L/O/G/OL/O/G/O

Senior research associate

NCPT MH RoK c.m.s., associate professor

L.K. Amanzholova

Scientific – practical activity of National Center of

Problems of Tuberculosis of MH of RoK

NCPT RoK manages all scientific and practical activities of the whole TB service in the Republic.

• The main objectives of the Center are: improvement of efficiency of diagnosis and treatment of tuberculosis, the development of preventive measures system, and the implementation and improvement of the methods of organization of TB control. 

• Bacteriological laboratories are equipped with modern laboratory equipment for the early detection of tuberculosis with multidrug resistance: BACTEC-Mitgit-960; molecular genetic method «Hain-test»,«G-Xpert».

• According to the data of NCPT in 2011 detection of infectious tuberculosis increased from 3.9% in 2010 to 4.1 %, compared to the previous year that meets international standards of WHO for the timely detection and diagnosis of TB and MDR-TB in patients, their qualitative treatment.

Theme of scientific program: Improvement of measures for prevention of treatment failures and the formation of drug-resistant forms of tuberculosis. Deadline 2009 - 2011.

The study of epidemiological peculiarities of tuberculosis in patients from the civil and penal systems and development of methods for reducing morbidity rate in RoK

Study the causes of backsets development and treatment failure in patients with first time diagnosed tuberculosis, MDR-TB and diabetes mellitus (a comparative retrospective analytical study)

Improving the effectiveness of surgical treatment in patients with pulmonary and extrapulmonary tuberculosis in patients with different types of drug resistance (analytical case-control study)

Clinical and epidemiological peculiarities of MDR-TB in children and teen-agers in RoK (retrospective comparative analytical study)

4

1

2

3

The program was executed by 4 fragments:

Purpose: Improvement of effectiveness of TB treatment with different types of drug resistance and development of preventive measures set to prevent the development of treatment failure, multi-and super-resistant forms of disease.

Scientific output in 2009-2011

-defended: 1 doctoral thesis;5 candidate thesis.

Published 154 articles, 12 methodical recommendations, 2 clinical manuals and 1 order of MH of RoK, 24 innovational patents, 3 applications for discovery, 165 implementation acts

Scientific Program: “Development and implementation of new technologies of qualitative diagnostics and treatment of resistant form of tuberculosis"

Implementation period of program: 2012-2014” Program is implemented by 4 fragments

1. “The study of molecular genetic features of MTB in patients with drug-resistant forms of tuberculosis”

Purpose: To study the frequency of mutations in the genes of MTB, responsible for the development of drug resistance and MIRU-VNTR typing of MTB, obtained from patients living in different regions of Kazakhstan.

2. “ORGANIZATIONAL AND METHODICAL AND SOCIAL FACTORS INCREASING COMPLIANCE OF PATIENTS WITH MDR-TB TO CONTINUED TREATMENT”

Purpose: Study of the main medical and social factors negatively affecting delivery of continuously controled treatment of MDR TB.

3. "Treatment of patients with tuberculosis of bones and joints, peripheral lymph nodes, based on the application of nanotechnologies in complex therapy"

Purpose: to study experimental and clinical application

4. "Development of the selective lung collapse method in the surgical treatment of patients with wide drug-resistant tuberculosis."

Purpose: Development of tactics of preoperative preparation and postoperative management of patients with XDR TB in collapse-surgical interventions in combination with the use of silicone implants with a valval bronchial blocker.

Cooperation with international organizations in the field of STPof RoK

STPNCPT MH

RoK

GFATMUSAID

TB CARE 1 (KNCV)

Qualitative public health

Dialogue on HIV with TB (AEWF)

World Bank

German Development Bank

(TB Care II)

Foundation “Soros-

Kazakhstan”

Partners for the health

WHO Project

EXPAND TB

RCS RK (Eli Lilly, IF Red Cross and Red Crescent,

Support of Japanese Government)

Project USAID TB CARE I(KNCV)Implementation period 2011-2014

Purpose – development of effective strategies on control of DR-TB in CAR and strengthening country capacity to control TB and MDR-TB in penal and civilian sectors of health care for delivery of qualitative and fast diagnostics and treatment of TB and MDR-TB.

