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Scientific – practical activity of National Center of Problems of Tuberculosis of MH of RoK

Scientific – practical activity of National Center of Problems of Tuberculosis of MH of RoK. Senior research associate NCPT MH RoK c.m.s. , associate professor L.K. Amanzholova. NCPT RoK manages all scientific and practical activities of the whole TB service in the R epublic.

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Scientific – practical activity of National Center of Problems of Tuberculosis of MH of RoK

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  1. Scientific – practical activity of National Center of Problems of Tuberculosis of MH of RoK Senior research associate NCPTMHRoKc.m.s., associate professor L.K. Amanzholova

  2. NCPT RoK manages all scientific and practical activities of the whole TB service in the Republic. • The main objectives of the Center are: improvement of efficiency of diagnosis and treatment of tuberculosis, the development of preventive measures system, and the implementation and improvement of the methods of organization of TB control.  • Bacteriological laboratories are equipped with modern laboratory equipment for the early detection of tuberculosis with multidrug resistance: BACTEC-Mitgit-960; molecular genetic method «Hain-test»,«G-Xpert». • According to the data of NCPT in 2011 detection of infectious tuberculosis increased from 3.9% in 2010 to 4.1 %, compared to the previous year that meets international standards of WHO for the timely detection and diagnosis of TB and MDR-TB in patients, their qualitative treatment.

  3. Theme of scientific program: Improvement of measures for prevention of treatment failures and the formation of drug-resistant forms of tuberculosis. Deadline 2009 - 2011. Purpose: Improvement of effectiveness of TB treatment with different types of drug resistance and development of preventive measures set to prevent the development of treatment failure, multi-and super-resistant forms of disease. The program was executed by 4 fragments: 1 The study of epidemiological peculiarities of tuberculosis in patients from the civil and penal systems and development of methods for reducing morbidity rate in RoK Study the causes of backsets development and treatment failure in patients with first time diagnosed tuberculosis, MDR-TB and diabetes mellitus (a comparative retrospective analytical study) 2 Improving the effectiveness of surgical treatment in patients with pulmonary and extrapulmonary tuberculosis in patients with different types of drug resistance (analytical case-control study) 3 4 Clinical and epidemiological peculiarities of MDR-TB in children and teen-agers in RoK (retrospective comparative analytical study)

  4. Scientific outputin 2009-2011 -defended: 1 doctoral thesis; 5 candidatethesis. Published 154 articles, 12 methodical recommendations, 2 clinical manualsand 1 order of MH of RoK, 24 innovational patents, 3 applications for discovery, 165 implementation acts

  5. Scientific Program: “Development and implementation of new technologies of qualitative diagnostics and treatment of resistant form of tuberculosis" Implementation period of program: 2012-2014” Program is implemented by 4 fragments • “The study of molecular genetic features of MTB in patients with drug-resistant forms of tuberculosis” Purpose: To study the frequency of mutations in the genes of MTB, responsible for the development of drug resistance and MIRU-VNTR typing of MTB, obtained from patients living in different regions of Kazakhstan. 2. “ORGANIZATIONAL AND METHODICAL AND SOCIAL FACTORS INCREASING COMPLIANCE OF PATIENTS WITH MDR-TB TO CONTINUED TREATMENT” Purpose: Study of the main medical and social factors negatively affecting delivery of continuously controled treatment of MDR TB. 3. "Treatment of patients with tuberculosis of bones and joints, peripheral lymph nodes, based on the application of nanotechnologies in complex therapy" Purpose: to study experimental and clinical application 4. "Development of the selective lung collapse method in the surgical treatment of patients with wide drug-resistant tuberculosis." Purpose: Development of tactics of preoperative preparation and postoperative management of patients with XDR TB in collapse-surgical interventions in combination with the use of silicone implants with a valval bronchial blocker.

  6. Cooperation with international organizationsin the field ofSTPof RoK GFATM WHOProjectEXPAND TB USAID TB CARE 1 (KNCV) Qualitative public health Dialogueon HIV with TB (AEWF) STP NCPTMHRoK World Bank German Development Bank (TB Care II) Foundation“Soros-Kazakhstan” Partners for the health RCS RK (Eli Lilly, IFRed Cross and RedCrescent, Support of Japanese Government)

  7. ProjectUSAID TB CARE I(KNCV)Implementation period 2011-2014 $ 1 281 909 Purpose – development of effective strategies on control of DR-TBinCAR and strengthening country capacity to control TB and MDR-TB in penal and civilian sectors of health care for delivery of qualitative and fast diagnostics and treatment of TB and MDR-TB.

  8. ProjectUSAID “Qualitative public health”Implementation period 01 10 2010 – 30 09 2015 Purpose– improving the health of vulnerable population groups through introduction of modern methods for improving quality of the health care reforms in CAR. Improvement of management, financing and delivery of health services related to TB, HIV / AIDS, maternal and child health and cardiovascular diseases.

  9. ProjectUSAID “Dialogue on HIV and tuberculosis” Implementation period 01 10 2009 – 30 09 2014 (PSI) $ 1 534 800 € 290 000 Purpose– stabilization of rates of HIV and TB spread among population with high risk of HIV and TB infection in CAR Improvement of population literacy in prevention of HIV and TB

  10. WHOBilateralprojects EXPAND TB “Expandingaccesstothe newdiagnostic agents oftuberculosis” Implementation period 2012 -2013 Purpose – introduction of technology G-Xpert MTB / RIF for the early detection and diagnostics of tuberculosis and drug resistance to rifampicin in three pilot laboratories in Astana, Almaty and Aktobe. MH of RoKwill develop a plan on reception arrangements of equipment and reagents, training of laboratory specialists.

