Post on 11-Jan-2016
description
L/O/G/OL/O/G/O
Senior research associate
NCPT MH RoK c.m.s., associate professor
L.K. Amanzholova
Scientific – practical activity of National Center of
Problems of Tuberculosis of MH of RoK
NCPT RoK manages all scientific and practical activities of the whole TB service in the Republic.
• The main objectives of the Center are: improvement of efficiency of diagnosis and treatment of tuberculosis, the development of preventive measures system, and the implementation and improvement of the methods of organization of TB control.
• Bacteriological laboratories are equipped with modern laboratory equipment for the early detection of tuberculosis with multidrug resistance: BACTEC-Mitgit-960; molecular genetic method «Hain-test»,«G-Xpert».
• According to the data of NCPT in 2011 detection of infectious tuberculosis increased from 3.9% in 2010 to 4.1 %, compared to the previous year that meets international standards of WHO for the timely detection and diagnosis of TB and MDR-TB in patients, their qualitative treatment.
Theme of scientific program: Improvement of measures for prevention of treatment failures and the formation of drug-resistant forms of tuberculosis. Deadline 2009 - 2011.
The study of epidemiological peculiarities of tuberculosis in patients from the civil and penal systems and development of methods for reducing morbidity rate in RoK
Study the causes of backsets development and treatment failure in patients with first time diagnosed tuberculosis, MDR-TB and diabetes mellitus (a comparative retrospective analytical study)
Improving the effectiveness of surgical treatment in patients with pulmonary and extrapulmonary tuberculosis in patients with different types of drug resistance (analytical case-control study)
Clinical and epidemiological peculiarities of MDR-TB in children and teen-agers in RoK (retrospective comparative analytical study)
4
1
2
3
The program was executed by 4 fragments:
Purpose: Improvement of effectiveness of TB treatment with different types of drug resistance and development of preventive measures set to prevent the development of treatment failure, multi-and super-resistant forms of disease.
Scientific output in 2009-2011
-defended: 1 doctoral thesis;5 candidate thesis.
Published 154 articles, 12 methodical recommendations, 2 clinical manuals and 1 order of MH of RoK, 24 innovational patents, 3 applications for discovery, 165 implementation acts
Scientific Program: “Development and implementation of new technologies of qualitative diagnostics and treatment of resistant form of tuberculosis"
Implementation period of program: 2012-2014” Program is implemented by 4 fragments
1. “The study of molecular genetic features of MTB in patients with drug-resistant forms of tuberculosis”
Purpose: To study the frequency of mutations in the genes of MTB, responsible for the development of drug resistance and MIRU-VNTR typing of MTB, obtained from patients living in different regions of Kazakhstan.
2. “ORGANIZATIONAL AND METHODICAL AND SOCIAL FACTORS INCREASING COMPLIANCE OF PATIENTS WITH MDR-TB TO CONTINUED TREATMENT”
Purpose: Study of the main medical and social factors negatively affecting delivery of continuously controled treatment of MDR TB.
3. "Treatment of patients with tuberculosis of bones and joints, peripheral lymph nodes, based on the application of nanotechnologies in complex therapy"
Purpose: to study experimental and clinical application
4. "Development of the selective lung collapse method in the surgical treatment of patients with wide drug-resistant tuberculosis."
Purpose: Development of tactics of preoperative preparation and postoperative management of patients with XDR TB in collapse-surgical interventions in combination with the use of silicone implants with a valval bronchial blocker.
Cooperation with international organizations in the field of STPof RoK
STPNCPT MH
RoK
GFATMUSAID
TB CARE 1 (KNCV)
Qualitative public health
Dialogue on HIV with TB (AEWF)
World Bank
German Development Bank
(TB Care II)
Foundation “Soros-
Kazakhstan”
Partners for the health
WHO Project
EXPAND TB
RCS RK (Eli Lilly, IF Red Cross and Red Crescent,
Support of Japanese Government)
Project USAID TB CARE I(KNCV)Implementation period 2011-2014
Purpose – development of effective strategies on control of DR-TB in CAR and strengthening country capacity to control TB and MDR-TB in penal and civilian sectors of health care for delivery of qualitative and fast diagnostics and treatment of TB and MDR-TB.
$ 1 281 909
Project USAID “Qualitative public health” Implementation period 01 10 2010 – 30 09 2015
Purpose – improving the health of vulnerable population groups through introduction of modern methods for improving quality of the health care reforms in CAR. Improvement of management, financing and delivery of health services related to TB, HIV / AIDS, maternal and child health and cardiovascular diseases.
Project USAID “Dialogue on HIV and tuberculosis” Implementation period 01 10 2009 – 30 09 2014 (PSI)
Purpose – stabilization of rates of HIV and TB spread among population with high risk of HIV and TB infection in CAR
Improvement of population literacy in prevention of HIV and TB
$ 1 534 800
€ 290 000
WHOBilateral projects EXPAND TB “Expanding access to the new diagnostic agents of tuberculosis” Implementation period 2012 -2013
Purpose – introduction of technology G-Xpert MTB / RIF for the early detection and diagnostics of tuberculosis and drug resistance to rifampicin in three pilot laboratories in Astana, Almaty and Aktobe. MH of RoK will develop a plan on reception arrangements of equipment and reagents, training of laboratory specialists.
German Bank for Reconstruction and
Development (KfW)Implementation period 2011 - 2014
Project “Support of National Program on control of TB II”.Purpose – improvement of diagnostics and treatment of different TB forms for prevention of infection chain to stop TB epidemic in Kazakhstan.
