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The USAID Eliminating Tuberculosis in Central Asia activity reduces the burden of tuberculosis (TB) in Central Asia by building local and regional capacity to improve the detection and treatment of drug-resistant (DR) TB

OVERVIEW

The USAID Eliminating Tuberculosis in Central Asia (ETICA) activity is leading measurable and sustainable improvements in the quality and availability of DR-TB services by building the capacity of Central Asian institutions in TB leadership, management, financing, and information systems. The activity improves TB service delivery by ensuring the availability of skilled and motivated providers in laboratories and health facilities and of accessible drugs, supplies, and services. The activity works with communities to reduce TB stigma and provides comprehensive support services to TB patients to ensure successful treatment completion.

OBJECTIVES

  • INCREASE DETECTION OF TB AND DR-TB 
  • INCREASE TREATMENT SUCCESS FOR TB AND ALL TYPES OF DR-TB 
  • IMPROVE ENABLING ENVIRONMENT AND FINANCIAL SUSTAINABILITY OF TB AND DR-TB PROGRAMS.

CHALLENGES AND SOLUTIONS

THE HIGH PROPORTION OF MULTIDRUG RESISTANT (MDR)-TB AMONG PATIENTS ACROSS CENTRAL ASIA SUGGESTS CONTINUED CHALLENGES IN THE DETECTION AND TREATMENT OF BOTH TB AND DR-TB. COUNTRIES IN THE REGION HAVE MADE SIGNIFICANT PROGRESS IN STRATEGIC PLANNING AND ALIGNING CLINICAL PRACTICE GUIDELINES WITH INTERNATIONAL RECOMMENDATIONS BUT IMPROVING TB OUTCOMES CANNOT BE ACHIEVED AT THE SERVICE DELIVERY LEVEL ALONE.

KEY ACHIEVEMENTS IN 2020-2022

KAZAKHSTAN

  • Supported the development of several national documents such as Guideline on TB Detection, Treatment, and Stigma Reduction for civil society organizations (CSOs), new National Strategic Plan (NSP) for 2021-2025, and recommendations on TB financing optimization. 
  • Updated the TB diagnostic algorithm, including GeneXpert testing and rapid molecular culture and drug susceptibility testing technologies in accordance with WHO recommendations. 
  • Supported the National Tuberculosis Program (NTP) to strengthen Laboratory Quality Management System by updating all Standard Operating Procedures (SOP) to the latest international standards. 
  • Supported the implementation of drug susceptibility testing (DST) for new and repurposed drugs (linezolid, clofazimine, bedaquilline and delamanid) in 20 TB laboratories across the country. 
  • Organized regional workshop on improving TB diagnosis and laboratory network for 55 specialists from Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan. 
  • Educated 23 CSO trainers, provided training seminars on TB detection, treatment and TB stigma reduction for health care providers and the general population. 
  • Provided validation and training to support the introduction of Xpert MTB/Rif Ultra cartridges. 
  • Helped the NTP introduce whole genome sequencing technology and build the capacity of lab specialists in using this technology. The National Reference Laboratory (NRL) successfully sequenced DNA, including bedaquiline-resistant strains. 
  • Assisted in conducting external quality assurance (EQA) in the country, with all 19 regional TB laboratories receiving quality certificates from the supranational laboratory. 
  • Installed tablets and webcams at the NRL to allow for remote training of lab specialists, including masterclasses by the SRL in Gauting, Germany. 
  • Raised awareness on TB and TB-related stigma and discrimination among over 536,500 people through World TB Day events, including the social media distribution of seven video stories of people affected by TB and three video spots targeting reduction of TB-related stigma.

THE KYRGYZ REPUBLIC

  • Built the capacity of TB service specialists from the Kyrgyz Republic through regional events on TB case management, TB drug supply chain management, laboratory network optimization, social contracting for TB care, and innovations in treatment and management of DR-TB.
  •  Facilitated participation of two TB decision makers, including the Minister of Health, in a regional high-level visit to the Institute of Microbiology and Laboratory Medicine in Gauting, Germany. 
  • Engaged the Kyrgyz Republic Mandatory Health Insurance Fund as hosts and mentors for a study tour for eight representatives of the MoH, NTP and Social Health Insurance Fund of Uzbekistan to familiarize them with the structure, functions, and operations of the reforms in the Kyrgyz Republic and established ongoing peer-to-peer professional and institutional relationships.

