TUBERCULOSIS: UZBEKISTAN IS MAKING EFFORTS TO

UNCLAS TASHKENT 000332 SIPDIS SENSITIVE SIPDIS DEPT FOR EUR/PGI DAVID TESSLER AND OES/IHB ANDREA LAURITZEN ASTANA FOR ALMATY/USAID E.O. 12958: N/A TAGS: PGOV TBIO EAID UZ SUBJECT: TUBERCULOSIS: UZBEKISTAN IS MAKING EFFORTS TO IMPLEMENT BERLIN DECLARATION REF: STATE 6989 SENSITIVE BUT UNCLASSIFIED -- PLEASE PROTECT ACCORDINGLY ¶1. (U) Summary: Per request in reftel, the Government of Uzbekistan is making efforts to fulfill its commitments under the 2007 Berlin Declaration on Tuberculosis. The tuberculosis threat in Central Asia is growing, and Uzbekistan is among the top ten countries in the world for the prevalence of drug-resistant strains of the disease. A World HEALTH Organization official in Tashkent working on the issue believes the Government of Uzbekistan has the political will to implement internationally-recognized tuberculosis control strategies. He also noted the government has implemented an electronic tuberculosis case-reporting system; expanded a pilot project to collaborate on tuberculosis and HIV programs throughout the country; trained neighborhood-level officials about tuberculosis; and are running two multiple drug-resistant (MDR-TB) management pilot programs. Major problems include: a lack of success under the directly observed treatment (DOTS) approach in identifying cases and completing the treatment courses; poor communication among medical professionals and between medical workers and patients; doctors over-prescribing medications; and keeping required medicines in stock. USAID continues to implement tuberculosis-focused programs in Uzbekistan. Early progress since the Berlin Declaration suggests the Government of Uzbekistan is taking the tuberculosis threat seriously and is prepared to cooperate with the international community. End summary. ¶2. (U) As in other countries of Central Asia, the tuberculosis threat in Uzbekistan is growing. There are approximately 40,000 active cases of tuberculosis in the country, with a rate of 148 cases per 100,000 population. Uzbekistan is also among the top ten countries in the world for the prevalence of drug-resistant strains of the disease. Thirteen percent of newly-registered tuberculosis cases are diagnosed as drug-resistant strains. ¶3. (SBU) Bakhtiyar Babamuradov (please protect),WHO's Tashkent-based National Tuberculosis Coordinator, believes the Government of Uzbekistan does have the political will to implement its commitments under the Berlin Declaration. Specific progress on the items spelled out in paragraph 5 of the Berlin Declaration (per reftel) include: implementation of an electronic tuberculosis case reporting system; expansion of a successful pilot project (originally in Tashkent City and Tashkent Region) to collaborate on tuberculosis and HIV programs to all areas of the country; training influential neighborhood-level (mahalla) officials about tuberculosis; and the implementation of two MDR-TB management pilot programs (in Karakalpakstan Province and Tashkent City) as well as a corresponding pilot program in the prison system (where tuberculosis is rampant). Babamuradov also noted that the Ministry of HEALTH is actively developing a National Tuberculosis Strategy for 2009 - 2014 that will be based on the STOP TB and the Plan to Stop TB in 18 High-Priority Countries in the WHO European Region, 2007 - 2015. ¶4. (SBU) Babamuradov noted that ONE area for improvement is to improve the strategy and quality of DOTS. According to a USAID official, other problems include poor communication of diagnoses and treatment plans to patients. Also, while patients may access tuberculosis treatment medicines at no cost, local doctors also often prescribe up to ten additional medicines to patients which are not free and are clinically worthless. As a result of these rampant problems it is often difficult to properly identify cases and convince patients to complete the necessary treatment programs. ¶5. (U) USAID continues an active program to counter tuberculosis. Project Hope is implementing a regional tuberculosis control project in Central Asia that runs through 2009. The Centers for Disease Control (CDC) does surveillance and laboratory quality work on tuberculosis. USAID funding also supports WHO experts on tuberculosis who have worked in Uzbekistan. USAID staff also directly conducted a public outreach event at post on March 14 which focused on tuberculosis. ¶6. (U) Comment: The September 2007 Berlin Declaration is still very new, and it is typical for initiatives to get off the ground very slowly in Uzbekistan. The country also had important Presidential elections in December 2007 that totally preoccupied the government until the New Year. Nonetheless, the actions taken thus far by the Government of Uzbekistan suggest it recognizes the serious threat posed by tuberculosis and is prepared to cooperate with the international community to curb it. HANSON