Addressing drug-resistant Tuberculosis in Kazakhstan

Project

Kazakhstan is one of thirty countries prioritised by the WHO because of its high-burden of multi drug-resistant (MDR)-Tuberculosis (TB).

Summary

The Centre for Applied Spatial Epidemiology (CASE) of KIT Royal Tropical Institute was requested by The Global Fund to apply the MATCH Approach to tuberculosis care to support National Toxicology Programs in the Central Asian region. Kazakhstan is one of thirty countries prioritised by the WHO because of its high-burden of multi drug-resistant (MDR)-Tuberculosis (TB). Like drug-sensitive TB, MDR-TB also spreads from person to person, but drug resistance can arise due to poor treatment adherence. It takes much longer and is more difficult, and is often more painful to treat compared to drug-sensitive TB. Therefore, in these settings, ensuring correct diagnosis and prompt treatment initiation, monitoring of adverse side effects, and providing treatment support to ensure treatment completion, are of utmost importance to limit the spread of MDR-TB. In Kazakhstan, an estimated 25% of all new TB cases have MDR-TB, while 43% of previously treated TB cases have MDR-TB.

Results

In the summer of 2017, the KIT CASE team joined WHO in performing an epidemiological review in Kazakhstan. The aim was to map and spatially analyse the notification of TB and MDR-TB patients, with the goal of identifying TB hot spots. Special attention was paid to treatment outcomes. To do so the team identified geographic regions where further investigation may help the NTP to understand factors associated with loss to follow-up and treatment failure. A comparison of the maps above allows one to identify regions with both a high percentage of MDR cases, and low treatment success rate. These areas may be prioritised for improved treatment monitoring to prevent the development of further drug resistance.