USAID’s TB CAP Program to Work with Central Asian Governments to Manage MDR-TB Cases

With the specter of multidrug-resistant tuberculosis (MDR-TB) threatening gains made in controlling TB throughout Central Asia, USAID has launched an initiative to combat the increasing prevalence of MDR-TB in the five former Soviet republics of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan.

According to the report Anti-Tuberculosis Drug Resistance in the World Report No. 4, which was issued in 2008, MDR-TB rates are at their highest ever. Nearly 500,000 new cases of MDR-TB emerged globally in 2006, with more than an estimated 80,000 cases in Central Asia and Eastern Europe. Central Asia and Eastern Europe continue to report the highest proportions of drug-resistant TB globally. On average, it is estimated that 15 percent of all new TB cases in the Central Asian Republics are MDR-TB (excluding Turkmenistan, where the data are limited). In addition, it is estimated that 50 percent of all previously treated TB cases in these countries are MDR-TB. MDR-TB occurs when traditional TB is not treated properly due to inadequate treatment regimens, poor quality drugs, or irregular drug taking by patients. When not treated properly the TB bacteria can become resistant to one or more of the prescribed first-line drugs. MDR-TB requires treatment for 18 to 24 months with second-line drugs that are much less effective, poorly tolerated by the patient, and far more costly.

In the new initiative, USAID is supporting the KNCV Tuberculosis Foundation through its Tuberculosis Control Assistance Program (TB CAP). TB CAP will work with Central Asian Governments to build human capacity to manage MDR-TB cases and to provide social support to patients infected with resistant strains of TB. In Kazakhstan, USAID and TB CAP will join the Kazakhstan National TB Center, the Kazakhstan Global Fund Project Implementation Unit, and the Almaty City TB Dispensary to upgrade training capacity, scale up case management, decrease the default rate of TB and MDR-TB patients, and develop best practice models to be replicated in other Central Asian countries.

The new initiative will build on the successful USAID-funded project that provided technical assistance on MDR-TB case management to the Almaty City TB Dispensary from 2003 – 2008. The number of patients properly identified and put on approved treatment for MDR-TB increased five-fold during this time.

The core of USAID’s work in TB is focused on building the capacity of developing countries to implement effective programs to combat and control TB. Our programs support the implementation of the WHO’s Stop TB Strategy to expand and strengthen basic TB programs as the key intervention for preventing and controlling drug-resistant TB.