Duration: 2015- 2019

Budget: 500,000 USD

Implementing Partner: KNCV Tuberculosis Foundation

Key Partners: National TB program, Ministry of Health, TB care facilities

Activity Locations: Nationwide

Website: www.challengetb.org

In the Kyrgyz Republic the Challenge TB project assists with the implementation of shorter regimen and regimens containing new drugs for the treatment of multidrug and extensively drug-resistant forms of TB.

The World Health Organization (WHO) estimates that 480,000 people developed multidrug-resistant tuberculosis (MDR-TB) in 2015 and 250,000 people died from the disease. Worldwide, only one in four cases of MDR-TB are actually diagnosed, and only one in five patients are put on treatment. Only 52% of these patients are successfully treated and when left untreated, a person with MDR-TB may infect 10-15 people every year. Antibacterial resistance to anti-TB drugs is a major public health problem that arises due to inadequate drug supply, improper prescribing of antibiotics, and/or the problems patients face in adhering to a long, often toxic, therapy.

MAJOR FOCUS AREAS

The Kyrgyz Republic is one of the 30 countries in the world with a high burden of MDR-TB, and it is estimated that every year there are 1,400 new MDR-TB cases. The country faces serious challenges, including long treatment periods, an absence of effective treatment options for the highly drug resistant forms of TB, such as extensively drug-resistant TB (XDR-TB). The recent endorsement of new anti-TB drugs by stringent regulatory authorities and WHO provides the opportunity to introduce new drugs and regimens for MDR-TB treatment in the Kyrgyz Republic.

The Challenge TB project aims to reduce the MDR-TB burden in the Kyrgyz Republic by improving health systems and clinicians’ skills in MDR-TB diagnosis and case management. Challenge TB has assisted the Kyrgyz Republic National TB Program in the development of a national plan for the introduction of new TB drugs such as Bedaquiline (Bdq) and Delamanid and shorter (9-12 month) treatment regimen for MDR-TB.

EXPECTED RESULTS AND ACHIEVEMENTS

The project assisted the National TB Program in preparing for the introduction of new drugs and regiments which resulted in enrollment of first patients in January 2017. In the first month 30 patients have been enrolled on shorter regimen and 29 patients have been enrolled on individualized regimens with new TB drugs.

The National TB Program and Challenge TB went through the following steps to implement the new treatment regimens:

• Development and approval of the national plan for implementation of new drugs and regimens as well as clinical guidelines and standard operating procedures on treatment of MDR/XDR TB.
• Inclusion of Bedaquiline on the list of drugs that can be imported without registration. Customs clearance for Bdq and permission from the Department of Drugs Provision to use the drug in clinical practice.

• Key clinicians from pilot sites and the National DR-TB coordinator attended an International Course on the Programmatic Management of Drug-resistant TB and new anti-TB drugs.

• Challenge TB trained National Reference Laboratory specialists on Drug Susceptibility Testing for Bedaquiline.
• In January 2017, the new diagnostic algorithm that forms the basis of patient enrollment was implemented in pilot sites.
• A database for the cohort of MDR-TB patients has been installed in pilot sites and initial data entry and analysis is ongoing.
• CTB is working on the development of a patient-centered case management strategy.

Over the next two years, the project will support the National TB Program to provide countrywide access to new drugs and regimens. This will include building the local technical and human resources capacities in close collaboration with national and international partners.