What is the project about

Background and Rationale for the Program

Turkmenistan is one of 18 high priority countries of the WHO European Region’s Plan to Stop TB, 2007–2015.The WHO estimated incidence for 2013 was 72 per 100’000 (WHO Global TB Report 2014), prevalence 103 per 100’000 population, and estimated TB mortality rate of 25 per 100 000. Based on the WHO Global TB report 2015, the estimated incidence and prevalence in 2014 was 64 per 100’000 population, and 88 per 100’000 population respectively. According to National TB Program (NTP) data, in 2014, 2’854 TB cases were notified (excluding penitentiary system). TB notifications have been decreasing since 2012: from 2’804 new cases in 2012 to 2’364 new cases in 2014; from 588 previously treated cases in 2012 to 452 in 2014. Treatment success rate (WHO Global TB Report 2014) in 2013 for the new cases (2012 cohort) was 84% and previously treated cases (2012 cohort) 63%.

Multi-drug resistant TB (MDR-TB) burden remains a key challenge for the NTP. There is no routine MDR-TB surveillance available in country. The first drug resistance survey (DRS) (countrywide) was conducted in 2013. The survey detected 13.9% MDR prevalence among new culture positive TB cases and 37.6% MDR prevalence among retreatment cases. There is no reliable data available regarding extreme drug resistant TB (XDR-TB) burden in Turkmenistan as the drugs susceptibility testing (DST) for second line drugs has started only in August 2015. In 2014, according to WHO estimation, there were 450 MDR-TB cases in Turkmenistan (270 cases among new and 180 among previously treated TB cases). Treatment of MDR-TB patients started in the country in 2013 with the first cohort consisting of 81 patients.

No HIV cases were officially registered in Turkmenistan and no TB/HIV co-infection data is available. The country is providing HIV testing for all TB patients.

With the support of WHO, the country has developed the National Strategic Plan (NSP) for the period 2016-2020. The main goal of the NSP is to decrease the burden of TB in Turkmenistan by ensuring universal access to timely and quality diagnosis and treatment of all forms of TB: (i) decreasing the targets for TB mortality and incidence rates to 2.4 and 56 per 100,000 respectively, by 2020; and (ii) achieving 90% case detection and 75% treatment success rate for MDR-TB by 2020. These targets will be attained by ensuring universal access to high quality TB care for all TB patients, with emphasis on quality patient-oriented treatment. Also, the basic principles of the NSP are closely linked to six core components suggested by the Stop TB Strategy, and are represented by: (i) pursue high quality DOTS enhancement; (ii) address TB/HIV, MDR-TB and other challenges; (iii) health system strengthening; (iv) implementation of the international TB control standards and engagement all care providers; (v) advocacy, communication and empower people with TB and communities; and (vi) promote scientific research.

The current grant is seen by the CCM as a key means for assisting country in its efforts to controlling drug-resistant tuberculosis in the country. The Goal of the grant is to decrease the burden of tuberculosis in Turkmenistan by ensuring universal access to timely and quality diagnosis and treatment of drug-resistant forms of tuberculosis. This grant covers interventions in both civilian and penitentiary sectors. 

Objectives:

·        To ensure universal access to early and quality diagnosis of all forms of TB

·        To ensure universal access to quality patient-centred treatment of all forms of TB

·        To strengthen the program management, M&E and improve the health system’s performance for effective TB control

Interventions:

·        Support to WHO-recommended diagnostics (WRDs) at reference laboratories

·        Strengthening of the country TB laboratory network, capacity building and quality assurance

·        Procurement of anti-TB drugs for treatment of M/XDR-TB patients

·        Ensuring the patient support to improve adherence to TB treatment

·        Development and implementation of health legislation, strategies and policies

·        Service organization and facility management

·        Improving the health system performance for TB control

·        Strengthening NTP management capacities program

Planned Activities:

·        Procurement of consumables to support DR-TB diagnosis

·        Technical assistance, support to external quality assurance, and training to strengthen laboratory capacity

·        Procurement of second line anti-TB drugs for MDR-TB, pre-XDR and XDR patients

·        Support treatment adherence for M/XDR-TB patients through incentives, patient support, and education during ambulatory care

·        Updating the national guidelines for TB treatment according to the latest international guidance for effective case management models

·        Technical assistance and training to strengthen TB case management in outpatient and prison settings

·        Conducting the review of the NTP

·        Conducting the National Drug Resistance Survey (DRS) in 2017

·        Introduction of the national TB electronic database

·        Supervision and routine reporting of NTP

·        Grant management and administration