FIGHTING TB IN CENTRAL ASIA

UNCLAS SECTION 01 OF 02 ASTANA 000407 SIPDIS STATE FOR EUR/PGI (D. TESSLER),OES/IHB (A. LAURITZEN),SCA/CEN (O'MARA) SIPDIS E.O. 12958: N/A TAGS: TBIO WHO KZ SUBJECT: FIGHTING TB IN CENTRAL ASIA REF: STATE 6989 ASTANA 00000407 001.2 OF 002 ¶1. Summary: Many of the guidelines stated in the Berlin Declaration have long been implemented in Kazakhstan, and the country is currently in line with WHO-DOTS tuberculosis (TB) guidelines. However, many of the TB-focused bodies are under-funded, and some operate under outdated guidelines. The major problem facing Kazakhstan is Multi-Drug Resistant (MDR) TB. Kazakhstan accounts for the most MDR-TB cases in Central Asia and currently 4/5 of TB cases in Kazakhstan are MDR-TB. Kazakhstan is just now starting to address co-infection of HIV-TB. Kazakhstan does have a national program to address the TB problem, which is co-funded by USAID, WHO, the German Development Bank, the Red Cross, and the Global Fund to Fight AIDS, TB, and Malaria. The major problem facing the national program is funding as well as personnel and infrastructure capacity limitations. The Kazakhstanian National TB Program is currently seeking continued USAID support through 2014. End summary. A Recognized Problem -------------- ¶2. Kazakhstan has identified TB as one of its national public health priorities and was the first Central Asian country to adopt DOTS as its national strategy, resulting in lowered TB incidence and TB death rate indicators over the last five years. However, the problem remains acute, with a consistently high incidence rate and a drug resistant TB rate reported as one of the world's highest. Kazakhstan signed the Berlin Declaration in 2007. Kazakhstan, with assistance from USAID, the Global Fund, the Centers for Disease Control and Prevention (CDC),other donors, and international organizations implements a comprehensive TB control strategy including diagnosis, treatment, and prevention. Regulations and Guidelines -------------- ¶3. Since signing the Berlin Declaration, a number of important developments in national TB control have been observed. The Government adopted a decree on 12 December 2007, "On protection measures of the population from TB in Kazakhstan," which set priorities and assigned responsibilities for different areas of TB control to local governments (regional TB programs),Ministry of Finance (control over budget allocations and spending),Ministry of Health (TB prevention, diagnosis, drug supply and treatment),and Ministry of Information and Culture (awareness raising activities). ¶4. Next, a number of important government regulations and national documents on TB control were developed with USAID technical assistance. The National TB Center developed a five-year national TB control plan for 2008-2012, which, when signed, will serve as the national TB program. National partners drafted a comprehensive up-to-date "National Manual on TB Control," which will be finalized and adopted in FY 2008. U.S. assistance also played a decisive role in the passage of two regulations in FY 2007 that put the TB system under the control of the Sanitary-Epidemiologic Service and introduced revised reporting forms. National guidelines for management of MDR-TB have been drafted with the use of protocols developed within the USAID program. The National TB Control Plan -------------- ¶5. In accordance with the national TB control plan, the GoK has started to strengthen TB facilities, including labs and in-/out-patient facilities through renovation, refurbishment, and improvement of infection control systems (e.g. ventilation, administrative procedures, and waste management). The Government has also initiated preparatory activities to build and equip the national reference laboratory under the National TB Center in accordance with international standards to strengthen TB detection. The existing lab is outdated and insufficient. ¶6. The TB reporting forms and reporting systems have been revised recently and a nation-wide electronic TB surveillance system has been implemented by CDC (with financial support from USAID). The newly-updated system includes MDR-TB data, which will help the country to better monitor and respond to the situation. With the assistance of international organizations and donors, the National TB Center conducts regular training activities on various TB control and DOTS implementation activities, which target TB staff-primary health care and penitentiary staff. The GoK, with support from international organizations, conducts public education events. Raising awareness on the occasion of World TB Day involves various educational, media, and community mobilization events. ¶7. The local governments and the Ministry of Social Protection have been requested under the new TB decree to provide low-income TB patients with social assistance (cash benefits, food packages, and ASTANA 00000407 002.2 OF 002 transport benefits). Special social assistance is envisioned for TB patients released from prisons. Drug-Resistant TB -------------- ¶8. With USG support, the national TB program and regional TB facilities have implemented a pilot program in Almaty on management of MDR-TB. As a result, patients with drug-resistant TB in Almaty receive better quality treatment and care. A set of clinical protocols on management of drug-resistant TB were developed, adopted at the city level, and recommended for the national guidelines for MDR TB management. The Government increased procurement of TB drugs in 2008, including second-line drugs. Some second-line drugs are also being procured by the Global Fund TB grant. Still, not all the MDR-TB patients (estimated 7,000) will be covered by drug treatment, as the GoK struggles to develop a system of uninterrupted supply of quality TB drugs, including second-line drugs needed to treat MDR-TB. TB Funding -------------- ¶9. Kazakhstan has the highest funding per TB patient in the Central Asia region. In late 2007, the Minister of Health reported that the GoK increased financing of health care, including TB, by 37 percent in 2008. Yet, domestic funding is not sufficient to reverse the TB epidemic and to address all the needs for TB control and treatment, including treatment of MDR TB cases. Donors and international organizations provide technical and financial assistance to the GoK to strengthen TB control. USAID and its partners, Global Fund, the German Development Bank, the Royal Netherlands Chemical Society, and AIDS Foundation East-West are active in TB control. In 2007, the GoK received a $9.8 million grant from Global Fund to combat TB. While implementing this grant, the GoK plans to apply for the 8th round of Global Fund applications, which will be the last time that Kazakhstan is allowed to apply. Kazakhstan, a middle-income country, will no longer be eligible for Global Fund assistance.