  11. GermanBankforReconstruction and Development(KfW)Implementation period 2011 - 2014 € 2 556 459,41 Project“Support of National Program on control of TBII”. Purpose – improvement of diagnostics and treatment of different TB forms for prevention of infection chain to stop TB epidemic in Kazakhstan.

  12. WorldBankforDevelopment and ReconstructionStart of implementation 2010 - continuation Project“Transfer of technologies and conducting institutional reforms in the sector of Health of RK” Purpose – restructuring of the hospital sector in order to improve TB services in RK.

  13. Red Crescent Society of RoK Project «TB prevention for funds of Japanese government». Implementation period from 2004. Project «MDR TB Program supported byUSAIDthrough International Red Cross and Red Crescent Movement. Implementation period 2008 - 2012 Project «MDR TB Program supported by pharmaceutical company Eli Lilly». Project «Program for social supportat the cost of GFATM». Implementation period: 2009 -2012 Project«TB and HIV prevention program in RoK». Implementation period : 2012 - 2013 Goal of projects - rise of potential of RCS of RoK in the field of TB control

  14. Global Fund against AIDS, Tuberculosis and Malaria Project under implementation: decrease of burden of tuberculosis by strengthening management of drug-resistant tuberculosis 6 round - $9 114 981 8 round - $ 35 583 755 (1 phase + 1 Q 2012) • 6 roundfrom 01 09 2007 through 31 08 2012 • 8 round from 01 01 2010 through 2014 Goal– efficiency rise of antituberculous actions in RoK

  15. Foundation «Soros-Kazakhstan»Implementation period2011 -2012 $ 39 000 Project«Monitoring of performance efficiency of state initiatives for TB control» Goal– enhancement of efficiency and performance of state programmes for TB control in order to meet targets for UN millennium development.

  16. Main Epidemiologic Data for Tuberculosis in RoK (for 100 thousands of population) Decree of RoK President 6 months of 2012 Morbidity Mortality

  17. Level of primary and secondary drug resistance of MTB in RoK (%) 60% 50% 30% 20% 10% 5% 0% Levels of primary and secondary MDR TB are related to timely diagnostics ofMTB resistance using accelerated high-avid bacteriological (BACTEK MIGIT-960) and molecular and genetic methods (Hain-test). In the current year in 4 pilot projects a new molecular and genetic method (G-Xpert) is implemented 53.3% 19.1% Secondary drug resistance Primary drug resistance 2011

  18. PVR Provision in 2012(number of consumptives expected for treatment) MDR TB Forecast Additional procurement from RB In the line of PF Main procurement from RB

  19. Epidemiologic TB Situation in Penal System of RoK 2011:incidence rate– 522.5 for 100 thous. population 2010: Incidence rate: 672.8 for 100 thous. population mortality – 61.4 for 100 thous. population TB mortality: 94 for 100 thous. population 6 months incidence rate for 100 thous.: 2011 – 673.3 2012 – 598.4 reduction by 11.1% 6 months incidence for 100 thous.: 2011 – 82.2 2012- 52.6 reduction by 36.0%

  20. Detectability of TB/HIV casesfrom 2008 through 2011in RoK(RC AIDS) Total number of detected HIV/TB cases Newly diagnosed HIV/TB 547 1518 436 1423 370 368 1317 1118 2008 2009 2010 2011 2008 2009 1317 2010 2011

  21. Allocation of TB and TB/HIV cases in regions of RoK, 2011. TB TB/HIV percent Almatinskaya Pavlodarskaya EKR Almaty Kostanayskaya SKR Kyzylordinskaya Zhambylskaya Akmolinskaya NKR Aktyubinskaya Atyrauskaya WKR Karagandinskaya Astana Mangystauskaya

  22. Chemoprophylaxis by Isoniazid 2011 (abs. number)in 2011 in RoK Coverage by Isoniazid Chemoprophylaxis for HIVcaseswas 88,6% (1019 persons). Karaganda Kyzylorda Akmola Kostanay Aktobe Almaty region Atyrau Mabgystau SKR EKR Taraz WKR Pavlodar NKR Astana city Almaty city received

  23. Assessmentof WHO Mission of Experts in Kazakhstan, 10-18 May 2012. As a whole, quality of STP being implemented is evaluated positively. WHO According to evaluation of experts of WHO mission in Kazakhstan, significant progress is registered in all aspects of prophylaxis, control of tuberculosis treatment (TB treatment, diagnostics and treatment of MDR TB, IC, follow-up care, M&A).

  24. Solutions (TB/HIV) Amendments to Decree of HM of RoK №722 in accordance with the latest WHO recommendations. Prescription of antiretroviral therapy for TB/HIV cases in earlier terms (during first 2 weeks) regardless level of CD-4 cells. Intensive detection of TB by PLH based on complaints of patients typical for TB. Controlled isoniazid chemoprophylaxis by PLHin PHC controlled by AIDS-centers. Monitoring and assessment of joint activity in TB/HIV control. Training of specialists of PTE, PHC and AIDS anddrug rehabilitation centers regarding TB/HIV matters.

  25. MAIN DIRECTIONS OF TUBERCULOSIS CONTROL IN THE REPUBLIC OF KAZAKHSTAN Strengthening of human resources Increase of adherence of consumptives to DCT by implementation of patient-oriented approaches Improvement of infection control actions in areas of increased risk Increase of Access for Target Group to timely detection and diagnostics of tuberculosis

  26. Thank you for attention!

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