Ms. Cao Lin
Turkmenistan is a upper-middle income country with estimated high burden of Multi-Drug Resistant Tuberculosis (MDR-TB). The WHO estimates that in 2012 there were 75 new TB cases and 8.4 deaths from TB per 100,000 population. Approximately 5,100 people with TB live in the country (range 1,800 – 10,000). Treatment success rate among newly diagnosed smear-positive cases of 2011 cohort was 83%. Preliminary data from the recently completed nationwide Drug Resistance Survey suggest that about 13% of all newly diagnosed and 40% of all retreatment cases of TB are resistant to 1st line TB drugs.
The Global Fund Round 9 grant on TB started on 1 October 2010 with the goal to reduce the burden of tuberculosis in Turkmenistan by consolidation of DOTS framework, its expansion by introducing and scaling up the management of drug-resistant tuberculosis and strengthening the health system performance for effective TB control. Three main objectives have been identified for the project:
The grant is implemented by the Principal Recipient, which is the UNDP Turkmenistan, and the National TB Programme as the key responsible party, with support from the Ministry of Health and Medical Industry of Turkmenistan and the Ministry of Internal Affairs of Turkmenistan. Other sub-recipients (SRs) and implementing partners include WHO, National Red Crescent Society of Turkmenistan and the Health Information Centre of the Ministry of Health.
The most important initiative is the start of MDR-TB case management by the National TB Programme. Since July 2013, 73 patients have been enrolled on quality-assured 2nd line treatment. National regulatory framework for TB control was revised accordingly in 2011-2012 with the WHO technical assistance. One hundred and seventeen TB and Primary Health Care doctors were trained in the management of MDR-TB. The National Red Crescent Society received trainings to educate and support the MDR-TB patients during their 16-months ambulatory treatment. Based on the findings of the first recently completed representative Drug-Resistant Survey, the NTP will expand the coverage of MDR-TB treatment in 2014-2015.
To enable laboratory capacity for detection of the drug-resistant TB, the project completed upgrade of the regional TB laboratories in Mary and Lebap velayats. This included installation of the air-ventilation systems for infection control and the equipment with all required medical technology and furniture. Since 2011, all regional TB laboratories perform microscopy testing with luminescent microscopes which are more sensitive and faster than the conventional microscopes. Simpler renovation works and provision of lab furniture were done in 28 district laboratories in order to improve quality of TB diagnosis at primary health care level. Ninety laboratory specialists improved their technical skills on microscopy of sputum smears. The laboratories in Ashgabat, Mary, Lebap and Dashoguz were introduced to rapid molecular diagnosis of TB with the most up-to-date Xpert MTB/RIF technology which enables detection of TB and resistance to a TB drug Rifampicin within 2 hours. The Mary and Turkemabat based regional TB laboratories have now the capacity to conduct culture investigations on solid and liquid cultures and drug susceptibility testing to all 1st line TB drugs. As a result, the coverage with drug resistance testing in the country increased from less than 10% in 2010 to 57% in 2013. On a quality side, the project maintains regular shipment of TB Mycobacterium samples to a WHO-certified laboratory abroad as part of the WHO External Quality Assurance programme.
One of the key areas supported by the project is sustaining the quality of human resources for TB care. Up to date, 228 TB doctors, 388 TB nurses, and 1,803 primary health care workforce were trained on quality diagnosis and treatment of TB, including the staff of the penitentiary sector. Key TB doctors underwent trainings on drug management, TB reporting and recording, monitoring and evaluation, and infection control. The trainings are conducted in the training facilities renovated with the project support.
In order to promote greater community involvement in TB care as part of NTP activities, the project partnered with 392 community activists and volunteers across the country for dissemination of TB information and fighting TB-related stigma at community level. With the project support the Health Information Centre has raised awareness of public activists and mass media on TB-related issues. The project also supports the Health Information Centre-based TB Resource Centre through access to library and internet for everyone.
The considerable share of the project budget is spent to provide the country with TB drugs, diagnostics, consumables, and medical equipment. The TB drugs and reagents are also provided to the penitentiary system. As well, in 2011 the Central Prison Hospital was equipped with the modern digital X-Ray machine. The project also implements Quality Assurance Plan: recently all TB facilities in need were provided with air-conditioners to ensure temperature control for the storage of TB drugs. The drug storage facilities at central and regional levels as well as drug transportation vehicles were provided with data loggers for temperature and humidity control. The project regularly ships a sample of TB drugs for external quality control testing to ensure conformity with the WHO standards.
One of the important initiatives introduced by the grant is patient support programme. Starting from 2011, all TB patients receive monthly food parcels as a means of motivation to adhere to the 4-5 months out-patient treatment course. About 8,746 patients have received such support so far. Adherence to the prescribed treatment ensures successful cure and prevents development of drug resistant forms of TB.
In order to maintain the achievements of the National TB Programme, the project supports monitoring and evaluation activities. In 2010 the project supported publication of National M&E Guide and since then conducted two M&E trainings and two M&E System Strengthening workshops. Specialists at central and regional levels of NTP conduct quarterly supervision visits to their subordinate TB and primary health care facilities. In 2011, the project procured vehicles for these visits. The project also provides support with the NTP operational expenses. Currently with the WHO’s technical assistance, the National TB Programme is developing National M&E Plan and is revising TB definitions in accordance with the recent WHO recommendations.
|Donor||Amount contributed, USD|
|The Global Fund to Fight AIDS, Tuberculosis and Malaria||16,706,268|