Kyrgyzstan, or the Kyrgyz Republic, is a Central Asian country bordered by Kazakhstan, Uzbekistan, Tajikistan and China. Kyrgyzstan’s mountainous terrain and great variation of climates prevent large parts of the country from being cultivated. As a result, the Kyrgyz economy is largely reliant on mining for raw materials and precious metals as well as agriculture. After a 2010 revolution, the governmental system was changed from a presidential to a parliamentary republic. The Kyrgyz health system has had difficulties transitioning away from its Soviet origins resulting in shortages of pharmaceuticals and trained medical staff at the end of the nineties, leading to an increase in the incidence of infectious diseases, especially tuberculosis.
Tuberculosis in the country
Kyrgyzstan is one of the countries with the highest prevalence of MDR-TB, with growing numbers of extensively drug-resistant TB (XDR-TB) patients. There was previously no effective treatment available for MDR-TB within the country but current efforts by KNCV and partners are starting to change this.
KNCV activities in the country
KNCV is assisting the National TB Program to step up efforts to improve the management of these dangerous strains of TB, which include pre-XDR-TB and XDR-TB (extensively drug-resistant TB). It is very important to treat these forms of TB appropriately, to stop the spread of these forms of the disease. At the same time KNCV is helping to develop measures to care for patients with forms of drug-resistant TB for whom no effective treatment is yet available and to prevent community transmission of the disease.
As the lead agency of the Challenge TB project in Kyrgyzstan, KNCV is helping the country to set up the essential treatment and management conditions for the use of new drugs and new treatment regimens. KNCV is supporting the introduction of new TB drugs, starting with bedaquiline. Bedaquiline is suitable for a selected group of patients with specific second-line TB drug resistance. Our support includes an assessment of the needs of the TB services and the patients, developing the implementation plan, staff training, and monitoring the implementation of the project.
Correct diagnosis is also essential in order to be able to treat drug-resistant TB appropriately. Earlier, KNCV helped to develop a comprehensive national approach to the implementation of the GeneXpert diagnostic tool. Without such overall coordination, the effectiveness of the whole GeneXpert intervention suffers.
An uninterrupted supply of appropriate drugs is crucial to successful treatment. This requires a reliable data management system. In Kyrgyzstan, KNCV is carrying out a pilot project to strengthen data management.
With our help local civil society organizations organized support to patients with drug-resistant TB, as well as the representation of TB patients’ interests in for example the Global Fund Country Coordinating Mechanism. The Kyrgyz Republic is one of thirty countries in the world dealing with a high burden of MDR-TB, and it is estimated that every year there are around 1,400 new MDR-TB cases. The recently endorsed new anti-TB drugs bring hope to these patients. In 2016, KNCV assisted the Kyrgyz Republic National TB Program in the development of a national plan for the introduction of new TB drugs such as Bedaquiline and Delamanid and a shorter (nine to twelve month) treatment regimen for MDR-TB. This resulted in the enrollment of the first patients in January 2017: 30 patients started a shorter treatment regimen and 29 patients were enrolled on individualized treatment regimens with new TB drugs. The National TB Program and KNCV worked closely together to make this happen.
As a result of preparations in 2016, 47 patients had been enrolled on shorter treatment regimens and 30 patients started individualized regimens with new TB drugs by 30 March, 2017.
A national plan for the implementation of new drugs and shorter regimens for the treatment of MDR/XDR-TB was approved in April 2016. Clinical guidelines and standard operating procedures were approved by the Ministry of Health in December 2016. In the same month, we facilitated the inclusion of Bedaquiline on the list of drugs that can be imported without registration. We made sure that key clinicians from the pilot sites as well as specialists from the National Reference Laboratory were trained. A new diagnostic algorithm was also implemented at the pilot sites.
Over the next few years we plan to support the National TB Program to provide countrywide access to new drugs and regimens, and to build the local technical and human resource capacities in close collaboration with national and international partners.