TAJIKISTAN

  • Screened over 61,971 people for TB, including vulnerable and high-risk groups across 55,587 households. 
  • Reached over 234,000 members of the general public and 932 people from key population groups with information about TB and COVID-19 preventive measures. 
  • Developed documents to improve quality of TB services, including Guidelines for TB Laboratory Diagnosis for TB Health Providers and Primary Care Clinicians, TB Laboratory Data Management Strategy, Guidelines for Civil Society Organizations, Management of Latent TB Infection and Guidelines for Integrated TB case management in Tajikistan. 
  • Updated 323 SOPs and developed five new SOPs for the NRL to strengthen laboratory system quality. 
  • Supported the NRL in earning certificates with excellence from the SRL for all molecular and phenotypic TB diagnostics. 
  • Supported the NTP in implementation of an electronic learning management system (e-LMS) , uploading seven training courses, and restoring and updating the NTP website. 
  • Supported participation of partners in regional events, including the 5th International TB Conference, WHO Collaborating Center online courses on clinical management of DR-TB, and webinars on various TB topics. 
  • As a result of USAID advocacy, X-ray examination was made free for contacts of TB patients. 
  • Enhanced the knowledge and skills of 832 health and 916 non-health professionals through training seminars on the prevention, diagnostic and treatment of TB and stigma and discrimination surrounding TB. 
  • Advocated for and achieved provision of food assistance and adherence support for 221 DR-TB patients. 
  • Supported 162 patients with DR-TB began treatment on new shorter, more effective, and safer drug regimens in an operational research setting. 
  • Supported the MOH in introducing salary top-ups for PHC staff to improve TB care; 229 health care workers are now receiving the top-ups. 
  • Provided technical support for developing an MOH “Standardized Package” which clarified the role of non-medical organizations in TB care and paved the way for social contracting of ancillary TB services. This effort resulted in the first ever social contracting grant for TB in Tajikistan: the grant of 80,000 somoni was allocated to an NGO for provision of treatment adherence support to 60 people with TB. 
  • Through public awareness events to commemorate World TB Day 2021 and 2022, reached around 8,500 people at Activity sites. 
  • Trained 18 bloggers and journalists from leading media outlets on effective approaches in covering TB-related issues, resulting in the publication of more than 56 pieces about TB.

TURKMENISTAN

  • Built the capacity of three NTP clinical specialists in clinical management of DR-TB through participation in the five-day online WHO collaborating center course on “Innovations in Treatment and Management of DR-TB.” 
  • Forged a trusted relationship with the leadership of the NTP of Turkmenistan, leading to discussions with the NTP on further collaboration. 
  • Through engagement in a regional online webinar, fostered dialogue and collaboration between the NTP and civil society organizations (Red Crescent Society of Turkmenistan) on TB care.

UZBEKISTAN 

  • Supported the development of a strong National Strategic Plan, 2020-2025, through the provision of technical expertise on TB diagnostics, TB treatment, TB drug management and quantification/cost calculations, strengthening of the laboratory network, and TB outreach to at-risk populations including migrants. Contributed to the development of the country’s application to the Global Fund. 
  • Through participation in national TWGs, supported the revision of the national guidelines and related documents for improved management of latent TB infection.
  • Provided small medical equipment to 43 district medical institutions in Djizzak, Syrdarya and Ferghana regions. 
  • Procured 46 GeneXpert Systems and 31 GeneXpert calibration kits for the National Tuberculosis Program. 
  • Trained about 2,300 health and over 800 non-health staff on topics ranging from diagnosis and management of TB prevention to treatment of TB/DR-TB cases and prevention of TB stigma and discrimination. 
  • Supported the revision of the protocol on video-supported TB treatment (VST) and helped health care workers start VST for 155 patients. 
  • Updated 82 NRL SOPs to be aligned with the latest international standards, and to ensure safe, effective, and up to date quality assurance procedures for TB laboratory tests. 
  • Through support to multidisciplinary teams, reached about 12,600 at-risk individuals from target groups with information about TB and advised nearly 5,300 at-risk individuals to test for TB, resulting in the detection of 93 cases of TB disease and 36 people with latent TB infection. 
  • Through public awareness events to commemorate World TB Day 2021 and 2022, reached around 6,000 people with information on TB and messaging to reduce TB-related stigma and discrimination. 
  • Trained 50 reporters, bloggers, and influencers from Activity sites on effective approaches for covering TB-related issues, resulting in the publication of 617 pieces about TB. 
  • Supported participation of partners in regional events, including webinars, the 5th International TB Conference, QMS training, and study tours to Kyrgyzstan and Germany.

ACTIVITY DURATION: September 2019-September 2024

ACTIVITY BUDGET: $31,574,313

IMPLEMENTING ORGANIZATIONS: Abt Associates with the Institute of Microbiology and Laboratory Medicine red GmbH, SNRL Munich-Gauting, Gauting, Germany; PATH; Republican Public Organization Afif Tajikistan; Public Fund AIDS Foundation East-West in Kazakhstan; The Resource & Policy Exchange, Inc.; and Red Crescent Society of Tajikistan.

ACTIVITY AREAS: Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan

CONTACT: Arman Toktabayanov, Regional TB Advisor, USAID/Central Asia E-mail: atoktabayanov@usaid.gov

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