$ 1 281 909

Project USAID “Qualitative public health” Implementation period 01 10 2010 – 30 09 2015

Purpose – improving the health of vulnerable population groups through introduction of modern methods for improving quality of the health care reforms in CAR. Improvement of management, financing and delivery of health services related to TB, HIV / AIDS, maternal and child health and cardiovascular diseases.

Project USAID “Dialogue on HIV and tuberculosis” Implementation period 01 10 2009 – 30 09 2014 (PSI)

Purpose – stabilization of rates of HIV and TB spread among population with high risk of HIV and TB infection in CAR

Improvement of population literacy in prevention of HIV and TB

$ 1 534 800

€ 290 000

WHOBilateral projects EXPAND TB “Expanding access to the new diagnostic agents of tuberculosis” Implementation period 2012 -2013

Purpose – introduction of technology G-Xpert MTB / RIF for the early detection and diagnostics of tuberculosis and drug resistance to rifampicin in three pilot laboratories in Astana, Almaty and Aktobe. MH of RoK will develop a plan on reception arrangements of equipment and reagents, training of laboratory specialists.

German Bank for Reconstruction and

Development (KfW)Implementation period 2011 - 2014

Project “Support of National Program on control of TB II”.Purpose – improvement of diagnostics and treatment of different TB forms for prevention of infection chain to stop TB epidemic in Kazakhstan.

€ 2 556 459,41

World Bank for Development and Reconstruction Start of implementation 2010 - continuation

Project “Transfer of technologies and conducting institutional reforms in the sector

of Health of RK”

Purpose – restructuring of the hospital sector in order to improve TB services in RK.

Red Crescent Society of RoK

Project «TB prevention for funds of Japanese government». Implementation period from 2004. Project «MDR TB Program supported by USAID through International Red Cross and Red Crescent Movement. Implementation period 2008 - 2012 Project «MDR TB Program supported by pharmaceutical company Eli Lilly».Project «Program for social support at the cost of GFATM». Implementation period: 2009 -2012 Project «TB and HIV prevention program in RoK». Implementation period : 2012 - 2013

Goal of projects - rise of potential of RCS of RoK in the field of TB control

Global Fund against AIDS, Tuberculosis and Malaria

• 6 round from 01 09 2007 through 31 08 2012

• 8 round from 01 01 2010 through 2014

Goal– efficiency rise of antituberculous actions in RoK

6 round - $9 114 9818 round - $ 35 583 755 (1 phase + 1 Q 2012)

Project under implementation: decrease of burden of tuberculosis by strengthening management of drug-resistant tuberculosis

Foundation «Soros-Kazakhstan»Implementation period 2011 -2012

Project «Monitoring of performance efficiency of state initiatives for TB control»

Goal– enhancement of efficiency and performance of state programmes for TB control in order to meet targets for UN millennium development.

$ 39 000

65,8 67,1

118,8

153,2 155,7165,1 160,4

154,3147,3

132,1126,4 125,5

105,395,3

86,6 86

10,1

26,438,4

26,4 24,5 24,2 22,4 20,6 20,8 20,3 18,1 16,9 12,9 10,6 8,4 7,4

0

20

40

60

80

100

120

140

160

1990 1995 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 6 мес 2012

г.заболеваемость

смертность

Decree of RoK

President

Main Epidemiologic Data for Tuberculosis in RoK (for 100 thousands of population)

6 months of 2012Morbidity

Mortality

Level of primary and secondary drug resistance of MTB in RoK (%)

0%

5%

10%

20%

30%

50%

60%

2011

Secondary drug resistance

Primary drug resistance

19.1%

53.3% Levels of primary and secondary MDR TB are related to timely diagnostics of MTB resistance using accelerated high-avid bacteriological (BACTEK MIGIT-960) and molecular and genetic methods (Hain-test). In the current year in 4 pilot projects a new molecular and genetic method (G-Xpert) is implemented

PVR Provision in 2012(number of consumptives expected for

treatment)

