Tuberculosis (TB) control is a priority for the Government of Turkmenistan, as the health system is vulnerable to the many challenges posed by TB. The DOTS (the internationally recommended strategy for TB control) case detection rate has not reached the World Health Organization’s (WHO’s) target of 70 percent, though over the past three years, the rate increased from 33 percent in 2004 to 58 percent in 2006. While case detection remains low, treatment success rates are satisfactory. The treatment success rate reached 86 percent in 2004, above the WHO target of 85 percent, but fell slightly to 81 in 2005. The DOTS strategy was introduced in Turkmenistan in 1999, and DOTS coverage reached 100 percent in 2007.1
In 1999, the Ministry of Health and Medical Industry of Turkmenistan (MOHMIT) established the National Program for Tuberculosis Prevention and Control (NPTPC), and, in coordination with the Interdepartmental Coordination Committee, the NPTPC has produced two five-year action plans. In 2008, the NPTC approved the second five-year plan, the National Program of Tuberculosis Prevention Turkmenistan for 2008–2015, which is based on the Stop TB Strategy. A major challenge to expanding DOTS is the vertical nature of the TB management system, which is not well integrated into other health structures, especially with primary health care (PHC). In 2008, only 677 out of 1,671 (41 percent) of PHC facilities had DOTS services, and just 7.4 percent of TB patients were detected at the PHC level. Because many of the prisons still practice outdated, non-DOTS case management, a pilot initiative was started in 2008 in one prison.
Turkmenistan has low levels of multidrug-resistant (MDR) TB compared with other regions, but more data are needed to obtain accurate estimates on the prevalence of MDR-TB. Turkmenistan is in the initial stages of setting up the infrastructure to manage MDR-TB, and the capacity for infection control and testing of MDR-TB is limited. The treatment failure rate, at 9 percent, is higher than in the other countries of the region. The TB-HIV/AIDS co-infection is low in Turkmenistan, and while routine testing of TB patients occurs, patients do not often receive their results.
USAID Approach and Key Activities
Chart with the following information: Country Population: 4,899,000, Estimated number of new TB cases: 3,175, Estimated TB incidence (all cases per 100,000 pop): 65, DOTS population coverage (%): 80, Rate of new sputum smear-positive (SS+) cases (per 100,000 pop): 29, DOTS case detection rate (new SS+,%): 58, DOTS treatment success rate in 2005 (new SS+,%): 81, Estimated adult TB cases HIV+(%): n/a, New TB cases multidrug-resistant (%): 3.8. Source: WHO Global TB Report 2008 and WHO Anti-Tuberculosis Drug Resistance in the World Report, 2008
Since 2000, USAID’s main partner, Project HOPE, has implemented a multi-component program to provide assistance to the Government of Turkmenistan to improve the quality and accessibility of medical services and to improve the awareness of the population about TB treatment and prevention. USAID has supported the fight against TB by helping the NPTPC implement DOTS through national-level interventions (policies, national guidelines, and capacity building of the NPTPC as well promoting community advocacy and social mobilization. USAID assistance includes the following activities and interventions:
* Strengthening political commitment and establishing the proper coordination between national health authorities and international partners in TB control
* Providing a wide range of training for public health professionals, including training PHC staff on integrating TB services at the PHC level to increase patient access to DOTS, and training managers on conducting operational research
* Advocating for the implementation of appropriate drug management procedures for second-line drugs
* Supporting rational planning of the TB laboratory network and training of staff to ensure efficient use of TB resources and qualified staff to conduct laboratory services
* Promoting the use of appropriate control measures in laboratories providing culture and drug susceptibility testing and in MDR-TB treatment facilities
* Supporting training, monitoring, and management of first line drugs to ensure patients receive correct drug regimens without interruptions in supply
* Improving program management by strengthening monitoring and evaluation skills of NPTPC staff through training on data collection, analysis, and application and introducing the electronic surveillance case management system, installed by the U.S. CDC
* Collaborating with the Press Center of the MOHMIT to facilitate increasing capacity in developing information, education, and communication (IEC) materials; change the behavior of medical staff and TB patients; and inform the public about TB
USAID program achievements include the following:
* Integrated DOTS at all levels of the medical education system
* Financed the expansion of DOTS to cover an additional 18 percent of the population.
* Developed a logistics management information system (LMIS), with future nationwide roll out planned.
* Supported the opening of a TB training center at the Turkmen State Medical Institute by providing educational materials, equipment and renovating the Training Center.
* Trained 82 TB specialists, 78 PHC doctors, 324 nurses, 113 other staff cadres, and 23 lab technicians in fiscal year 2008, and provided DOTS materials to 2,500 health workers nationally.
* Developed LMIS guidelines to ensure an adequate TB drug supply nationwide
* Assisted the MOHMIT in drafting its National Strategy on Health Communication and applying for Global Drug Facility funding for TB medication for children, which was approved
* Developed and disseminated IEC materials for health workers, the general population, and patients
* Facilitated the formation of a high-level working group, which provides a forum for donors and technical agencies to coordinate their activities with the national government, approve technical documents, and develop recommendations for the government
* Delivered 40 binocular microscopes, reagents, and other laboratory materials to MOHMIT sites, enabling the country to further expand DOTS
** Note: DOTS treatment success rate for 2006 will be reported in the 2009 global report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008.
USAID is one of the main donors and provides technical assistance in almost all areas of TB control through Project HOPE. Project HOPE is the lead member of a consortium that includes John Snow, Inc., Johns Hopkins University’s Center for Communication Programs, and the New Jersey Medical School Global Tuberculosis Institute. Turkmenistan has not received any funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria, although USAID will provide technical assistance for proposal preparation for the Round 9 application for funding.