National TB Programme (NTP) of Turkmenistan made significant progress in control of TB over the last decade. In 2007-2016 the WHO estimated incidence of TB declined by 32% (from 88 to 60 per 100,000) and mortality – by 46% (from 14 to 7.6 per 100,000). TB case detection rate improved from 48% in 2007 to 80% in 2015, and the treatment outcomes of new and relapse drug-sensitive cases – from 83,6% in 2007 to 86% in 2015 cohort. Coverage with drug susceptibility testing (DST) increased from 28% in 2011 to 79% in 2016 due to roll-out of DST at regional level since 2013.
Currently the TB activities are guided by the National Program for Prevention and Control of Tuberculosis in Turkmenistan for years 2016-2020. The main goal of the program is to decrease the burden of TB in Turkmenistan by ensuring universal access to timely and quality diagnosis and treatment of all forms of TB. In line with the Global End TB Strategy, the NTP defined the following targets to be met by 2020:
· TB mortality rate: 2.4 per 100000
· TB incidence rate: 56 per 100000
· MDR TB treatment success rate: 75%
· Case notification rate for MDR TB: over 90%
These targets are to be attained by ensuring universal access to high quality TB care for all TB patients, with emphasis on quality patient-oriented treatment.
NTP started treatment of MDR-TB in 2013. In 2012 quality 2nd line TB treatment was not available, but by 2016 the NTP made effort to reach already 74% treatment coverage. In total 1,225 cases were enrolled in 2013-2016. The scaleup of MDR-TB case detection and treatment was due not only to the Global Fund support, but also to the Government funding since 2016. Ambulatory treatment of TB in all regions of the country also contributed to the NTP capacity to manage more MDR-TB cases. The final treatment outcomes for MDR-TB are available for the 2013 cohort: treatment success of 53% although below the desired 75% target is close to the average treatment success rate reported in the European Region of WHO (49%). Since mid-2017 treatment of extremely drug-resistant TB (XDR-TB) with “novel TB drugs has become available.
Despite those achievements, a high level of drug resistant TB remains a challenge. According to the 2012 nationwide Drug Resistance Survey (DRS), prevalence of multiple drug resistant TB MDR-TB among new TB cases was 13.9% and among retreatment cases - 37.6%. The data on burden of XDR-TB are not yet available, but the estimation is that about 13%-15% of MDR-TB cases might develop XDR-TB.
The burden of drug-resistant TB gradually accumulated because of prevalent (backlog) cases not covered by diagnostics and treatment in the previous years. Since 2017 with the Government funding the backlog cases have been extensively tested and put on treatment.
In addition, as an upper-middle income country in 2016 Turkmenistan became ineligible for the Global Fund TB funding. Thus, the country will fully exit from the Global Fund support by 2021. However, the share of the Government funding of the NTP needs has been already high at 94%.
To ensure effective transition to the domestic financing of the NTP, in June 2017 the Country Coordinating Mechanism (CCM) under the lead of the Ministry of Health (MoH) assessed the risk for the transition from donor to full domestic financing. The Transition preparedness assessment (TPA) showed that transition risk from donors to domestic funding for National TB program in Turkmenistan is moderate to low. At the same time, NTP needs to address several complex issues related to core mechanisms for building Resilient and Sustainable Systems for Health.
Goal of the project
The goal of the project is to enable successful transition and strengthen the sustainability of the Global Fund TB grant in Turkmenistan through progressive government co-financing of all key interventions by 2021. The challenges of transition process will be addressed through two objectives:
1. To advance policies and capacities for the successful transition to full domestic funding of the TB grant;
2. To ensure the sustainability of universal access to TB prevention, diagnosis and treatment services of good quality and applying patient-centered strategic interventions during the transition period.