Regions where PIH Russia now has MDR-TB programs.

 

Just south of Siberia, where PIH Russia has been combating tuberculosis for over a decade, lies another country with one of the highest rates of drug-resistant tuberculosis in the world—Kazakhstan.

PIH recently began a new program in partnership with the Government of Kazakhstan to help address this epidemic  of multidrug-resistant tuberculosis (MDR-TB).

Kazakhstan, the ninth largest country in the world and a population of 16 million people, suffers from about 20,000 new cases of TB each year, according to the World Health Organization.  About 20 percent of all new TB cases detected in the large Central Asian country are MDR-TB, meaning that these patients are infected with dangerous strains of TB that cannot be cured by the most common first-line drugs used for treating the disease.

“The problem of TB became critical in Kazakhstan, as in the rest of the former Soviet countries, after the socio-economical devastation of 1990s, which resulted in the emergence of its drug-resistant strains, especially in prisons,” said Dr. Askar Yedilbayev, PIH’s Program Director for Kazakhstan. “Kazakhstan estimates around 7,000 MDR-TB cases and only 25 percent of them currently receiving adequate treatment.”

Since 1998, PIH Russia has been curing MDR-TB patients in Tomsk, Siberia.  With a track record of successfully treating the disease in both prison and civilian populations, PIH Russia has also trained clinicians from every region in Russia, and from 10 countries of the former Soviet Union.  The new program in Kazakhstan is PIH Russia’s first formal international partnership that will include more than basic technical training and assistance.

MDR-TB is notoriously hard to treat, as patients must endure a more intensive—and expensive—second-line drug regimen, which usually requires a 2 years of drugs that carry debilitating side effects. Strains of the disease that cannot be treated by either first-line or second-line drugs are referred to as extensively drug-resistant TB (XDR-TB). About 10 percent of the 7,000 MDR-TB cases in Kazakhstan are XDR, said Dr. Yedilbayev.

PIH Russia—along with other PIH-affiliated MDR-TB programs around the world—has been so successful in treating the disease because of its reliance on community health workers to help support patients during the difficult drug regimen. These local workers help patients stay on the drug regimen and make sure that they are able to access the comprehensive services offered by our programs (including medical care as well as food, housing, and emotional support).

Other components key to successful programs  include improving diagnostics in order to detect cases earlier, developing a comprehensive strategy to promote adherence among patients, improving infection control in hospitals and clinics and decreasing transmission of TB to HIV-positive patients.

The Kazakh program will begin in the northeastern Pavlodar region (which borders Siberia), and the central Karaganda region of Kazakhstan.

“Through the implementation of PIH activities in Kazakhstan, medical professionals from two regions of the country will be trained on management and clinical aspects of MDR-TB treatment," said Dr. Alex Golubkov, Medical Director for Russia and Kazakhstan. Plans for the Kazakh partnership include: extensive training on management, clinical, and laboratory aspects of running an effective MDR-TB treatment program; helping to monitor and evaluate treatment programs; and helping to implement a comprehensive program for supporting MDR-TB patients to help ensure treatment adherence.

"PIH's work in Kazakhstan will result in increasing the number of MDR-TB patients provided with appropriate treatment and will increase quality of treatment provided," said Dr. Golubkov. "Moreover, we expect that through the fast scale-up of the MDR-TB program in Pavlodar and Karaganda the level of drug-resistant TB will be reduced and many lives will be saved”

[published March 2010]

 

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