VZCZCXRO3146
RR RUEHAST RUEHBI RUEHCI RUEHLH RUEHPW
DE RUEHTA #0407/01 0631120
ZNR UUUUU ZZH
R 031120Z MAR 08
FM AMEMBASSY ASTANA
TO RUEHC/SECSTATE WASHDC 1868
INFO RUEHAST/USOFFICE ALMATY 0259
RUCNCLS/SCA COLLECTIVE

UNCLAS SECTION 01 OF 02 ASTANA 000407 
 
SIPDIS 
 
STATE FOR EUR/PGI (D. TESSLER), OES/IHB (A. LAURITZEN), SCA/CEN 
(O'MARA) 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO WHO KZ
 
SUBJECT: FIGHTING TB IN CENTRAL ASIA 
 
REF: STATE 6989 
 
ASTANA 00000407  001.2 OF 002 
 
 
¶1. Summary:  Many of the guidelines stated in the Berlin Declaration 
have long been implemented in Kazakhstan, and the country is 
currently in line with WHO-DOTS tuberculosis (TB) guidelines. 
However, many of the TB-focused bodies are under-funded, and some 
operate under outdated guidelines. The major problem facing 
Kazakhstan is Multi-Drug Resistant (MDR) TB. Kazakhstan accounts for 
the most MDR-TB cases in Central Asia and currently 4/5 of TB cases 
in Kazakhstan are MDR-TB. Kazakhstan is just now starting to address 
co-infection of HIV-TB.  Kazakhstan does have a national program to 
address the TB problem, which is co-funded by USAID, WHO, the German 
Development Bank, the Red Cross, and the Global Fund to Fight AIDS, 
TB, and Malaria. The major problem facing the national program is 
funding as well as personnel and infrastructure capacity 
limitations. The Kazakhstanian National TB Program is currently 
seeking continued USAID support through 2014.   End summary. 
 
A Recognized Problem 
--------------------- 
 
¶2.  Kazakhstan has identified TB as one of its national public 
health priorities and was the first Central Asian country to adopt 
DOTS as its national strategy, resulting in lowered TB incidence and 
TB death rate indicators over the last five years. However, the 
problem remains acute, with a consistently high incidence rate and a 
drug resistant TB rate reported as one of the world's highest. 
Kazakhstan signed the Berlin Declaration in 2007. Kazakhstan, with 
assistance from USAID, the Global Fund, the Centers for Disease 
Control and Prevention (CDC), other donors, and international 
organizations implements a comprehensive TB control strategy 
including diagnosis, treatment, and prevention. 
 
Regulations and Guidelines 
------------------------------------- 
 
¶3.  Since signing the Berlin Declaration, a number of important 
developments in national TB control have been observed.  The 
Government adopted a decree on 12 December 2007, "On protection 
measures of the population from TB in Kazakhstan," which set 
priorities and assigned responsibilities for different areas of TB 
control to local governments (regional TB programs), Ministry of 
Finance (control over budget allocations and spending), Ministry of 
Health (TB prevention, diagnosis, drug supply and treatment), and 
Ministry of Information and Culture (awareness raising activities). 
 
¶4.  Next, a number of important government regulations and national 
documents on TB control were developed with USAID technical 
assistance. The National TB Center developed a five-year national TB 
control plan for 2008-2012, which, when signed, will serve as the 
national TB program.  National partners drafted a comprehensive 
up-to-date "National Manual on TB Control," which will be finalized 
and adopted in FY 2008. U.S. assistance also played a decisive role 
in the passage of two regulations in FY 2007 that put the TB system 
under the control of the Sanitary-Epidemiologic Service and 
introduced revised reporting forms. National guidelines for 
management of MDR-TB have been drafted with the use of protocols 
developed within the USAID program. 
 
The National TB Control Plan 
----------------------------- 
 
¶5. In accordance with the national TB control plan, the GoK has 
started to strengthen TB facilities, including labs and 
in-/out-patient facilities through renovation, refurbishment, and 
improvement of infection control systems (e.g. ventilation, 
administrative procedures, and waste management). The Government has 
also initiated preparatory activities to build and equip the 
national reference laboratory under the National TB Center in 
accordance with international standards to strengthen TB detection. 
The existing lab is outdated and insufficient. 
 
¶6.  The TB reporting forms and reporting systems have been revised 
recently and a nation-wide electronic TB surveillance system has 
been implemented by CDC (with financial support from USAID). The 
newly-updated system includes MDR-TB data, which will help the 
country to better monitor and respond to the situation. With the 
assistance of international organizations and donors, the National 
TB Center conducts regular training activities on various TB control 
and DOTS implementation activities, which target TB staff-primary 
health care and penitentiary staff. The GoK, with support from 
international organizations, conducts public education events. 
Raising awareness on the occasion of World TB Day involves various 
educational, media, and community mobilization events. 
 
¶7. The local governments and the Ministry of Social Protection have 
been requested under the new TB decree to provide low-income TB 
patients with social assistance (cash benefits, food packages, and 
 
ASTANA 00000407  002.2 OF 002 
 
 
transport benefits). Special social assistance is envisioned for TB 
patients released from prisons. 
 
Drug-Resistant TB 
------------------ 
 
¶8. With USG support, the national TB program and regional TB 
facilities have implemented a pilot program in Almaty on management 
of MDR-TB. As a result, patients with drug-resistant TB in Almaty 
receive better quality treatment and care.  A set of clinical 
protocols on management of drug-resistant TB were developed, adopted 
at the city level, and recommended for the national guidelines for 
MDR TB management.  The Government increased procurement of TB drugs 
in 2008, including second-line drugs. Some second-line drugs are 
also being procured by the Global Fund TB grant. Still, not all the 
MDR-TB patients (estimated 7,000) will be covered by drug treatment, 
as the GoK struggles to develop a system of uninterrupted supply of 
quality TB drugs, including second-line drugs needed to treat 
MDR-TB. 
 
 
TB Funding 
---------------- 
 
¶9.  Kazakhstan has the highest funding per TB patient in the Central 
Asia region. In late 2007, the Minister of Health reported that the 
GoK increased financing of health care, including TB, by 37 percent 
in 2008. Yet, domestic funding is not sufficient to reverse the TB 
epidemic and to address all the needs for TB control and treatment, 
including treatment of MDR TB cases. Donors and international 
organizations provide technical and financial assistance to the GoK 
to strengthen TB control. USAID and its partners, Global Fund, the 
German Development Bank, the Royal Netherlands Chemical Society, and 
AIDS Foundation East-West are active in TB control.  In 2007, the 
GoK received a $9.8 million grant from Global Fund to combat TB. 
While implementing this grant, the GoK plans to apply for the 8th 
round of Global Fund applications, which will be the last time that 
Kazakhstan is allowed to apply.  Kazakhstan, a middle-income 
country, will no longer be eligible for Global Fund assistance.