVED OF FREEDOM: Every person migrant or person deprived of freedom with suspected or affected by Tuberculosis has the right to receive comprehensive medical care.

• 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 suspected or affected by TB is guaranteed. Such condition does not nullify the right to enjoy labor guarantees stipulated in Labor Protection Laws and International Regulations. Regarding disabilities, the provisions of the Labor Code, the Social Security Law and its Regulation shall apply.

• 7)

  RIGHT TO THE PROTECTION OF HONOR AND DIGNITY: It consists in the privacy and respect for the dignity of their 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 areas in which they develop.

• 9)

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

• 10)

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

• 11)

  RIGHT TO ADMINISTRATIVE AND JUDICIAL GUARANTEES: To file complaints or reports in the corresponding administrative bodies through the channels established at 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 symptomatics and directing them to attend the health facility.

• 13)

  RIGHT TO RECEIVE NUTRITIONAL SUPPORT: To receive from the State through the pertinent institutions quality nutritional provisions, according to special cases (extreme poverty, compromised nutritional status, living alone, with informal work, functional limitation, domestic service, among others), during the period they are undergoing treatment.

Persons affected by TB have the following responsibilities:

• 1)

  notify in writing, attaching a document that supports their medical diagnosis to their employer as soon as possible of their condition of being affected by TB;

• 2)

  strictly comply with the prescribed treatment scheme and their disability due to the disease in order to protect their health and that of others, as well as attend their control and follow-up appointments;

• 3)

  in case of migrating to another country must notify the health facility of the zone to make the respective coordination in order to continue treatment;

• 4)

  in case of internal migration must notify the health facility of the destination community to make the respective coordination in order to continue treatment;

• 5)

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

• 6)

  to prevent the transmission of TB in persons diagnosed with and undergoing treatment, the mandatory use of surgical masks is required for a period of not less than three (3) weeks, until their bacilloscopy becomes negative.

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

The Ministry of Education, Public and Private Universities, Associations and Professional Associations in the Health Field, Formal and Informal Education Institutions, External Cooperation Organizations, and Non-Governmental Organizations (NGOs), must educate and inform the population they serve about matters concerning the characteristics of Tuberculosis, its forms of prevention, and its mechanisms of transmission and control. The aforementioned institutions must educate, inform, and promote based on 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 appropriate facilities to students affected by Tuberculosis; so that they can comply with their treatment and follow-up and that this does not affect their educational process. Patients with Tuberculosis can return to their school and work activities under medical certification, which guarantees that the patient is not in the contagious phase.

Under the guidelines of the Ministry of Health, the Education authorities must proceed with the review and reform of the curriculum syllabus of public and private universities in the areas of health, in order to include Tuberculosis modules in the same.

Under the guidelines of the Ministry of Health, Health Facilities must design and implement Tuberculosis education programs aimed at parents and other members of the community.

The Ministry of Health must establish continuous training programs in Tuberculosis for all its human resources.

The Ministry of Health must implement an information system that captures data in nominal and functional form, guaranteeing the confidentiality of data, except for epidemiological information about the disease.

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

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

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

The Ministry of Health must oversee the content of messages transmitted through radio, written, television, or any other nature media, aimed at informing the population about preventive measures and forms of transmission of Tuberculosis.

The National Telecommunications Commission (CONATEL), at the request of the Ministry of Health, must order the emission of messages free of charge through public and private mass communication media, aimed at guiding the general population regarding the prevention of Tuberculosis.

The Ministry of Health, in accompaniment with the institutions that make up the multisectoral responsibility framework, must conduct educational campaigns regarding the prevention and transmission of Tuberculosis, through programs aimed 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 patients, persons deprived of freedom, migrants, factory and maquila workers, indigenous peoples, health workers, children under five (5) years of age, and persons in contact with patients with Tuberculosis, drug-addicted patients, psychiatric patients, and patients receiving immunosuppressive treatment.

The Ministry of Health must establish the appropriate mechanisms for control and data records 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. These mechanisms must be uniform for all hospitals, clinics, public and private health facilities, as well as for medicine professionals who practice independently.