1370

3423

8900

2872

прогноз МЛУ ТБ основной закуп изРБ

допзакуп из РБ по линии ГФMDR TB Forecast

Main procurement from RB

Additional procurement from

RBIn the line of PF

Epidemiologic TB Situation in Penal System of RoK

2010:Incidence rate: 672.8 for 100 thous. population

TB mortality: 94 for 100 thous. population

2011: incidence rate– 522.5 for 100 thous. population

6 months incidence rate for 100 thous.: 2011 – 673.3 2012 – 598.4

reduction by 11.1%

6 months incidence for 100 thous.:2011 – 82.2

2012- 52.6 reduction by 36.0%

mortality – 61.4 for 100 thous. population

Detectability of TB/HIV casesfrom 2008 through 2011 in RoK (RC AIDS)

2008 2009 2010

Total number of detected HIV/TB cases Newly diagnosed HIV/TB

13172008 2009 2010

14231317

436

368370

2011

547

2011

1518

1118

Allocation of TB and TB/HIV cases in regions of RoK,

2011.

0%

5%

10%

15%

20%

25%

Ка

ра

гсн

ди

нска

я

гАл

ма

ты

Ко

ста

на

йска

я

Ал

ма

тин

ска

я

ЮК

О

Па

вл

од

ар

ска

я

ВК

О

Акм

ол

ин

ска

я

Жа

мб

ыл

ска

я

Ско

Акт

юб

ин

ска

я

Аты

ра

уска

я

ЗК

О

г.А

ста

на

Кы

зыл

ор

ди

нска

я

Ма

нги

ста

уска

я

области

пр

оц

ен

т

ТБ

ТБ/ВИЧ

TBTB/HIV

Ka

rag

an

din

ska

ya

Alm

aty

Ko

sta

na

yska

ya

Alm

atin

ska

ya

SK

R

Pa

vlo

da

rska

ya

EK

R

Akm

olin

ska

ya

Zh

am

byl

ska

ya

NK

R

Akt

yub

insk

aya

Aty

rau

ska

ya

WK

R

Ast

an

a

Kyz

ylo

rdin

ska

ya

Ma

ng

ysta

usk

aya

perc

ent

Chemoprophylaxis by Isoniazid 2011 (abs. number)in 2011 in RoK Coverage by Isoniazid Chemoprophylaxis for HIV cases was 88,6%

(1019 persons).

521

112

9

100

29

47

149

225 9

94

4462

221

91

0

50

100

150

200

250

Акм

ол

а

Акто

бе

Ал

ма

ты о

бл

Аты

ра

у

ВК

О

Та

ра

з

ЗК

О

Ка

ра

ган

да

Ко

ста

на

й

Кы

зыл

ор

да

Ма

нгы

ста

у

Па

вл

од

ар

СК

О

ЮК

О

г.Ал

ма

ты

г.Аста

на

получили

Akm

ola

Aktobe

Alm

aty region

Atyrau

EK

R

Taraz

WK

R

Karaganda

Kostanay

Kyzylorda

Mabgystau

Pavlodar

NK

R

SK

R

Alm

aty city

Astana city

received

As a whole, quality of STP being implemented is evaluated positively.

According to evaluation of experts of WHO mission in Kazakhstan, significant progress is registered in all aspects of prophylaxis, control of tuberculosis treatment (TB treatment, diagnostics and treatment of MDR TB, IC, follow-up care, M&A).

Assessmentof WHO Mission of Experts in Kazakhstan,

10-18 May 2012.

WHO

WHO

Solutions (TB/HIV)• Amendments to Decree of HM of RoK №722 in

accordance with the latest WHO recommendations.• Prescription of antiretroviral therapy for TB/HIV cases

in earlier terms (during first 2 weeks) regardless level of CD-4 cells.

• Intensive detection of TB by PLH based on complaints of patients typical for TB.

• Controlled isoniazid chemoprophylaxis by PLH in PHC controlled by AIDS-centers.

• Monitoring and assessment of joint activity in TB/HIV control.

• Training of specialists of PTE, PHC and AIDS and drug rehabilitation centers regarding TB/HIV matters.

MAIN DIRECTIONS OF TUBERCULOSIS CONTROL IN THE REPUBLIC OF KAZAKHSTAN

Increase of Access for Target Group

to timely detection and diagnostics of tuberculosis

Increase of adherence of consumptives to DCT by implementation of patient-oriented approaches

Improvement of infection control actions in areas ofincreased risk

Strengthening of human resources

L/O/G/OL/O/G/O

Thank you for attention!