PIH’s project in Kazakhstan held its first training session for Kazakh clinicians last month in Tomsk, Russia.
Initiated earlier this year in partnership with the Kazakh Government, PIH Kazakhstan is focusing on addressing an epidemic of multidrug-resistant tuberculosis (MDR-TB) in two regions of the Central Asian country--Karaganda and Pavlodar oblasts. Training and building capacity of Kazakh tuberculosis specialists is a key component of the project.
“TB is a challenging disease that demands using a variety of strategies to combat the epidemic,” said Julia Jezmir, project assistant for PIH Russia and Kazakhstan, who helped organize the training. “Such trainings provide an opportunity for TB medical professionals to learn from other TB experts and walk away with a practical guide of how to follow international standards and evidence-based best practices for combating the disease.”
The recent training was based on the best clinical and program practices and lessons learned through established PIH tuberculosis programs—specifically PIH’s partner project in Tomsk, Russia, which has a decade of experience combating the disease. From 2000 to 2008, the Tomsk project saw the TB mortality rate in Tomsk drop from 18.6 deaths per 100,000 people to 8.6. In comparison, the TB mortality rate for Russia as a whole was 22.6 per 100,000 people in 2005. Likewise, the case notification rate (the number of new cases per 100,000 people) in Tomsk fell from 114.2 to 101.4 during that same time period. Because of these successes, the project hosts a number of trainings each year for TB specialists throughout Russia and the former Soviet Union.The government of Kazakhstan also requested the partnership with PIH on the basis of these successes.
Twelve Kazakh clinicians—eight from the civilian sector and four from the penitentiary system—took part in the first training. They represented the Pavolodar and Karaganda regions of the country—both which are heavily burdened by the disease. The TB mortality rate for Kazakhstan nationwide is about 17 deaths per 100,000 people, with a case notification rate of 155 per 100,000.
The training sessions, led by staff from the PIH Russia and Boston offices, covered the management of running an effective MDR-TB treatment program, including how to monitor and evaluate programs, as well as clinical aspects of drug-resistant TB management, program monitoring, and patients' adherence to treatment. One topic that the Kazakh clinicians found particularly interesting was the patient-centered approach of Tomsk’s ambulatory care program. In this model, TB nurses pay daily home visits to patients, bringing medication and food packages, as well as social and psychological support to help them adhere to the rigorous treatment regimens needed to treat the disease. This model proved extremely effective in Tomsk. The Kazakh physicians expressed interest in ways to integrate this kind of community-based patient-centered program into their own system.
As the interactive format of the training also allowed for a two-way exchange of ideas and best practices, the Tomsk physicians also learned about aspects of the Kazakh system, in particular Kazakhstan’s compulsory care program for the most difficult patients—those that need extra support to adhere to the treatment regimen.
"The law of compulsory treatment for infectious patient refusing treatment was accepted by the Kazakh Parliament in 2007, with the aim to protect the society from isolating the most infectious patients," said explained Askar Yedilbayev, program director for PIH Kazakhstan. "However, the law, as a tool of epidemiological protection, is not commonly used by the physicians in Kazakhstan, as the country is lacking the isolated facilities. I hope that the trainees from Kazakhstan have accepted and will further totally support the Tomsk model of community-based care, and PIH proposed patient-centered approach back home."
By the end of the year, the project plans to hold 10 more trainings in Kazakhstan, which will train over 200 clinicians in total.
The training, as well as the Kazakh project itself, is funded by a Global Fund to Fight AIDS, Tuberculosis and Malaria.