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National Strategy for Tuberculosis Control in Georgia 2019-2022

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National Strategy for Tuberculosis Control in Georgia 2019-2022 Final National Strategy for Tuberculosis Control in Georgia 2019-2022 1 Contents Acronyms ........................................................................................................................................................................... 3 Introduction ...................................................................................................................................................................... 5 1. Situational Analysis .............................................................................................................................. 5 1.1 Analysis of the legislative framework ...................................................................................................................... 5 1.2 Alignment with the United Nations Sustainable Development Goals ...................................................................... 6 1.3 The burden of TB in Georgia ................................................................................................................................... 6 1.4 Organization of National TB Program ..................................................................................................................... 9 1.5 Main achievements of the National TB Program ................................................................................................... 11 1.6 Key challenges for TB control ............................................................................................................................... 11 2. Goal, Targets, Principles and Objectives .......................................................................................... 12 3. Components of the National Strategic Plan ..................................................................................... 13 Objective 1. To provide universal access to early and quality diagnosis of all forms of TB including M/XDR-TB........................................................................................................................................... 13 Objective 2. To provide universal access to quality treatment of all forms of TB including M/XDR-TB with appropriate patient support ........................................................................................................... 23 Objective 3. To enable supportive environments and systems for effective TB control ........................................... 35 4. Implementation Responsibilities ....................................................................................................... 46 5. Financing of TB Control Interventions ............................................................................................ 49 6. Potential risks associated with the Strategy implementation .......................................................... 55 7. Indicators for monitoring implementation ....................................................................................... 56 Annex 1. Monitoring and Evaluation Framework ....................................................................................................... 56 Annex 2. Georgia TB NSP 2019-2022 Implementation Plan ....................................................................................... 59 2 Acronyms ACF Active case finding ACSM Advocacy, communication and social mobilization ADRs Adverse drug reactions AIDS Acquired immune deficiency syndrome ART Anti-retroviral therapy BCG Bacillus Calmette-Guérin (vaccine) CCM Country Coordination Mechanism CPT Cotrimoxazole-preventive therapy DCT Diagnostic counseling and testing DOT Direct observation of treatment DOTS Directly observed treatment, short-course DRS Drug resistance survey DR-TB Drug-resistant tuberculosis DSM Direct smear microscopy DST Drug susceptibility testing EQA External quality assurance EU European Union FIND Foundation for Innovative Diagnostics FLDs First-line anti-TB drugs GEL Georgian Lari GLC Green Light Committee GNI Gross National Income GoG Government of Georgia GTSF Global Tuberculosis Strategy and Framework HIV Human immune deficiency virus ICRC International Committee of the Red Cross IDACIRC Infectious Diseases, AIDS and Clinical Immunology Research Center IGRA Interferon-gamma release assays ISO International Organization for Standardization KAP Knowledge, attitude and practices KfW Kreditanstalt für Wiederaufbau (the German Development Bank) LED Light-emitting diode LPA Line probe assays LSS Laboratory Surveillance Station LTBI Latent tuberculosis infection M. Tb Mycobacterium tuberculosis MDR-TB Multidrug-resistant TB MGIT Mycobacterium growth indication tube MoC Ministry of Corrections MoIDP&LHSA Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia 3 MSF Médecins Sans Frontières MSM Men having sex with men NAP National AIDS Program NCDCPH National Center for Disease Control and Public Health NCTLD National Center for Tuberculosis and Lung Diseases NGO Non-governmental organization NHA National Health Accounts NRL National Reference Laboratory NSP National Strategic Plan NTC National Tuberculosis Council NTP National Tuberculosis Program PAL Practical Approach to Lung Health PDR-TB Polydrug-resistant TB PHC Primary health care PLHIV People living with HIV PWID People who inject drugs QMS Quality Management System SARMA State Agency for Regulation of Medical Activities SLDs Second-line anti-TB drugs SRL Supranational Reference Laboratory SSA Social Service Agency SWs Sex workers TB Tuberculosis TGF The Global Fund to Fight AIDS, Tuberculosis and Malaria TPP Tuberculosis Prevention Project TST Tuberculin skin test TWG Technical Working Group UHC Universal Health Coverage UN United Nations UNAIDS Joint United Nations Program on HIV/AIDS UNICEF United Nations Children’s Fund URC University Research Company USAID United States Agency for International Development USD United States dollar WHO World Health Organization XDR-TB Extensively drug-resistant tuberculosis ZDL Zonal Diagnostic Laboratory 4 Introduction Tuberculosis (TB) remains an important public health problem in Georgia. Despite significant progress in the implementation of TB control interventions during the last decade, the country faces a number of important challenges that require further intensified and streamlined efforts to effectively control the epidemic by securing universal access to prevention, diagnosis and treatment of all forms of the disease, and ensuring effective integration and management of TB control interventions within the overall health system framework. The Government of Georgia is committed to increasingly allocate financial and other resources for effective TB control. National TB Control interventions are currently guided by the National TB Strategy for 2016- 2020. Based on a mid-term review of 2016 data, the revised strategy defined targets and priorities for the National TB Response for the 2019-2022 period. In order to clearly illustrate progress towards the End TB Strategy targets the strategy includes 2015 estimated TB incidence (99 per 100000) and mortality (5 per 100000) as a baseline for impact and selected outcome indicators. The costed action plan was developed for this four-year implementation period. The Strategy development was coordinated by the Georgia Country Coordinating Mechanism (CCM)1 for TB, HIV/AIDS and Malaria. Stakeholders involved included the Parliamentary Committee for Health and Social Issues, Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia , Ministry of Corrections2, National Center for Disease Control and Public Health (NCDC&PH), Research Practice Center for Infectious Diseases, AIDS and Clinical Immunology, National Center for Tuberculosis and Lung Diseases, Representatives from United States Agency for International Development (USAID), United Nations (UN) Populations Fund, non-governmental organizations (NGOs) working in the TB field, representatives from the most affected communities, and TB patients. The Policy and Advocacy Advisory Committee (PAAC) established under the auspices of CCM, which unites representatives of all the above mentioned partners, was used as a platform for national dialogue and ongoing consultations. Thus, the present Plan represents the outcome of the cooperation of all country stakeholders and international experts participating in TB control who have provided technical assistance to the country to ensure compliance of proposed interventions with international standards and best practices. The Government is grateful to the Global Fund to Fight Aids, Tuberculosis and Malaria and USAID3 for provision of technical assistance in the development of this Plan. 1. Situational Analysis 1.1 Analysis of the legislative framework The legal framework for TB control in Georgia is composed of a set of laws and regulations which stipulate the right of Georgian citizens to receive quality medical services in a non-discriminatory environment where all basic human rights, freedoms and guarantees are protected. The Constitution of Georgia and the following laws guide the National TB Response and clearly define the government’s commitment in the fight against TB: 1. Georgian Law on Public Health 2. Law of Georgia on Health Care 3. Law of Georgia on Medical Activities 4. Law of Georgia on Patient’s Rights 1 CCM ordinance is adopted by #220 decree of Georgian Government from June 18, 2012 2 Ministry of Corrections is being integrated with the Ministry of Justice
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