KAZAKHSTAN: WORLD TUBERCULOSIS DAY -- INSPIRING STUDENTS

UNCLAS ASTANA 000661


STATE FOR SCA/CEN, EUR/ACE, F, OES/IHB
STATE PLEASE PASS TO USAID

E.O. 12958: N/A
TAGS: PGOV PREL EAID EINV TBIO SOCI KZ
SUBJECT: KAZAKHSTAN: WORLD TUBERCULOSIS DAY -- INSPIRING STUDENTS
TO MEET A CRITICAL NEED

REF: STATE 17303



1. SUMMARY: The DCM addressed a World Tuberculosis Day conference
for medical students at the Kazakhstan National Medical University
on April 7. The conference, entitled "We Can Stop TB," aimed to
motivate students to get involved in the country's fight against
tuberculosis (TB) -- a disease that claims the lives of over 2,000
Kazakhstanis every year -- and to generate awareness among the
general public. The event also emphasized the role of primary
health-care practitioners as a first line of defense in controlling
the disease. Approximately 80 students and faculty from the
Kazakhstan National Medical University attended the event, which
several national media outlets covered. END SUMMARY.


2. The conference was co-organized by USAID and the Kazakhstan
National Medical University, whose rector, Dr. Aikan Akanov, has
twice served as Kazakhstan's Vice Minister of Health. Dr. Akanov, a
respected and proven champion in Kazakhstan's fight to control TB,
reiterated his appreciation for U.S. Government support and
recognized the friendship between the two countries. He expressed
his interest in U.S. health sector commercial sales and investment
in Kazakhstan. Dr. Akanov is a former cardiologist who speaks
fluent English.

KAZAKHSTAN'S TUBERCULOSIS EPIDEMIC


3. Kazakhstan's TB epidemic compounded by HIV/AIDS could
potentially impact Kazakhstan's development. The TB epidemic
presents a major challenge to the country's health-care system and
to its economy via decreased workforce productivity. Kazakhstan
suffers from one of the world's highest recorded rates of TB. In
Kazakhstan, according to the World Health Organization's (WHO)
latest figures, 139 people per 100,000 have TB, as opposed to six
per 100,000 in the United States. Further exacerbating the epidemic
is the emergence of "multi-drug-resistant" (MDR) TB, a form of TB
which cannot be treated with a standard course of antibiotics. WHO
identifies Kazakhstan as one of the world's 22 highest-burden
countries faced with the prevalence of this deadlier version of TB.
Factors that contribute to the spread of MDR TB include deviation
from international treatment standards, interruptions in drug
supply, poor patient compliance with treatment, and poor infection
control in TB and penitentiary facilities.

CHALLENGES IN TREATMENT: TB VERSUS MDR TB


4. It is far easier to treat "normal" TB than drug-resistant forms.
Patients infected with "normal" TB face treatment regimens lasting
between six and 12 months with a standard course of antibiotics that
are affordable ($40) and readily available. However, to cure MDR
TB, the patient must undergo at least two years of treatment with a
more complex regimen of drugs that are up to 1,000 times more
expensive than the standard course of antibiotics. Drug-resistant
TB is a concern because treatment can be debilitating -- not just
due to duration of treatment, but also due to the side effects
caused by the more sophisticated antibiotics. Further, all who are
infected by a drug-resistant TB carrier also acquire a resistant
form of the infection.

WHO IS AT RISK?


5. Populations most at risk of becoming infected with TB are
prisoners and people living with HIV, which is predominantly spread
via injected drug use in Kazakhstan. TB is the leading cause of
death among HIV patients worldwide and in Kazakhstan. The
Kazakhstan National AIDS Center reported that 40 percent of HIV
patients died from TB in 2008. The challenge for prisoners is not
only contracting TB and/or HIV in prison, but also defaulting from
treatment upon release.

HISTORY IS PARTLY TO BLAME


6. A legacy of Soviet times, Kazakhstan's health-care system relies
on many "vertical" structures -- that is, highly independent,
stand-alone facilities charged with diagnosing and treating specific
diseases or conditions. The TB and HIV/AIDS systems of care are
typical vertical structures, operating separate databases and using
different protocols that allow for little interaction or
collaboration outside the disease-specific facilities. These
vertical structures present an obstacle for HIV-positive patients in
need of TB diagnosis, counselling, and treatment, and vice-versa for
TB patients. Prisoners participate in yet another vertical system
of care that is not connected to civil health-care systems,
presenting problems for newly-released prisoners who are suffering
from TB and/or HIV.

THE RESPONSE IN KAZAKHSTAN


7. In 1998, Kazakhstan adopted the "DOTS" strategy, the
internationally-recognized approach to controlling TB. One year
later, Kazakhstan reported 100% DOTS coverage in the civilian
system, and models have since been developed for TB management in
prisons. This "success" is deceptive: the quality of DOTS
implementation has been questionable, with good detection rates, but
low treatment-success rates. Although the Government has drafted a
number of TB-control decrees (e.g., a 2008-2012 national TB plan,
and TB and MDR TB management guidelines),there remains a dearth of
specialists who can interpret and analyze data, conduct operational
research, test interventions, design evidence-based action plans,
and monitor impact.


8. Despite shortages of trained TB specialists and inadequate
technical capacity to treat MDR TB, the Government of Kazakhstan
would like to rapidly scale up MDR TB case management nationwide.
To guard against resistance to MDR TB drugs, TB medical staff must
be well-trained to monitor treatment and resistance, and MDR TB
drugs are made available consistently and affordably throughout
Kazakhstan.


9. In concert with the World Bank; the Global Fund to Fight AIDS,
TB, and Malaria; and other donors, the U.S. Government -- through
USAID -- has responded by providing support to Kazakhstan's national
TB program. Activities include expanding social support services to
increase patients' adherence to treatment; providing better
information to high-risk groups to increase care-seeking and early
diagnosis; providing training to improve diagnosis, treatment, and
support for those infected with TB; and improving the collection and
use of data to make sound policy decisions.

THE WAY FORWARD


10. Some efforts have demonstrated progress in the fight to control
TB, such as enhancing laboratories' capacity to correctly diagnose
the infection, and a pilot MDR TB treatment project in Almaty that
had a treatment success rate of 84 percent compared to the national
average of 76 percent. However, given the high rates of TB, MDR TB,
and TB/HIV co-infection, it is clear that much more needs to be done
to prevent the further spread of this disease in Kazakhstan. For
example, although TB mortality rates were reduced by half in 2008,
18,000 new TB cases were registered -- of which 14 percent had a
drug-resistant strain -- and 2,500 people died of TB.


11. COMMENT: The "We Can Stop TB" conference is just one of many
activities to encourage Kazakhstan's medical students -- the
prospective leaders of the country's uphill battle against TB -- to
focus on this important disease. TB is not only a threat to
Kazakhstan, but to the greater region and the world. END COMMENT.

HOAGLAND