€ 2 556 459,41
World Bank for Development and Reconstruction Start of implementation 2010 - continuation
Project “Transfer of technologies and conducting institutional reforms in the sector
of Health of RK”
Purpose – restructuring of the hospital sector in order to improve TB services in RK.
Red Crescent Society of RoK
Project «TB prevention for funds of Japanese government». Implementation period from 2004. Project «MDR TB Program supported by USAID through International Red Cross and Red Crescent Movement. Implementation period 2008 - 2012 Project «MDR TB Program supported by pharmaceutical company Eli Lilly».Project «Program for social support at the cost of GFATM». Implementation period: 2009 -2012 Project «TB and HIV prevention program in RoK». Implementation period : 2012 - 2013
Goal of projects - rise of potential of RCS of RoK in the field of TB control
Global Fund against AIDS, Tuberculosis and Malaria
• 6 round from 01 09 2007 through 31 08 2012
• 8 round from 01 01 2010 through 2014
Goal– efficiency rise of antituberculous actions in RoK
6 round - $9 114 9818 round - $ 35 583 755 (1 phase + 1 Q 2012)
Project under implementation: decrease of burden of tuberculosis by strengthening management of drug-resistant tuberculosis
Foundation «Soros-Kazakhstan»Implementation period 2011 -2012
Project «Monitoring of performance efficiency of state initiatives for TB control»
Goal– enhancement of efficiency and performance of state programmes for TB control in order to meet targets for UN millennium development.
$ 39 000
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118,8
153,2 155,7165,1 160,4
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132,1126,4 125,5
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86,6 86
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0
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1990 1995 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 6 мес 2012
г.заболеваемость
смертность
Decree of RoK
President
Main Epidemiologic Data for Tuberculosis in RoK (for 100 thousands of population)
6 months of 2012Morbidity
Mortality
Level of primary and secondary drug resistance of MTB in RoK (%)
0%
5%
10%
20%
30%
50%
60%
2011
Secondary drug resistance
Primary drug resistance
19.1%
53.3% Levels of primary and secondary MDR TB are related to timely diagnostics of MTB resistance using accelerated high-avid bacteriological (BACTEK MIGIT-960) and molecular and genetic methods (Hain-test). In the current year in 4 pilot projects a new molecular and genetic method (G-Xpert) is implemented
PVR Provision in 2012(number of consumptives expected for
treatment)
1370
3423
8900
2872
прогноз МЛУ ТБ основной закуп изРБ
допзакуп из РБ по линии ГФMDR TB Forecast
Main procurement from RB
Additional procurement from
RBIn the line of PF
Epidemiologic TB Situation in Penal System of RoK
2010:Incidence rate: 672.8 for 100 thous. population
TB mortality: 94 for 100 thous. population
2011: incidence rate– 522.5 for 100 thous. population
6 months incidence rate for 100 thous.: 2011 – 673.3 2012 – 598.4
reduction by 11.1%
6 months incidence for 100 thous.:2011 – 82.2
2012- 52.6 reduction by 36.0%
mortality – 61.4 for 100 thous. population
Detectability of TB/HIV casesfrom 2008 through 2011 in RoK (RC AIDS)
2008 2009 2010
Total number of detected HIV/TB cases Newly diagnosed HIV/TB
13172008 2009 2010
14231317
436
368370
2011
547
2011
1518
1118
Allocation of TB and TB/HIV cases in regions of RoK,
2011.
0%
5%
10%
15%
20%
25%
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ent
Chemoprophylaxis by Isoniazid 2011 (abs. number)in 2011 in RoK Coverage by Isoniazid Chemoprophylaxis for HIV cases was 88,6%
(1019 persons).
521
112
9
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29
47
149
225 9
94
4462
221
91
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50
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ola
Aktobe
Alm
aty region
Atyrau
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Taraz
WK
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Karaganda
Kostanay
Kyzylorda
Mabgystau
Pavlodar
NK
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R
Alm
aty city
Astana city
received
As a whole, quality of STP being implemented is evaluated positively.
According to evaluation of experts of WHO mission in Kazakhstan, significant progress is registered in all aspects of prophylaxis, control of tuberculosis treatment (TB treatment, diagnostics and treatment of MDR TB, IC, follow-up care, M&A).
Assessmentof WHO Mission of Experts in Kazakhstan,
10-18 May 2012.
WHO
WHO
Solutions (TB/HIV)• Amendments to Decree of HM of RoK №722 in
accordance with the latest WHO recommendations.• Prescription of antiretroviral therapy for TB/HIV cases
in earlier terms (during first 2 weeks) regardless level of CD-4 cells.
• Intensive detection of TB by PLH based on complaints of patients typical for TB.
• Controlled isoniazid chemoprophylaxis by PLH in PHC controlled by AIDS-centers.
• Monitoring and assessment of joint activity in TB/HIV control.
• Training of specialists of PTE, PHC and AIDS and drug rehabilitation centers regarding TB/HIV matters.
MAIN DIRECTIONS OF TUBERCULOSIS CONTROL IN THE REPUBLIC OF KAZAKHSTAN
Increase of Access for Target Group
to timely detection and diagnostics of tuberculosis
Increase of adherence of consumptives to DCT by implementation of patient-oriented approaches
Improvement of infection control actions in areas ofincreased risk
Strengthening of human resources
L/O/G/OL/O/G/O
Thank you for attention!