Uzbekistan
According to the World Health Organization’s (WHO’s) Global Tuberculosis Control
Report 2009, Uzbekistan had almost 31,000 new tuberculosis (TB) cases in 2007, with
an estimated incidence rate of 113 cases per 100,000 population, the sixth highest in
WHO’s European Region. The National TB Control Program (NTCP) began DOTS
(the internationally recommended strategy for TB control) in 1998 and has made
progress in expanding it throughout the country. Between 2002 and 2005, DOTS
coverage increased from 41 percent to 100 percent and this has been maintained at
100 percent for the past two years. The DOTS treatment success rate remains strong,
close to WHO’s target of 85 percent, but the DOTS case detection rate remains low
at only 45 percent, well below WHO’s target of 70 percent.
While TB-HIV/AIDS co-infection remains very limited, Uzbekistan is facing a serious
challenge to TB control and management from multidrug-resistant (MDR) TB.
Extensively drug resistant (XDR) TB has also been found in Uzbekistan. WHO
estimates that Uzbekistan had 6,900 cases of MDR-TB, with just 484 cases that were
diagnosed and notified. Sixty percent of previously treated cases were MDR-TB. These
high numbers may even underestimate the actual level. As in other countries in the
Central Asian region, Uzbekistan has a high number of “chronic” TB patients who have
repeatedly relapsed while on treatment. This presents a public health threat, as
chronic patients can become a source of MDR-TB transmission to the greater
population. Another challenge to MDR-TB management is the limited infection control
procedures at health facilities and limited diagnostic capacity at laboratories. As
improved drug sensitivity testing and access to second-line drugs increase, the
detection rate and treatment of MDR-TB will likely improve.
The Government of Uzbekistan (GOU) is committed to TB prevention and control. In
2001, the GOU issued a law that provides for a systematic approach to TB
interventions, including the provision of free treatment to all citizens and resident
foreigners. It also established the National DOTS Center under the Ministry of Health
(MOH) to oversee the implementation of the Stop TB Strategy. In 2003, the
government put forth a Strategic Program to Reduce Morbidity and Prophylaxis of
Tuberculosis in 2004–2008, which called for the expansion and improvement of DOTS.
USAID Approach and Key
Activities
USAID’s TB program goal for Uzbekistan is to improve the capacity of the NTCP to
implement quality DOTS and manage MDR-TB, as well as directly increase access to
quality TB diagnosis and treatment, with special focus on vulnerable groups (the poor,
prisoners, migrants, and people living with HIV/AIDS). USAID’s main partner is Project
HOPE and its consortium of partners. In fiscal year 2008, Uzbekistan received $1.7
million in TB funding from USAID. USAID support includes the following activities:
- Increasing the quality of DOTS in two sectors: the TB care network and the
primary health care (PHC) system
- Strengthening the laboratory network and creating rational drug management
systems
- Building national capacity to manage MDR-TB cases and developing and
enhancing infection control measures in civil and prison systems to prevent
both TB and MDR-TB transmission
- Strengthening the NTCP’s capacity to conduct monitoring and evaluation,
including training on case recording and reporting systems and the use of data
to improve program performance
- Integrating TB and HIV treatment by creating a routine referral system, a unified TB-HIV/AIDS case data collection
system, and a program coordinating mechanism
- Providing technical assistance (TA) to a group of experts that direct ad hoc meetings by organizing thematic working
group discussions on MDR-TB; TB-HIV/AIDS; drug management; information, education, and communication; and
monitoring
- Conducting operational research in close collaboration with the NTCP and MOH
USAID Program Achievements
USAID’s assistance has contributed to improvement in human resources, infrastructure, and management capacity through the
following activities:
- Provided basic DOTS trainings for 695 TB specialists; 1,657 PHC doctors; 1,114 nurses; and seven other staff cadres
since 2001
- Trained 110 lab technicians in microscopy and 280 oblast- and city-level staff in monitoring and supervision to increase
sustainability of human resource capacity of NTCP staff
- Provided training to TB staff on the TB Electronic Surveillance and Case Management Software system developed and
introduced by the U.S. CDC and trained staff to conduct epidemiological analyses
- Provided TA for two successful applications to the Green Light Committee to provide second-line treatment for more
than 1,100 patients
- Supported the implementation of a logistics management information system to improve drug management practices
- Revised preservice education curricula for doctors and nurses to include DOTS and revised curricula already being used,
though awaiting official endorsement
- Conducted trainings on interpersonal communication skills among nurses and developed information materials that
include video material, pamphlets, and posters
- Developed a communication strategy and organized media campaigns in order to increase the awareness of TB among
the population and improve compliance with TB treatment
- Conducted operational studies to better understand the causes of TB patient default and to assess provider prescribing
practices for TB patients
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Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
USAID is one of the main donors and provides TA in almost all areas of TB control through Project HOPE. Project HOPE is the
lead member of a consortium that includes John Snow, Inc., Johns Hopkins University’s Center for Communication Programs, and
the New Jersey Medical School’s Global Tuberculosis Institute. The KfW (German Development Bank) is supporting the
strengthening of the laboratory network and limited procurement of second-line drugs. Doctors Without Borders and WHO also
provide TA. Uzbekistan received $13.3 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria in Round 4 in 2005
and $13.9 million in Round 8 in 2009.
May 2009
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