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World Health Organization/United Nations Development Programme Review of Tuberculosis Control in the Republic of Tajikistan

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World Health Organization/United Nations Development Programme Review of Tuberculosis Control in the Republic of Tajikistan WORLD HEALTH ORGANIZATION/UNITED NATIONS DEVELOPMENT PROGRAMME REVIEW OF TUBERCULOSIS CONTROL IN THE REPUBLIC OF TAJIKISTAN Dr Richard Zaleskis Dr Gombogaram Tsogt Dr Andrei Dadu Dr Santino Severoni Dr Stefan Talevski Dr Kai Blondal Dr Harald Hoffman Dr Maria Idrissova Dr Sayohat Hasanova Dr Zumrad Maksumova Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2009 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Objectives of the National Tuberculosis Programme Review .......................................................... 5 Executive Summary .......................................................................................................................... 6 1. Background ................................................................................................................................... 9 1.1. Country health profile........................................................................................................ 9 1.2 The health system .............................................................................................................. 10 2. TB Epidemiology ....................................................................................................................... 13 3. TB Case finding .......................................................................................................................... 16 3.1 Case finding........................................................................................................................ 16 3.2 Diagnostics and follow-ups.............................................................................................. 20 4. Laboratories................................................................................................................................. 23 4.1 The network........................................................................................................................ 23 4.2 Logistics............................................................................................................................... 28 4.3 Laboratory capacity ........................................................................................................... 30 4.4 Standard operating procedures ....................................................................................... 31 4.5 Supervision and collaboration ......................................................................................... 31 5. TB treatment................................................................................................................................ 33 6. MDR TB...................................................................................................................................... 36 7. TB control in prisons................................................................................................................... 41 7.1 Policy considerations......................................................................................................... 41 7.2 The TB control programme in prisons............................................................................ 44 7.3 Site visits.............................................................................................................................. 48 8. Recording and reporting.............................................................................................................. 51 8.1 Notification ......................................................................................................................... 51 8.2 Monitoring and evaluation and field supervision ........................................................ 51 9. Drug management ....................................................................................................................... 54 9.1 The drug supply................................................................................................................. 54 9.2 Drug financing.................................................................................................................... 56 10. Improving the health care system.............................................................................................. 58 10.1. Social determinants of TB .............................................................................................. 58 10.2 Integration into primary health care ............................................................................. 58 10.3 Training ............................................................................................................................. 59 10.4 The practical approach to lung health (PAL)............................................................... 60 10.5 Involvement of all care providers.................................................................................. 61 10.6 International standards for tuberculosis Care (ISTC)................................................. 62 10.7 Empowering people with TB ......................................................................................... 62 10.8 Community participation in TB care............................................................................. 64 Annex 1. TB diagnosis flowchart.................................................................................................... 68 Annex 2. Tajikistan health profile................................................................................................... 69 Annex 3. General information on Tajikistan................................................................................... 74 Annex 4. Structure of the TB Control Programme ......................................................................... 76 Annex 5. Second-line drugs in Tajikistan ................................................................................. 77 Annex 6. TB M&E and field supervision structure ................................................................. 78 Annex 7. Agenda of the WHO/UNDP mission on review of TB control ....................................... 79 Annex 8 List of people visited/met with ......................................................................................... 85 Annex 9 International TB stakeholders........................................................................................... 87 Annex 10. TB institutions visited by the mission ........................................................................... 88 3 ABBREVIATIONS ACSM advocacy, communication and social mobilization AFEW AIDS Foundation East-West DCA Department of Correctional Affairs DOT directly observed treatment DOTS directly observed treatment, short course DST drug susceptibility testing GBAR Gorno-Badakhshan Autonomous Region GDF global drug facility GF ATM Global Fund to fight against HIV/AIDS, Tuberculosis and Malaria GLC Green Light Committee HR human resources IML Institute of Microbiology and Laboratory Medicine M&E monitoring and evaluation MDR multidrug resistance MMR mass miniature radiography MTB Mycobacterium tuberculosis (complex) NGO nongovernmental organization NIS New Independent States NRC National TB Reference Centre Laboratory Diagnostics NRL National Reference Laboratory of TB NTC National TB Centre NTP National TB programme OOP out-of-pocket payment PAL Practical Approach to Lung Health PHC primary health care PPM private-public mix PS penitentiary system QA quality assurance QMS quality management system R&R recording and reporting RNBC Republican National TB Centre RRS Districts of Republican Subordination RTBH Republican TB Hospital SASES State Agency for Sanitary and Epidemiological Service SES Sanitary and Epidemiology Service SRL supranational reference
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