Ending Drug-Resistant Tuberculosis in Central Asia

The Ending Drug-Resistant Tuberculosis in Central Asia program is based on a comprehensive multi-component approach to provide support to the National Tuberculosis Programs (NTPs) of Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan in significantly scaling up the prevention, detection, and treatment of drug-resistant tuberculosis (DR-TB).

Our Work

The overall goal of this program is to improve the prevention, detection, and treatment of DR-TB across Central Asia. The program supports the NTPs to implement TB control interventions that contribute to reaching targets set forth in the United Nations High Level Meeting of the General Assembly to Fight TB in September 2018, the United States Government Global TB Strategy 2015-2019, and the National Action Plan for Combating Multidrug-Resistant Tuberculosis 2020-2025, WHO End TB Strategy. The program focuses on high-level policy engagement with national governments and provides technical assistance with the introduction and scale-up of new approaches for DR-TB treatment and care.

Program Highlights

The main challenge in TB control in Central Asian countries is the high burden of multidrug-rifampicin-resistant tuberculosis (MDR/RR-TB). To address this challenge, the program:

Assists in development and update of the National TB Strategic Plans and strengthening of regulatory frameworks;
Supports introduction, implementation, and scale-up of latest WHO-recommended guidelines for TB and DR-TB prevention and programmatic management of TB preventive treatment to enhance contact tracing, identify and test of individuals at high risk, increase access to quality DR-TB diagnostics, and ensure access to quality treatment and care for all TB patients;
Updates National Clinical Protocols on DR-TB management, provides training of trainers to instruct TB doctors at all levels on operationalizing new clinical protocols;
Stimulates and supports the introduction of newly recommended modified fully-oral shorter treatment regimens for DR-TB by facilitating evidence-based decision-making and advocating for a patient-centered approach;
Assists the NTPs in strengthening surveillance monitoring and evaluation systems for effective TB case management.

Key Accomplishments

The Regional Initiative to introduce modified shorter treatment regimens (mSTR) under operational research conditions has been initiated in 14 countries in the WHO European Region, including countries in the Central Asia region. Under this initiative, Kazakhstan, Turkmenistan, Tajikistan, and Uzbekistan received support to adapt the WHO generic operational research protocol to country conditions and submitted for approval by local Ethics Review Committees and WHO Ethics Review Committee. Enrollment of patients is ongoing, with over 100 patients enrolled so far.

Kazakhstan:

Provided assistance with development of the National TB Strategic Plan 2021-2025;
Developed National Consolidated Guideline on TB Preventive Therapy and Systematic Screening for Tuberculosis and the pre final version was submitted to the NTP for review and clearance;
Implemented operational research on introduction of mSTRs for MDR/RR-TB patients continuing. One hundred and thirty-nine patients were enrolled onto mSTRs so far and started treatment with modified fully oral shorter treatment regimens.

Tajikistan:

Implemented operational research on introduction of mSTRs for MDR/RR-TB patients continuing. Forty-eight patients were enrolled onto mSTRs so far and started treatment with modified fully oral shorter treatment regimens;
Conducted a training series on mSTR for 62 TB specialists from across the country;
Revised the National Guidelines on Latent TB Infection (LTBI) management to reflect the latest WHO recommendations on TB preventive treatment;
Provided assistance and on-the-job training on the National TB electronic database through monitoring and evaluation visits with the Ministry of Health and NTP staff.

Turkmenistan:

Developed the National Guidelines on TB Control in Prisons and trained 25 medical staff of penitentiary system on TB control in prisons;
Completed first draft of the National Guideline on Management of TB in Children was and submitted to the Ministry of Health for approval;
Implemented operational research on introduction of mSTRs for MDR/RR-TB patients continuing. Twenty-three patients were enrolled onto mSTRs so far and started treatment with modified fully oral shorter treatment regimens.

Uzbekistan:

Provided assistance on development of the National TB Strategic Plan for 2021-2025;
Trained 160 TB laboratory specialists from across the country on ‘Practical aspects of diagnosis of DR-TB’;
Developed ‘Programmatic Management of DR-TB’ guidelines and trained 384 TB specialists;
Conducted 21 training sessions on clinical and programmatic management of DR-TB for regional TB specialists from across the country;
Implemented operational research on the introduction of mSTRs for MDR/RR-TB patients continuing. Seventy patients have been enrolled onto mSTRs so far and started treatment with modified fully oral shorter treatment regimens;
Developed protocol on adaptation of District Health Information Software 2 (an open source, web-based platform most commonly used as a health management information system) tracker with the support of WHO consultants from the University of Oslo.