Europe And Eurasia
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USAID provides support for TB control and prevention in nine countries (Russia, the
five Central Asia Republics, Ukraine, Georgia, and Azerbaijan), which are among those
with the highest burden of tuberculosis (TB) in the Europe and Eurasia (E&E) region.
USAID provides technical assistance (TA) and support to the World Health
Organization’s (WHO’s) European Regional Office for TB control activities. These
nine countries accounted for two-thirds of all cases in WHO’s European Region in
2007. Forty-four percent of the new cases in 2007 were sputum-smear positive (SS+).
Russia, with close to 157,300 new cases, has the highest number of new cases;
however, Tajikistan has the highest incidence rate, at 231 cases per 100,000 population,
in WHO’s European Region. Incidence declined slightly in Kazakhstan and Ukraine
between 2006 and 2007, but most countries in the region have experienced little
change, while incidence increased 9.1 percent in Tajikistan. Treatment default and
failure rates among new patients are higher in several E&E countries than the average
rate for WHO high-burden TB countries (HBCs). Default under DOTS (the
internationally recommended strategy for TB control) in HBCs averages 4.6 percent;
failure averages 1.5 percent and death, 3.9 percent. Among the TB focus countries in
the E&E region, default ranges from 4 to 12 percent; failure ranges from 3 to 16
percent, while death ranges from 3 to 12 percent. Trend data on TB case fatality rates
show that it has not substantially declined in these countries over the past 10 years.
Although Georgia has made some progress, the average case fatality rate among the
focus countries has increased from 12.7 to 17.6 cases per 100,000 population, and the
average annual number of TB deaths in these countries have increased from 4,131 to
5,004 deaths. This is mostly due to treatment interruption, drug resistance, and weak
health systems.
All countries are now implementing WHO’s DOTS strategy. Treatment success rates
have improved in several countries between 2003 and 2006, but have declined slightly
in Russia and Kazakhstan, and sharply in Azerbaijan. This may be due in part to the rise
in drug-resistant TB. Case detection rates have steadily improved in most countries
between 2003 and 2007, but remained level in Kyrgyzstan have and have declined in
Kazakhstan. It should be noted that several countries in the region have struggled to
reform and maintain their health systems since the collapse of the Soviet Union, and
there have been issues with determining case detection and treatment under DOTS.
Multidrug-resistant (MDR) TB and extensively drug-resistant (XDR) TB rates have
soared throughout the region over the past decade. Five of the nine countries have had
at least one reported case of XDR-TB (Azerbaijan, Georgia, Russia, Ukraine, and
Uzbekistan). This has created greater demands on health services, especially laboratory
diagnosis as well as financing and delivery of TB treatment with second-line drugs.
Together, the nine E&E countries accounted for 16.5 percent of the global MDR-TB
burden in 2007.
TB-HIV/AIDS co-infection rates are low in most E&E countries; the percentage of new
cases that tested HIV positive in 2007 ranged from 2.1 percent in Uzbekistan to much
higher rates of 16.3 and 20.0 percent in Russia and Ukraine, respectively. After Russia,
Ukraine has the largest number of co-infected cases in WHO’s European Region, with
nearly 9,500 cases, or 22 percent of the total number of co-infected cases. Addressing
gaps in services for most-at-risk populations is important to reduce the risk of coinfection
and MDR-TB.
USAID Approach and Key
Activities
The E&E regional activities focus on increasing political commitment and human
resources capacity for TB control. USAID support has focused on training health
professionals, integrating TB services into primary health care (PHC) programs,
improving the knowledge and skills of providers and clients, and fostering collaboration and coordination among the National TB Control Programs (NTCPs) and international partners. USAID supports the following
activities in the region:
- Strengthening and expanding quality DOTS services
- Developing and revising national- and district-level policies to meet international standards for TB prevention, care, and
treatment
- Training health professionals to improve case detection of TB and adherence to the DOTS regimen and reduce the risk
of MDR-TB and XDR-TB
- Improving access to testing and treatment among high-risk populations
- Improving and supporting the integration of TB services into the PHC setting, critical to the prevention and control of
TB in all countries
- Increasing civil society involvement in TB control efforts
- Supporting the U.S. CDC to develop and strengthen surveillance of MDR-TB
- Supporting efforts to improve government policies in order to ensure the uninterrupted supply of quality TB
pharmaceuticals at reduced prices
- Participating in and providing TA to National TB Working Groups and Country Coordinating Mechanisms
USAID Program Achievements
USAID support has contributed to the following achievements:
- Developed recommendations and a plan of action to implement WHO’s strategy on the Practical Approach to Lung
Health in order to strengthen the overall management of respiratory diseases at the PHC level
- Provided TA to Georgia and five regions in Russia, which enabled their successful application to WHO’s Green Light
Committee for second-line drugs to fight MDR-TB
- Provided TA to Kazakhstan and Georgia to enable the successful application to the Global Fund to Fight AIDS,
Tuberculosis and Malaria; and provided TA to Georgia, Turkmenistan, and Kazakhstan to enable the successful
application to the Global TB Drug Facility to receive pediatric doses of TB drugs
- Piloted a logistics management information system (LMIS) project in Kazakhstan, Kyrgyzstan, and Uzbekistan and trained
TB staff on it, ensuring that Kazakhstan will implement the LMIS nationwide
- Facilitated the integration of DOTS into all levels of medical education in Kazakhstan and Turkmenistan
- Financed the expansion of DOTS to reach a total of 90 percent of the population in Turkmenistan and delivered 10
microscopes and other laboratory materials to government health centers
- Facilitated the integration of DOTS services into the PHC level, ensuring direct observation of treatment in Georgia and
Armenia
- Provided TA to implement and expand a computer-based TB Electronic Surveillance and Case Management system in
Kyrgyzstan, Kazakhstan, and Uzbekistan, which provides decision-makers with key data to make informed decisions
about TB policy
- Opened a new Center of Excellence in Orel, Russia, which will serve as a national training center
- Trained all health staff (TB and general practitioners) to provide high-quality DOTS, covering the eight largest oblasts in
Ukraine
- Completed a groundbreaking study of 258 TB treatment defaulters in Uzbekistan, which was commissioned by the
national DOTS center, with the results to be used to improve Uzbekistan’s treatment success rate
- Supported the TB laboratory in the Khakasia Republic of Russia to attain the highest proficiency in TB testing nationwide
- Improved the quality of seven regional laboratories in Russia to approach U.S. CDC standards
- Enabled WHO to provide training on MDR-TB activities to 18 national TB program managers and to print and distribute
WHO’s Guidelines for the Programmatic Management of Drug Resistant Tuberculosis
- Established the Russian-English TB Web site to provide TB educational materials specific to the region and to educate
communities about TB-HIV/AIDS co-infection and MDR-TB, resulting in more than 50,000 people from 54 different
countries/territories visiting the forum on MDR-TB
- Established the Virtual Leadership Development Program to address TB-HIV/AIDS co-infection by strengthening the
national leadership’s ability to address the challenges in TB and HIV/AIDS program coordination
Partnerships
USAID is the leading donor supporting DOTS implementation in these countries. USAID’s partners include the national
governments and Ministries of Health, NTCPs, WHO, the U.S. CDC, Project HOPE, The Capacity Project, and PATH. The
Global Fund has disbursed a total of $129.5 million to Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, and
Uzbekistan during Rounds 2 through 8. Turkmenistan and Ukraine have not received funding from the Global Fund for TB activities.
May 2009
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