Annual Report: TB CARE I - Kazakhstan, Year 2 (October 1, 2011 – September 30, 2012)

The project aims to improve tuberculosis (TB) control in Kazakhstan, with a focus on six technical areas: Universal and Early Access, Laboratories, Infection Control, Programmatic Management of Drug Resistant TB, Health System Strengthening, and Monitoring and Evaluation, Operational Research. In the second year of the project, TB CARE I focused on improving TB control in prisons, strengthening coordination and collaboration between prison and general TB services, developing Childhood TB and MDR-TB protocols, and introducing innovative approaches to outpatient care for MDR-TB patients and psychosocial support for patients. The project also provided technical assistance to the National TB Center (NCTB) for the implementation of new diagnostic tools, including XpertMTB/RIF. TB CARE I established a multidisciplinary working group for the development and piloting of an outpatient care model in Akmola oblast. The group drafted a model of outpatient care and psychosocial support system for TB patients, which was finalized by the end of the year. The working group also developed a plan for piloting and further expansion of outpatient care and customized psychosocial support system in the whole Akmola region. The project implemented XpertMTB/RIF in four sites, including the National Reference Laboratory, Almaty City TB dispensary, Akmola, and East Kazakhstan oblasts. A total of 720 tests were conducted from July to September by the four sites. The project also conducted a press conference on the successful introduction of GeneXpert in Kazakhstan, which was attended by the United States Ambassador to Kazakhstan, Kenneth Fairfax, and officials from the Ministry of Health and NTP. TB CARE I facilitated the finalization of new MDR-TB protocols that provide a more structured, comprehensive, and detailed guidance on MDR-TB management, including TB/HIV, TB in Children, and other components. The protocols were developed under the guidance of NTP and introduced in Akmola and East Kazakhstan oblasts. These protocols will now be reviewed by NTP and will be the basis for new amendments to MDR-TB Order #218 expected to be released later in 2012. The project also contributed to strengthening local capacities in training on different aspects of TB control. TB CARE I created an electronic database for data entry and utilization in accordance with approved Operational Research (OR) protocol, and focused on the improvement of skills of interviewers on collecting data for operational research. The project supported existing technical working groups and involved specialists from general and prison TB services, SES, and HIV/AIDS services. TB CARE I activities were implemented in close collaboration with NTP, prison system, GFATM project, and other USAID projects, including Quality Health Care Project and Dialogue on HIV and TB. Regular partners' meetings were conducted by TB CARE I with USAID Quality Healthcare and Dialogue Projects on HIV and TB to coordinate and plan activities and share information. TB CARE I also conducted regular meetings with NTP and PIU GF project to synchronize activities. TB CARE I had weekly meetings with USAID mission to provide updates on project implementation. The project achieved several key outcomes, including the establishment of a multidisciplinary working group for outpatient care, the implementation of XpertMTB/RIF in four sites, and the finalization of new MDR-TB protocols. The project also contributed to strengthening local capacities in training on different aspects of TB control and improved the quality of TB services delivered among all care providers in prisons.