Kazakhstan
Kazakhstan is among the top priority countries in Europe for improved tuberculosis (TB)
control and prevention. In November 1998, the Ministry of Health (MOH) issued an
official regulation making DOTS (the internationally recommended strategy for TB
control ) the standard national protocol for TB treatment, and DOTS coverage has been
maintained at 100 percent since 1999. The estimated TB incidence rate of 130 cases per
100,000 population is the third highest in Europe and Eurasia. According to the World
Health Organization's (WHO's) Global TB Report 2008, Kazakhstan had nearly 20,000
TB cases in 2006, almost a 10 percent decline from the peak number reported in 2003.
Of these, about 45 percent were cases of sputum smear-positive (SS+) TB.
While incidence is declining and the overall management of TB in the country is
improving, intensified measures are needed to stem Kazakhstan's increasing prevalence
of multidrug-resistant (MDR) TB. In 2008, there were 2,836 cases of MDR-TB patients
among new cases that represented 14 percent of the total new cases reported, and an
additional 3,773 reported MDR-TB cases among old cases. National data estimate
MDR-TB to be as high as 20 percent, with an estimated 7,000 – 8,000 new MDR-TB
patients in Kazakhstan each year.1 TB is also an acute problem in the penitentiary
system and among former prisoners. In 2007, the case notification rate in prisons was
750 cases per 100,000 population, about five times the countrywide level, and
treatment follow-up of released prisoners is a challenge to TB control. The National
TB Center (NTBC), which implements TB activities, faces many challenges, as financial
and human resource allocation within the TB program is inefficient.
Despite these difficulties, Kazakhstan is considered a relatively successful country
compared to other Central Asian Republic countries. The Government of Kazakhstan
recognizes the importance of TB control and is working to establish an effective system
to fight TB. The NTBC, with USAID support, has developed the National Intersectoral
Action Plan for Implementation of TB Control Program for 2008 – 2012. Most case
detection occurs within the primary health care system, and all TB and primary health
care providers are responsible for identification and referral of TB suspects. Much
progress has been made toward integrating TB diagnosis and treatment into primary
care; however, Kazakhstan still maintains some outdated practices. With a Round 8
grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the government
plans to establish a routine drug resistance surveillance system that utilizes drug
susceptibility testing in the near future.
USAID Approach and Key
Activities
USAID assistance is channeled through national-level interventions (policies, national
guidelines, and capacity building of the NTBC), as well as through oblast-level activities
at pilot sites. Since 1997, USAID has supported Project HOPE to address TB control
and since 2000, Project HOPE has worked primarily in the Almaty oblast. In 2008,
USAID committed additional financial resources to assist in DOTS expansion to five
additional regions. In fiscal year 2008, USAID funds for TB programming totaled $1.4
million. USAID's assistance includes the following activities and interventions:
- Improving the capacity to implement quality DOTS in three sectors: the TB
care network, at the primary health care level, and the prison system
- Strengthening the health system by supporting integration of health care
services, outcome-based TB financing, and result-oriented health care
management
- Investing in technical assistance (TA) for drug management and logistics and advocating for sustained national funding and
centralized procurement of TB drugs
- Developing a comprehensive policy for human resource development for TB control
- Building capacity of the National TB Control Program in epidemiology, data analysis, evidence-based decision-making, and the use
of the TB Electronic Surveillance and Case Management system
- Supporting the design and implementation of community mobilization activities in order to reduce stigma and encourage careseeking
behaviors
- Creating a routine referral and data collection system for TB-HIV cases and improving TB staff knowledge in HIV/AIDS issues
- Providing social support to TB patients released from prison in order to increase adherence to TB treatment
USAID Program Achievements
USAID’s assistance has contributed to the following improvements in TB control:
- Assisted the NTBC in developing a five-year TB control strategy
- Supported procedures that direct MOH staff on how to manage MDR-TB
- Implemented external quality assurance for microscopy laboratories in the Almaty region that can be adopted for use at the
national level
- Conducted a study on TB among migrants in two oblasts and the city of Almaty to assess TB burden among at-risk populations
- Financed an MDR-TB control program piloted in the Almaty region that was adopted for use at the national level
- Improved TB referral mechanisms between civilian outpatient and penitentiary systems
- Provided national experts with TB drug management logistics training to help decentralize drug procurement
- Conducted operational research to support the institutionalization of undergraduate medical education and developed a list of
recommendations on improving practical skills at the undergraduate level
- Provided TA on the successful application to the Green Light Committee for second-line drugs for 350 patients in Almaty
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 global report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
Partnerships are an important element in combating TB in Kazakhstan. USAID is one of the main donors in Kazakhstan and provides support mainly through the Project HOPE, who is the lead member of a consortium that includes John Snow, Inc, Johns Hopkins University’s Center for Communication Programs, and the New Jersey Medical School's Global Tuberculosis Institute. USAID also supports a two-year MDR-TB case management and social support project that is being implemented by the Tuberculosis Control
Assistance Program, which is managed by the KNCV Tuberculosis Foundation. The KfW (German Development Bank) supports TB
control through investments in facility renovations and procurement of equipment for laboratories, and WHO provides TA. USAID also
provides support to the U.S. CDC for national TB surveillance and information systems, the Capacity Project, and the ZdravPlus Project.
The Global Fund approved a Round 6 grant to Kazakhstan for $9.8 million in 2007 and a Round 8 grant for $63.0 million in 2008 to reduce
the burden of TB and scale up the management of MDR-TB.
1 WHO Anti-Tuberculosis Drug Resistance in the World Report, 2008
March 2009
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