Kazakhstan

In 2010, Partners In Health launched a new partnership to combat drug-resistant tuberculosis (MDR-TB) in Kazakhstan, a central Asian country that borders regions in Siberia where PIH-Russia has spearheaded a successful MDR-TB program since 1998. Because of PIH’s track record of curing and curbing the spread of drug-resistant tuberculosis in the Russian Federation, the Kazakhstan Ministry of Health invited PIH to help fight one of the highest rates of drug-resistant TB in the world.

Kazakhstan is a vast but sparsely populated country, with the ninth largest land area in the world and a population of 16 million people. According to the World Health Organization, Kazakhstan suffers from about 20,000 new cases of TB each year of which about 20 percent (or 4,000 cases) are MDR-TB. Patients with MDR-TB are infected with dangerous strains of TB that cannot be cured by the most common first-line drugs used to treat the disease. The Kazakhstan Ministry of Health estimates that only a quarter of the estimated 7,000 MDR-TB patients in the country are currently receiving adequate care.

PIH-Russia began treating MDR-TB patients in Tomsk, Siberia, more than a decade ago and has established a track record of successfully treating the disease in both prison and civilian populations. Based on that success, PIH-Russia has also trained clinicians from every region in Russia, and from 10 countries of the former Soviet Union, including Kazakhstan. The new program in Kazakhstan is PIH-Russia’s first formal international partnership that will include more than basic technical training and assistance.

MDR-TB is notoriously difficult and expensive to treat. Patients must endure an intensive regimen that usually requires two years of drugs that carry debilitating side effects. Strains of the disease that cannot be treated by either first-line or second-line drugs are referred to as extensively drug-resistant TB (XDR-TB). About 10 percent of the 7,000 MDR-TB cases in Kazakhstan are XDR.

PIH-Russia—like other PIH-affiliated MDR-TB programs around the world—has been successful in treating the disease because it employs community health workers to visit and support patients throughout the difficult drug regimen. These local workers help patients stay on the drug regimen and make sure that they are able to access the comprehensive services offered by our programs (including nutritional and emotional support as well as medical care).

Other keys to successful programs include improving diagnostics in order to detect cases earlier, developing a comprehensive strategy to promote adherence among patients, improving infection control in hospitals and clinics, and decreasing transmission of TB to HIV-positive patients.

PIH established an office in Kazakhstan, headed by Program Director Dr. Askar Yedilbayev, a native of Kazakhstan who previously worked with PIH in both Russia and Lesotho. Initially, the program is concentrating its efforts in the northeastern Pavlodar region (which borders Siberia) and the central Karaganda region. In both regions, PIH is providing extensive training on management, clinical, and laboratory aspects of running an effective MDR-TB treatment program; helping to monitor and evaluate treatment programs; and helping to implement a comprehensive program for supporting MDR-TB patients to help ensure treatment adherence.