The WHO Regional REVIEW OF TUBERCULOSIS PREVENTION, CONTROL AND CARE IN AZERBAIJAN Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Review of Iceland Ireland Israel Italy Tuberculosis Kazakhstan Edited by: Masoud Dara Kyrgyzstan Latvia Ogtay Gozalov Lithuania Orkhan Javadli Prevention, Control Luxembourg Malta Nonna Turusbekova Monaco Montenegro and Care in Netherlands Norway Poland Portugal Azerbaijan Republic of Moldova Romania Russian Federation San Marino 11-17 April 2012 Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 33 70 01 Email: [email protected] Website: www.euro.who.int Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 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 2013 All rights reserved. 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Written by Masoud Dara Ogtay Gozalov Kai Blondal Javahir Suleymanova Nestani Tukvadze Nonna Turusbekova Irina Eramova Alain Disu Ucha Nanava Susan Adolph Ekaterina Kurbatova Veriko Mirtskhulava Orkhan Javadli Sevim Ahmedov Bhavna Patel Samantha Huffman Edited by Masoud Dara Ogtay Gozalov Orkhan Javadli Nonna Turusbekova 2 TABLE of CONTENT ACRONYMS ........................................................................................................ 5 FULL LIST OF RECOMMENDATIONS: ............................................................. 10 BACKGROUND INFORMATION ........................................................................ 15 1.STRUCTURE OF TB PREVENTION, CONTROL AND CARE .............................19 2.SERVICE DELIVERY ....................................................................................... 21 3.HEALTH WORKFORCE ................................................................................. 47 4.INFORMATION ............................................................................................... 51 5.MEDICAL PRODUCTS, VACCINES, TECHNOLOGIES .................................... 56 6.FINANCING ................................................................................................... 62 7.LEADERSHIP AND GOVERNANCE ................................................................ 66 ANNEX I. TB-IC FACILITY RISK ASSESSMENT ................................................... 74 Annex II. Activity of Reference National Laboratory of Baku ........................ 82 Annex III. Contamination rates on BACTEC MGIT and Lowenstein-Jensen .. 83 Annex IV. List of the 1st line (non-GDF), the 2nd line anti-TB drugs, BCG, and Tuberculin currently used in the TB network of the Republic of Azerbaijan . 84 Annex V. Customs clearance of the 1st line anti-T drugs procured by ISC...... 85 Annex VI. Distribution of the 1st line anti-TB drugs ....................................... 86 Annex VII. CSOs participating in TB control program in Azerbaijan ............. 87 Annex VIII. List of National Counterparts Participating in Review ................91 Annex IX. Programme of the visit ................................................................. 93 Annex X. List of Mission Members ................................................................ 98 Annex XI. Field Visits .................................................................................. 100 Annex XII. References ................................................................................. 118 3 ACKNOWLEDGEMENTS The Ministry of Health shall be commended for their renewed commitment to TB and M/XDR-TB prevention and control. The authors of the report acknowledge the director of National TB Control programme, the director and staff of the National Institute of Tuberculosis, chief doctors, chief TB doctors and health care staff in the districts visited. Extensive review to TB prevention, Control and Care could only be conducted thanks to their full collaboration. Special gratitude goes to the Ministry of Justice for their transparency and collaboration. WHO Regional Office in Europe would like to thank national and international partners particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria. 4 ACRONYMS ACSM Advocacy, Communication and Social Mobilization AEC Analytic Expertise Center AFB Acid-fast bacillus AR The Republic of Azerbaijan ART Antiretroviral therapy BCG bacille Calmette-Guérin (Antituberculosis Vaccine) BSC Biosafety Cabinet CAT Category CCM Country Coordinating Mechanism CM Capreomycin CMS Central Medical Store CS Cycloserine CSO Civil Society Organization CU Coordination Unit CXR Chest X-ray DOT Directly Observed Treatment DR Drug resistance DR-TB Drug-Resistant Tuberculosis DST Drug-Susceptibility Testing EIDSS Electronic Integrated Disease Surveillance System EMEA European Medicines Agency FELTP Field Epidemiology and Laboratory Training Program FDC Fixed-Dose Combination FLD First-line drugs FSU Former Soviet Union FWA Federal Way Assurance GDF Global Drug Facility GDP Good Distribution Practices GF The Global Fund to Fight AIDS, Tuberculosis and Malaria GIZ/GTZ German Agency for International Cooperation GLC The Green Light Committee GMP Good Manufacturing Practice HEC Hygiene – Epidemiological Centers HRD Human Resource Development IC Infection Control ICRC International Committee of the Red Cross IDPs Internally Displaced People IDU Injecting drug user INH Isoniazid INN International Non-proprietary Names IPT Insulin potentiation therapy IRB Institutional Review Board ISC Innovation and Supply Center ISO International Organization on Standardization KfW Reconstruction Credit Institute of Germany KM Kanamycin LFX Levofloxacin LTBI Latent Tuberculosis Infection LPA Line-probe assay M&E Monitoring and evaluation MDR-TB Multi-Drug-Resistant Tuberculosis MFX Moxifloxacin MGIT Mycobacteria growth indicator tube 5 MoH Ministry of Health MoJ Ministry of Justice MRA Medicines Regulatory Authority MTB Mycobacterium tuberculosis MTCT Mother-to-child transmission NAP National Action Plan NGO Non-Governmental Organization NTP National Tuberculosis Programme NRL National Reference Laboratories OFX Ofloxacin OOP Out-of pocket payments OPD Outpatient Department OR Operational Research PAS Para-aminosalicylic acid PDR Poly-Drug Resistant Tuberculosis PHC Primary Care Health Facility PHRC Public Health and Reforms Center PIU Project Implementation Unit PLWHA People living with HIV/AIDS PPD Purified protein derivative PTO Prothionamide PU Progress Update QA Quality Assurance QI Quality Improvement RAD Return after default R&R Recording and reporting RIF Resistance to rifampicin RMP Rifampin SAT Self-Administrated Treatment SES Socioeconomic Status SES Sanitary Epidemiological Station SLD Second-Line Drugs SRILD Scientific-Research Institute of Lung Diseases of AR SRL Supranational Reference Laboratory SSES State Sanitary and Epidemiological Surveillance STI Sexually Transmitted Infection STID Specialized Treatment Institution for Detainees TB Tuberculosis TST Tuberculin Skin Testing USAID United States Agency for International Development UV Ultraviolet WB World Bank WHO World Health Organization XDR-TB Extensively Drug-Resistant Tuberculosis Z Pyrazinamide 6 EXECUTIVE