New Successes in Tackling TB in Turkmenistan

 TB testing lab Mary (Photo: UNDP Turkmenistan)
TB testing lab Mary (Photo: UNDP Turkmenistan)

The past 20 years have seen an increase in the spread of drug-resistant tuberculosis (DR-TB) throughout Central Asia. This strain of TB, cannot be cured by basic antibiotics. It needs to be treated with ‘second line’ drugs.  It needs to be detected at an early stage through drug susceptibility testing (DST) by trained staff at specialized TB laboratories using sophisticated equipment in a highly controlled environment.

Timely diagnosis and treatment with ‘second line’ drugs is crucial to reduce the suffering of patients with DR-TB and prevent transmission of the disease. Until very recently, however, the facilities needed to test for DR-TB were extremely limited in this region.  In Turkmenistan, such facilities were only available in the capital at the National Reference TB Laboratory in Ashgabat.

Highlights

  • The Global Fund grant amount in Turkmenistan is USD 16,3 million.
  • Coverage with drug susceptibility testing increased from 27% in 2011 to 44% in 2014.
  • Rapid molecular detection of MDR-TB (Xpert technology) is available in Ashgabat and all regions of the country.
  • 120 TB and family doctors are trained on management of MDR-TB.
  • In total 550 MDR-TB patients will be enrolled on treatment by the end of 2015.

The lack of laboratories and DST resources to perform DST has been identified as one of the main causes behind the spread of DR-TB in Turkmenistan and other developing countries in the region. “Without the necessary equipment and laboratories for drug susceptibility testing,” explains UNDP’s TB Project Manager Rustam Alymov, “sufferers of drug-resistant tuberculosis are typically given antibiotics that only serve to exacerbate the problem. This treatment not only fails to cure the disease but leads to further transmission of DR-TB in the population. Over time this leads to the development of more resistant bacteria and the emergence of completely incurable forms of TB.”

To end this vicious cycle, UNDP’s supported the Ministry of Health and Medical Industry to launch a major regional initiative in 2013 for supported interventions, comprehensively upgrading two TB laboratories in the two most populated regions of Turkmenistan, Mary and Lebap.

These upgrades included the renovation of facilities and technical equipment as well as the installation of special ventilation systems to prevent laboratory staff from being exposed to contagion. Staff were also trained in applying the most up-to-date methods of DST, such as the rapid Expert MTB/Rif technology which can provide results within just two hours of testing.

Before the project intervened it was hard for people in this country to obtain an accurate diagnosis and get the treatment they needed on time. And it was especially difficult for people living in remote areas who had to spend a lot of time and money travelling to the capital for testing. Now the people in the Mary and Lebap regions can get an accurate test result in a few hours and begin with the appropriate treatment on the same day.

UNDP’s TB project is now upgrading a third TB laboratory in Dashoguz. By the end of this upgrade in 2015, DST coverage of the population throughout the country is set to reach 72 per cent. (Prior to the project interventions, only 27% of the population was covered.) The National TB Programme also plans to scale up treatment, aiming to make treatment available for some 750 patients per year by 2016.

Supported by the Global Fund to Fight AIDS, TB and Malaria, this 16,5 million USD worth project has managed to bring about a steady decline in rates of TB infection in Turkmenistan since 2013 and a significant increase in successful treatment of DR-TB.  

By late April 2015, patients were receiving treatment both in hospitals and in outpatient settings, expanding outreach in accordance with the recommendations of the World Health Organization. Trained staff now provide patients and their families with comprehensive support, including motivational monthly food packages and information about their disease and treatment. 

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