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

The Ministry of Health must guarantee the provision of necessary biosafety equipment to health personnel who care for, manage, and follow up with persons with Tuberculosis.

To prevent the transmission of TB by persons in contact with diagnosed and treated patients, the latter must mandatorily use surgical masks while the bacilloscopy is positive.

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

The Ministry of Health, through the Health Surveillance Unit through the National Tuberculosis Surveillance Laboratory, must provide the necessary guidelines for the diagnosis of Tuberculosis.

The prevention of the transmission of Tuberculosis is the responsibility of the State and its institutions, organized civil society, the private sector, and the general population; the Ministry of Health being the institution responsible for dictating the guidelines to follow on this matter.

The Ministry of Health must prepare updated semiannual lists of reagents, medications, vaccines, biological products, materials, and equipment that have demonstrated effectiveness in the specific diagnosis and treatment of Tuberculosis infection for importation, which shall be exempt from payment of corresponding import tariffs. The Ministry of Health may make use of the multiple acquisition mechanisms of products necessary for addressing Tuberculosis that offer the best conditions in terms of delivery time, quality, cost, and product expiration time.

The Regulatory Health Agency (ARSA), in coordination with the Ministry of Health, shall apply the control and regulatory mechanisms it deems necessary for the importation of essential products for addressing Tuberculosis.

Treatment scheme: the treatment schemes and TB control that the Ministry of Health approves must be complied with in all public health facilities in the country.

Guaranteed reserve and quality standards: 1) The Ministry of Health must guarantee the necessary and sufficient supply to meet the demand for anti-TB medications at the national level. 2) The Ministry of Health must guarantee the storage and transfer of medications under quality standards.

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

Persons diagnosed with TB have the right to access, as applicable, the health facilities of the Ministry of Health (SESAL) or the Honduran Social Security Institute (IHSS); to comply with strictly supervised treatment, free of charge and strict supervision of medication administration is established.

Dismissal due to TB is considered as follows: 1) When dismissal is executed after notifying the employer 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 a dismissal has occurred due to the employee's tuberculosis (TB) condition, the worker may sue their employer in accordance with what is established in applicable 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 adequate adherence to their medications according to medical indications. Additionally to the penalty established in labor laws, a pecuniary penalty shall be imposed in favor of the person affected by TB, the same that must be developed in the Regulation of this Law.

Continuity of the employee in their work. In case the person affected by TB has recovered, returns to work, and by medical prescription cannot perform the same activities due to their condition, the employer must reassign functions that they can perform without putting their health at risk.

The employer must guarantee the granting of necessary facilities for the person with Tuberculosis to receive and comply with their anti-TB treatment.

The Ministry of Health as the governing body must coordinate with the National Penitentiary Institute (INP) the necessary actions so that the disease is prevented, diagnosed timely, cared for, treated, and controlled in persons deprived of freedom in cases of suspected or evidenced TB. Considering that penitentiary institutions have budget for activities corresponding to such purpose; it is 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 Health.

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

The National Penitentiary Institute (INP), in coordination with the Ministry of Health, must take the necessary actions to guarantee the continuity of anti-TB treatment to all persons deprived of freedom 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 warrant medical care of greater complexity, applying all biosafety measures, both for the person deprived of freedom and for the personnel in charge of carrying out the transfer and custody.

The National Penitentiary Institute (INP) must notify the corresponding Sanitary Region of the discharge of the person deprived of freedom with TB, in order to ensure continuity of treatment and prevent new infections.

Under the guidelines of the Ministry of Health, it must promote and coordinate the development of research on issues related to Tuberculosis in Honduras with higher education centers or medical research centers and other bodies dedicated to research in different areas.

The Ministry of Health must ensure compliance with the ethical provisions of research conducted on the subject of Tuberculosis.

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

Financing cannot be reduced over time.

This Law must be regulated by the Ministry 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 Health shall submit to the consideration of the Executive Power the corresponding Regulation.

This Law shall enter into force on the day of its publication in the Official Gazette ("La Gaceta"). Done 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.