The program
The Government Of The Kyrgyz Republic
"TB - V" for the years 2017-2021
I. Overall assessment of the current situation
The Kyrgyz Republic is one of the countries with high levels of TB according to the European regional office of the world health organization and is among the countries of the 27 countries with high levels of multi-drug resistant tuberculosis (hereinafter MDR-TB).
As a result of implementation of the previous National TB programmes improved the quality of diagnosis and treatment of TB patients, which led to the reduction of the morbidity and mortality from tuberculosis.
The incidence rate of tuberculosis reduced from to 167.8 cases per 100,000 population (2001) to 93.4 cases (2016), TB mortality - from 27,0 cases (2001) to 5.6 cases (2016) per 100 000 population. Almost four times decreased the incidence of children, 82.2 per cases (2002) to 20.8 cases per 100 000 population (2016). The effectiveness of treatment of patients with sensitive TB in the Republic amounted to 80.5 %, of patients with MDR-TB – 56,1 %, which is below the recommended indicators of the world health organization (85 % and 75 %, respectively).
The introduction of modern molecular methods of diagnosis, increased coverage of cultural research and testing for drug sensitivity is increased, the number of confirmed cases of drug-resistant forms of tuberculosis.
II. Legal and regulatory framework
The program of the Government of the Kyrgyz Republic "TB – V" for the years 2017-2021 (hereinafter - the Program) is a strategic document defining the main priorities in the field of TB control in the Kyrgyz Republic. This Program is coordinated with National health reform program "Den sooluk" for 2012-2018, approved by the decree of the Government of the Kyrgyz Republic of 24 may 2012 № 309 and action Plan on optimizing the provision of TB care to the population of the Kyrgyz Republic for the years 2017-2026, the approved order of the Government of the Kyrgyz Republic of January 17, 2017 No. 9-R.
III. Achievements and challenges
Political commitment of the state to control tuberculosis have contributed to the allocation of funds from the state budget for the purchase of anti-TB first-line drugs starting in 2016. However, the purchase of anti-TB second line drugs are still financed by the Global Fund to fight AIDS, tuberculosis and malaria (hereinafter – GFATM).
In the country introduced and used modern and effective methods of diagnosis and treatment of tuberculosis. In 2013, put into operation a new building of the national reference laboratories with modern equipment.
Patients with drug-resistant form of tuberculosis are provided high-quality medicines, including 2017 new TB drugs and shorter treatment regimens.
Successfully implemented modern approaches to the management of patients with tuberculosis, MDR-SBM combined with HIV infection. The interaction between stakeholders at all levels of medical care.
Of particular concern is the quality of treatment of TB patients in the organizations of primary health care. Lack of compliance with the patient-centred approach in organization of supervised treatment of tuberculosis in out-patient conditions creates the risk of isolation of patients from treatment and violations of treatment.
Up to the present time not worked out the issue of social support to TB patients. This issue requires the involvement of all stakeholders: state bodies, non-governmental and donor organizations.
One of the important problems is the high incidence of TB, external migrants, there is a need for the development and implementation of cross-border mechanisms for their detection and treatment. Stigma and discrimination towards TB patients in society contribute to late detection of disease and isolation from the treatment.
IV. Goal
The Programme is aimed at further reducing morbidity and mortality from tuberculosis in the Kyrgyz Republic, prevention of rise in the incidence of drug-resistant tuberculosis.
V. Priorities
The main priorities of the Program are prevention, detection and diagnosis, improving the efficiency of treatment of patients with tuberculosis, the formation of patient-focused care models, strengthening cooperation with civil society in TB control.
Planned activities will be implemented with emphasis on high risk group of developing tuberculosis, including contact children up to 5 years, individuals with HIV infection, persons with chemical and alcohol dependency, migrants, ex-prisoners, medical personnel, persons with chronic diseases associated with reduced immune status.
