Scaling up the Management of Drug-Resistant Tuberculosis in Azerbaijan
Azerbaijan was one of the first countries in the WHO European Region to introduce DOTS in 1995; however, early implementation had been flawed and country-wide coverage was reached only 10 years later. Currently, TB control in the country is regulated by the National Strategy for Tuberculosis Control for years 2011-2015, adopted by the Ministry of Health’s from 21 September 2010 and a number of other relevant regulations. The Ministry of Health (MOH) has the overall responsibility for TB control in the country. It undertakes this function through the National TB Control Program Central Unit (NTP CU) designated at the Research Institute of Lung Diseases (RILD). The NTP CU is responsible for practical aspects of planning, implementation, monitoring and evaluation of TB interventions. The Ministry of Justice (MoJ) through its Medical Department is responsible for TB control in the penitentiary system.
TB diagnostic and curative services are provided to the population through a network of 69 specialized TB institutions (2 specialized TB hospitals in the civilian sector, one TB hospital in prisons, 26 TB dispensaries, 8 TB departments in general district hospitals and 32 TB clinics (‘TB cabinets’) in out-patient polyclinics) in collaboration with general health service, in particular, at primary health care (PHC) level. Microscopy laboratories are attached to each peripheral TB facility and are supervised by the National Reference Laboratory (NRL) at RILD and recently established five regional reference laboratories (in Ganja, Zakatala, Guba, Masally and Nakhchivan).
In summary, the following are considered as the main achievements of the national TB program in Azerbaijan during the last decade: strengthened laboratory network and improved TB case detection and diagnosis; uninterrupted supply of 1st line anti-TB drugs and improved drug management; consolidated NTP management by the NTP Central Office; functional system of regular NTP supervision to all regions and institutions; improved TB recording and reporting system; well developing collaboration for control of TB/HIV co-infection, and sustained effective TB control interventions in the penitentiaries. These achievements became possible thanks to the support of international partners such as the Global Fund, WHO, German Government (KfW / GOPA), ICRC.
Today the Government of Azerbaijan is committed to fight the disease and increasingly allocate financial, human, infrastructural and other resources for this purpose. However, due to the continuing economic constraints, substantial funding and programmatic gaps exist, especially in regard to the complex and costly interventions in the management of drug-resistant TB (DR-TB).
For bridging gaps in DR-TB management, the Country Coordination Mechanism (CCM) solicited support from the Global Fund in Round 7. In October 2008, the Ministry of Health launched GFATM-granted project “Scaling up the Management of Drug-Resistant Tuberculosis in Azerbaijan”. The overall Goal of the Project is to reduce the burden of tuberculosis in Azerbaijan by scaling up the management of drug-resistant tuberculosis and preventing the further spread of drug resistance including the extreme drug resistance (XDR-TB). The Project contributes to ensuring universal access of the population to the diagnosis and treatment of DR-TB. The Goal is set in accordance with the international recommendations (laid down in the revised WHO Stop TB Strategy and the Global Plan to Stop TB (2006-2015) to introduce and scale up DR-TB management as a routine and integral part of the National TB Programs in countries with high burden of drug resistance. While further strengthening essential DOTS interventions remains the main instrument for preventing resistance, it has become clear that timely diagnosis and proper treatment of DR-TB cases are necessary for the overall success in combating the epidemic (e.g. reducing transmission of drug-resistant TB and preventing XDR-TB) and achieving the global TB control targets and the MDGs.
Objective 1. Strengthened management and coordination of the National Tuberculosis Control Program
• Capacity building for strengthening Program management
• Support to NTP supervision
• Training of TB service staff
Objective 2. Improved TB detection and case management by integration of tuberculosis control in Primary Health Care
• Establishment of framework and capacity building for involvement of Primary Health Care in TB control
Objective 3. Ensured universal access to diagnosis and treatment of drug-resistant tuberculosis
• Strengthening national capacities for management of drug-resistant tuberculosis
• Drug resistance surveillance and diagnosis of drug-resistant tuberculosis cases
• Treatment of drug-resistant tuberculosis cases with patient support
• Operational research on DR-TB
The accomplishment of the objectives is ensured through strengthening human and infrastructural capacities, sustaining routine drug-resistance surveillance throughout the country, upgrading the laboratory services and providing up-to-date treatment of DR-TB cases with appropriate patient support to ensure adherence. The project has a country-wide scope and covers the needs of both civilian and penitentiary sectors.
Treatment of drug-resistant tuberculosis cases
Treatment of MDR-TB patients under approval of the Green Light Committee (GLC) in Azerbaijan started in April 2007 in the penitentiary sector and in August 2008 – in the civilian sector. Since 2011 funding for procurement of 2nd line TB drugs is provided through the Global Fund. The current annual enrolment schedule is aligned with GF funding and includes 110 MDR patients per year in prisons and 490 patients – in the civilian sector. In the civilian sector, in-patient MDR treatment takes place at the TB Dispensary No. 6 in Baku, followed by out-patient treatment at service delivery sites where the patients reside. In prisons, the entire course of treatment is conducted at the Specialized Treatment Institution for Detainees with TB (STID) in Bina, outskirts of Baku. Now, of 223 DOT points covering all ambulatory patients 23 cabinets are based in Baku and 200 in regions. In penitentiary sector the number of MDR-TB patients enrolled into the treatment reached 60 patients. The accomplishment of the Objectives is ensured through strengthening human and infrastructural capacities, sustaining routine drug-resistance surveillance throughout the country, upgrading the laboratory services and providing up-to-date treatment of DR-TB cases with appropriate patient support to ensure adherence. The project has a country-wide scope and covers the needs of both civilian and penitentiary sectors.
• Strengthening the management and coordination of the NTP’s activities in penitentiary sector
• Providing drug resistance surveillance and diagnosis of DR-TB cases;
• Strengthening national capacities for management of DR- TB (including renovating and equipping penitentiary and civilian MDR-TB facilities);
• Procuring drugs and supplies for MDR-TB diagnosis, case management and follow-up;
• Providing treatment of DR-TB cases with patient support
• Improving TB case finding in penitentiaries;
• TB information, education and communication (IEC) activities in penitentiaries;
• Providing HIV diagnostic counseling and testing among TB patients;
• Conducting operational research and information, education and communication activities among labor migrants, refugees and internally displaced people.
The Ministry of Health is the Principal Recipient (PR) of the Global Fund grant, and the project is implementing through two main sub-recipients, namely the AR Ministry of Justice and the Research Institute of Lung Diseases.