By Aliya Aitpayeva, PIH-Kazakhstan Administrative Manager
Though tuberculosis continues to be a major public health threat in Kazakhstan, especially in penitentiaries and rural areas, the number of new infections each year has slowed. According to the KZ Ministry of Health, roughly 240 Kazaks (per 100,000) were living with TB in 2009—a dramatic decrease from 2003, when the number was closer to 482.
Yet, Kazakhstan is far from eradicating the disease. Because of the long-term requirements and complexity of treatment, patients frequently fail to complete treatment, which only spreads the disease.
“Patients’ adherence to treatment is one of the main bottlenecks for successful completion of treatment for our patients,” says Dr. Maya Omarova, the PIH project coordinator in Pavlodar Oblast. “The majority of patients lack the resources needed to sustain their families while being on treatment, as they are the only source of income; thus, they abandon treatment to search for work and money.”
With the invitation of the Kazakhstan government, Partners In Health began providing technical and methodological assistance to the National TB Program of Kazakhstan in two territories with high rates of MDR-TB—the oblasts of Karaganda and Pavlodar—in April 2010.
Financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, PIH’s Kazakhstan project (PIH-KZ) accompanies the National TB Program as it scales up medical and program management MDR-TB services. This includes providing intensive MDR-TB management training to TB nurses and doctors, onsite technical assistance for medical management, monitoring the progress of each clinic, and assisting with operational research.
As PIH-KZ expands its services, it draws heavily on the lessons learned in neighboring Russia, where PIH has been working for in Tomsk Oblast for 15 years. To support their new colleagues, PIH-Russia staff presented four seminars on medical and program management of MDR-TB to the KZ team.
In Tomsk, PIH introduced the Patient-Centered Approach Initiative in order to provide patients with higher quality and more convenient access to treatment, to provide comprehensive socio-psychological support, and to reduce the stigma attached to the diseases in the region.
The PIH-KZ patient adherence program trains TB nurses to counsel, educate, and empower their patients. In addition, nurses guide patients through a 10-module program that includes information on patients’ rights, social support, and adherence.
To date PIH-KZ has conducted 6 sessions, training 107 civilian and prison TB nurses from Karaganda and Pavlodar.
“These seminars had showed the necessity of a person who act as counselor or supporter and provide education of patients at all stages of treatment,” says PIH-Russia’s Dr. Alexandra Solovyeva. “Patients must know their rights and responsibilities in order to act as equal partners in the treatment process.”
“I am certain that the initiative will improve patient adherence in Kazakhstan,” continues Alexandra. “PIH-Russia will replicate some of what we’ve learned in Kazakhstan back in the Russia program.”
Government-payed TB physicians in KZ have also received additional training. Two clinicians from PIH-Russia, Alexandra Solovyeva and Viktoriya Livchits, and a specialist from Tomsk TB Program, Tatyana Fedotkina, are acting as mentors to staff working with TB patients.
Beyond re-training staff, PIH-KZ is committed to shifting the country’s larger policy and advocacy conversations around tuberculosis.
PIH-Russia and PIH-Kazakhstan organized two international trainings for 21 leading Kazakh specialists and prison health authorities in Tomsk, Russia. Kazakhstan officials were impressed by PIH’s MDR-TB Program and have replicated the PIH-Russia model known as the “Sputnik” initiative. These initiatives are currently being implemented in the nation’s prison system, improving treatment for sick prisoners.
In early 2011, the government asked PIH-Kazakhstan to expand its services to four additional regions in Kazakhstan.