How did the TB service work during the COVID-19 pandemic?

Как противотуберкулезная служба работала во время пандемии COVID-19?

During the COVID-19 pandemic, all the forces and resources of the health care system were thrown into the fight against a hitherto unknown infection. All diseases were relegated to the background, including such a no less dangerous infectious disease as tuberculosis. In order to minimize the negative impact of the pandemic, the Ministry of Health of the Kyrgyz Republic issued an order, according to which emergency measures were taken to provide controlled treatment of TB patients in emergency conditions. For example, using the Internet or telephone communications - the so-called video-controlled treatment. Another point of the order is to expand the application of the modern patient-centered approach in outpatient treatment of tuberculosis, known as "involving community helpers in treatment." Its essence is that the doctor, together with the patient, chooses an assistant for him from among his relatives and friends, who is willing to voluntarily and gratuitously help in treatment. In Kyrgyzstan, both video-controlled treatment and the involvement of community assistants are being implemented within the framework of USAID tuberculosis projects.

Kemin district was one of the first to begin not only to attract public assistants in the treatment of patients with tuberculosis, but also to increase their number during a pandemic. “Before that, some patients were treated without the involvement of assistants, patients themselves came to the medical centers to take anti-tuberculosis drugs,” says district TB doctor Nadezhda Bidzhanova. - But during the pandemic, since medical practitioners were employed in COVID, as a compulsory measure, we also assigned public assistants to them. If earlier anti-tuberculosis drugs were issued for 7 days, then when the pandemic intensified, checkpoints were set up everywhere and patients could not independently get to medical institutions, by order we gave drugs to public assistants for 14 days. The patient takes medication under the supervision of a public assistant, they have special forms where they mark the medication every day and donate them to us at the end of the month ”.
Eight patients with tuberculosis of the family doctor Baktygul Sharsheyeva, who is now working in the mobile team, also had public assistants: “The assistants came to us and took the medicines according to the bill. Then we consulted them by phone, explained when to come for the next batch of medicines. First, drugs were given for 7 days, then for 14 days. "
In the Kemin district, where 24 FAPs, 6 FGPs and 1 CGVP, during the pandemic, they were also able to organize the process of collecting analyzes and transporting them to the laboratory of the district FMC. Nadezhda Bidzhanova: “Our patients must be tested monthly, they must always be under control. And we were afraid that the analyzes would not be delivered to the FMC laboratory on time. But volunteers and public assistants came to our aid. Remember, there were checkpoints everywhere, only medical workers could pass and volunteers? At that time, patients from villages could not get to the center in any way. Therefore, volunteers and public assistants came. Therefore, we have trained community assistants on how to properly collect and transport sputum samples. Then this is a requirement of the time, an emergency measure. "
Since some of the analyzes are examined in the laboratory of the district FMC, and some are to be delivered to the National Reference Laboratory in Bishkek, during the pandemic, the system for transporting biomaterials, introduced into the country's anti-tuberculosis service with the technical support of the USAID "Cure Tuberculosis" project, was also rigorously tested. According to the head of the National Reference Laboratory Gulmira Kalmambetova, the test was successful: “A patient can collect a sample of his analysis anywhere and, despite quarantine, restrictions on movement, the sample must be taken to the laboratory (wherever it is) and examined. From this point of view, the transport company with which we work, being a state and not a private structure, has worked 100 percent. Despite all the restrictive measures during the state of emergency, the emergency, as they brought samples at normal times, they also brought them in quarantine time. The well-oiled mechanism has shown itself to be more than effective and consistent. "
Bringing analyzes to the central laboratory, on the way back, the transport company performs another important task - it delivers anti-tuberculosis drugs from the capital to the districts.
And although the measures taken in recent years to reform the anti-tuberculosis service in Kyrgyzstan in emergency conditions turned out to be very useful, it is nevertheless clear that work in this direction needs to be continued. There is no doubt that people will accept the new, as they were able to quickly change their behavior in an extreme situation - an unexpected positive effect from the coronavirus pandemic is noted by the district TB doctor Nadezhda Bidzhanova: “We can say that during the pandemic our patients have increased discipline. Previously, we controlled them all the time, but now self-control has been added. They call themselves, they say, I have 2-3 days of pills left, what to do. There were no such calls before ”.

Information taken from the official website of the Ministry of Health of the Kyrgyz Republic

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