Uniting to scale up TB care in central Asia: urgent action is needed

On 14-15 April 2011 more than one hundred tuberculosis experts came together in Tashkent to discuss their experiences with and the challenges around scaling up tuberculosis (TB) care in the Central Asia region. In the end, everyone agreed: urgent action is needed.

The symposium "Uniting to Scale up TB Care in Central Asia", organized by Médecins Sans Frontières (MSF) and the Ministry of Health of the Republic of Uzbekistan, brought together a wide range of actors from across the region to discuss experiences and challenges related to TB and multidrug-resistant TB (MDR-TB) care and the need for scale up of access to diagnosis and treatment of the disease. More than 100 participants from regional Ministries of Health, international organisations and academics attended the symposium, exchanged experiences and discussed challenges as well as best practice examples on the way to scale up TB and MDR-TB care in the Central Asian and neighboring countries represented at the symposium.

“There was a common consensus amongst the participants that there is an urgent need to scale up treatment in order to confront the growing threat that TB and DR-TB in particular represents in the region”, says Dr Philipp DU CROS, senior TB expert at MSF.  “One of the main prerequisites to enable scale up is to achieve acceptance for an ambulatory treatment model, which is the advised model from the World Health organization, and to reserve hospitalization for very severe patients only. It was good to see that there was a general acceptance for the ambulatory approach from all sides at the symposium.”

The Uzbek Ministry of Health opened the symposium presenting their recently launched national TB strategy, which envisages a wide range of activities on prophylaxis, early diagnostics and TB treatment, on the optimization and addition of new TB health facilities, as well as training and refresher courses for medical doctors and nursing staff. A participant from the Medical University in Tajikistan mentioned a legislative reform to ban the free sale of TB drugs on the market in Tajikistan, and a representative from the National TB Centre in Kazakhstan urged for a general reform of the public health system that would allow for new methods of financing and capacity building, requiring political commitment on every level and from all actors involved, which should clearly be reflected in allocated budgets for TB care.

“Definitely there is a lot of momentum and a lot of progress in TB care at this point in time. Still, TB is a very complex disease and there is yet a long way to go. One major outcome of the symposium was a general agreement among the participants that universal access to early diagnosis and treatment is needed and needed urgently,” says DU CROS. Through some of the presentations on pediatric TB and TB care in prisons, it was made clear that this access has to be “truly universal;” including patient groups which are more difficult to diagnose and keep on treatment, like children, migrants, prisoners and patients suffering from TB/HIV co-infection.

“I would say that the conference is going serve as a sort of a provocative injection, which will give us a chance to think hard about the existing problems that were covered during the two days. And it must be noted that we managed to discuss a lot of things over just two days, and the discussions were really very interesting. Our country has set big tasks in front of it, and we are going to solve these tasks. We are going to scale up the diagnostics and TB treatment”, concludes Prof Nargiza PARPIEVA, Chief TB Doctor of the Ministry of Health of the Republic of Uzbekistan after the symposium.

TB and its drug resistant forms (DR-TB) are a threat to global health around the world. The disease kills approximately 1.8 million people each year and is also a growing challenge in the Central Asia region, where there is a high prevalence of TB and DR-TB. In many places, access to an exact diagnosis for drug-resistance is still lacking. As a consequence, the majority of people suffering from TB remain undiagnosed and hence untreated.