1. Prevention of tuberculosis
Prevention of tuberculosis within the Program are reflected in the action Plan for the implementation of this Program and include specific immunization (BCG vaccination), chemoprophylaxis for persons from high-risk groups. Need BCG vaccination of all healthy newborns at 2-3 days of life, coverage of newborn children at least 95 %.
Chemoprophylaxis will be conducted by the persons who belong to a high risk of the disease tuberculosis-contact children under 5 years with positive Mantoux breakdown, children and adults with HIV infection.
The program provides activities for the examination of persons who were exposed to TB, especially MDR-TB patients, the question of financing x-ray examination, including computed tomography for children.
To reduce the risk of transmission and spread of tuberculosis infection in all health care organizations will be strengthened measures of infection control. The introduction of outpatient treatment will be a measure aimed at reducing the risk of nosocomial infection with TB.
2. Improving detection and diagnosis of TB patients
The programme envisages a complex of measures, including measures of active tuberculosis. The basis of a more detailed analysis will be refined a contingent of high-risk groups and determine the most effective screening methods for TB. Will the developed approach and methodology of the survey the contact persons, objectives of primary health care and public health service in matters of early detection of tuberculosis.
With the aim of improving rapid diagnosis of tuberculosis was purchased and installed in the regions 24 of the GeneXpert platform. The program provides a solution to the issue of maintenance of these platforms to ensure their cartridges, the transportation of pathological material for examination (sputum, pleural fluid, swab of throat, pus, etc.).
3. Improving the quality and efficiency the treatment of tuberculosis
Uninterrupted supply of TB drugs is the key to the success of TB control activities.
The program envisages a gradual transition from donor to government funding of the procurement of anti-TB drugs for the treatment of drug-resistant forms of tuberculosis, by ensuring their quality.
The Programme will address issues of effective use of new TB drugs and the introduction of shortened treatment regimens, effective patient-centric approaches to the controlled outpatient treatment, psychological support in the treatment process.
The programme provides for the issue of social assistance to patients and their families. Today the care of patients with funded by GFATM and includes food packages, compensation of transport costs and incentive payments to patients to maintain adherence to treatment.
4. Improving the system of monitoring and evaluation
Approved guidelines for the monitoring and evaluation of the TB program, implemented a national electronic tracking system for cases of tuberculosis in the Kyrgyz Republic "ES/TB-KG". These tools ensure the timely registration of cases of tuberculosis, monitoring of treatment, planning the purchase of medicines, improvement of system of accounting and reporting for TB in the country, conducting adequate analysis of the data.
5. The interaction with civil society
Civil society is an important partner of the Program. It is necessary to develop the mechanism of its active involvement in the fight against tuberculosis, as well as activities to reduce stigma and discrimination towards TB patients. Civil society includes NGOs, community groups, religious organizations, foundations, advocacy groups and organizations of people with various diseases.
6. The gradual increase of state financing of TB services
The GFATM provides financial support for procurement of TB drugs, reagents, consumables for laboratory analysis, incentive payments to TB patients.
Given the expected reduction in funding from the GFATM, starting in 2018, there is a need to incrementally increase the state contribution in financing of TB control activities.
VI. Monitoring and evaluation of the Programme
Monitoring the execution of the Program will be implemented by the Ministry of health of the Kyrgyz Republic according to the developed Plan of measures for its implementation.
VII. Resource support for the Program
44 % of the needs of the Program will be funded from the state budget, 24 % by international organizations, 32 % – will continue the search for sources of funding. State funds will be used to pay salaries for medical workers, contributions to Social Fund of the Kyrgyz Republic, the nutrition of patients in hospitals and community services anti-tuberculosis organizations.
VIII. Implementation Plan for implementation of the Program
Coordinating the implementation of the action Plan for implementation of the Program will be implemented by the Ministry of health of the Kyrgyz Republic through:
- ensure monitoring of implementation of the Plan for implementation of the Program;
- cooperation with international partners, local non-governmental organizations, interested state bodies.